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YEAR 2: CSI > Depression > Flashcards

Depression Flashcards

1
Q

What are some risk factors for depression?

A
  • Traumatic experiences e.g. bereavement, losing your job, bullying
  • Genetic susceptibility i.e. family history
  • Having a physical/ chronic disorder
  • Having characteristic negative patterns of thinking, deficits in coping skills, impaired emotional intelligence
  • Upbringing
  • Lack of social support
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2
Q

What guidelines are used in the UK, to diagnose depression?

A

DSM-V (Diagnostic and Statistical manual of mental disorders)

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3
Q

What is the criteria to diagnose someone with Major Depressive Disorder?

A

≥ 1 key symptom AND ≥ 5 total symptoms

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4
Q

What are the key symptoms?

A
  • persistent sadness/ low mood

- marked loss of interests or pleasure (anhedonia)

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5
Q

What are the associated symptoms?

A
  • Tearfulness
  • Feeling constantly tired
  • disturbed sleep
  • decreased/ increased appetite or weight
  • anergia
  • agitation or slowing down of movements + speech (psychomotor retardation)
  • reduced libido
  • poor concentration
  • poor self-esteem
  • Suicidal ideation
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6
Q

Which group has the highest incidence of self harm?

A

17-19 yr females

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7
Q

Which group has the highest incidence of suicide?

A

40-59 yr males

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8
Q

What is suicide?

A

A fatal act of self-harm initiated with the intention of ending one’s own life.

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9
Q

What model describes factors which contribute to depression?

A

Biopsychosocial model

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10
Q

What are some social factors which contribute to depression? (overlap)

A
  • financial security
  • family circumstances
  • culture
  • work/school
  • social support
  • traumatic life events
  • interpersonal relationships
  • diet/lifestyle
  • drug effects
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11
Q

What are some psychological factors which contribute to depression? (overlap)

A
  • attitudes and beliefs
  • self-esteem
  • personality
  • coping skills
  • traumatic life events
  • interpersonal relationships
  • emotions
  • cognitive factors
  • sleep
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12
Q

What are some biological factors which contribute to depression? (overlap)

A
  • genetic vulnerability
  • physical health
  • neurochemistry
  • immune/ stress response
  • metabolic disorders
  • diet/lifestyle
  • drug effects
  • emotions
  • cognitive factors
  • sleep
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13
Q

What are ACEs?

A

Adverse Childhood Events are potentially traumatic events experienced during childhood that can have negative, lasting effects on health and well-being.

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14
Q

Which behaviours/ morbidities have been shown to have a significant association with ACE scores (0- ≥4)?

A
  • Binge drinking
  • Heavy drinking
  • Smoking
  • High risk HIV behaviour
  • Depression
  • Disability caused by ill health
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15
Q

What is bias?

A

When systematic error is introduced into sampling or testing by selecting or encouraging 1 outcome or answer over others.

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16
Q

What is the monoamine hypothesis?

A

It suggests that a deficiency of monoamine neurotransmitters is the cause of depression.

17
Q

Name some monoamine neurotransmitters.

A
  • serotonin
  • dopamine
  • Noradrenaline
18
Q

Name some groups of anti-depressants prescribed for those with moderate to severe depression.

A
  1. Monoamine oxidase inhibitors
  2. Tricyclics
  3. Selective Serotonin Reuptake Inhibitors (SSRIs)
  4. Serotonin- NA Reuptake Inhibitors (SNRIs)
  5. Post-synaptic serotonin receptor agonists
  6. Serotonin autoreceptor antagonist
19
Q

How do MAOIs (first generation antidepressants) work?

A

They inhibit monoamine oxidase enzyme that break down monoamine neurotransmitters - this means that more neurotransmitter is available in the synapse.

20
Q

Why do MAOIs have so many side effects?

A

They are not specific since they just target monoamine oxidase in presynaptic neurones. These are found all over the body and therefore interferes with liver metabolism and digestion.

21
Q

How do tricyclics (TCAs -> first generation) work?

A

They block serotonin and NA reuptake channels which increases levels of the neurotransmitters in the synapse.

22
Q

Why are TCAs rarely first line anti-depressants?

A

They are toxic if too much is taken

23
Q

When are TCAs prescribed?

A
  • bipolar disorder

- severe depression which hasn’t responded to other anti-depressants.

24
Q

How do SSRIs work? (first line anti-depressants, 2nd generation anti-depressants)

A

They increase levels of serotonin in synapse by blocking specific serotonin reuptake channels.

25
Q

Name some SSRIs.

A
  • Prozac (Fluoxetine)
  • Citalopram
  • Sertraline
26
Q

What are some of the side effects of using SSRIs?

A

Few due to high selectivity. They may include…

  • weight gain
  • sexual dysfunction
  • sleeping problems
  • increased risk of peptic ulcers
  • serotonin syndrome (too much serotonin)
27
Q

How are SNRIs (e.g. venlafaxine) different to SSRIs?

A

Rather than just targeting serotonin reuptake channels, they also block NA reuptake channels (lower selectivity but still effective).

28
Q

How do serotonin autoreceptor antagonists work?

A

These inhibit the autoreceptor so that the presynaptic neurone doesn’t reduce the amount of serotonin it is producing (no negative feedback).

29
Q

Drugs alone are not effective. What else is prescribed?

A
  • CBT

- social prescribing

30
Q

What is CBT?

A

Short term talking therapy helps people to deal with negative thinking and teaches coping strategies.

It combines 2 types of therapy to help you deal with these thoughts and behaviours:

  • cognitive therapy, examining the things you think
  • behaviour therapy, examining the things you do.
31
Q

How are people with mild depression managed? (stepped mental health care)

A
  • ‘watchful waiting’
  • CBT
  • lifestyle changes
32
Q

What is social prescribing?

A

It is a means of enabling health professionals to refer people to a range of local, non-clinical services to help them take greater control of their own health.

33
Q

How does social prescribing work?

A

Each person is assigned a line-worker who directs them to local sources of support.

34
Q

What are some examples of social prescribing?

A

1) Link worker or navigator
2) Local activities: volunteering, exploring hobbies
3) Support groups: correcting habits
4) Lifestyle advice: exercise
5) Online educational programmes

35
Q

After the person has gone into remission (symptoms of depression have gone), are the anti-depressants stopped immediately?

A

NO -> they continue for 6 more months and must be weaned gradually

36
Q

Why is a tryptophan hydroxylase inhibitor not a suitable anti-depressant?

A

Tryptophan is the precursor to serotonin so inhibiting the synthesis of serotonin will actually reduce the amount of available serotonin.

37
Q

Name a TCA.

A

Amitriptyline

38
Q

Name a MAOI.

A

Isocarboxazid

YEAR 2: CSI (8 decks)

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