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CPCP > Year 2 - Week 2 - Low Mood > Flashcards

Year 2 - Week 2 - Low Mood Flashcards

1
Q

According to the DSM5 - what 3 features must be present to diagnose a major depressive episode?

A

Depressed mood or loss of interest/pleasure in daily activities for more than 2 weeks.

The mood change is a change from the P’s baseline

Should be impaired function - social, occupational or educational.

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2
Q

According to DSM5 - what are the 9 specific symptoms that Ps need to have 5 of each day to be diagnosed with a major depressive illness?

A

Depressed / irritable most of day, nearly every day.

Decreased interest or pleasure in activities

Significant weight change or change in appetite

Change in sleep

Change in activity

Fatigue or loss of energy

Guilt / worthlessness

Concentration impaired

Suicidality

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3
Q

What is it called when a P cannot (a) sleep or (b) sleeps too much.

A

(a) Insomnia

(b). Hypersomina

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4
Q

Which is the most prevalent anxiety?

A

Generalised anxiety disorder (GAD)

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5
Q

How long does anxiety have to prevail to be diagnosed with GAD?

A

6 months

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6
Q

How many men v. women get diagnosed with depression and anxiety?

A

1 : 2

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7
Q

What age to common mental disorders peak?

A

45-54

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8
Q

Which people are at higher risk for developing anxiety or depression?

A

Ps in care homes
Poorer Ps
Long-term sick or physically impaired
Unemployed

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9
Q

What can Ps who are suffering with medically unexplained symptoms actually have?

A

Depression and anxiety

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10
Q

What can cause a variation in presentation of depression?

A

Culture
Age

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11
Q

What symptoms are older Ps with depression more likely to have?

A

Agitation
Somatic symptoms

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12
Q

What symptoms are younger Ps with depression more likely to have?

A

Guilt
Loss of libido

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13
Q

What can you use to assess whether a P presenting has depression?

A

Biopsychosocial assessment questionnaire - e.g. PHQ9

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14
Q

What is the management of depression and anxiety in UK primary care based on?

A

Stepped-care model

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15
Q

What is the underlying principle of the stepped-care model?

A

Intervention offers should be the least intrusive and appropriate to the severity of the illness.

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16
Q

What treatment is suggested for Ps with all known and suspected presentations of depression?

A

Assessment
Support
Psychoeducation
Active monitoring
Referral for further assessment / interventions

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17
Q

What thought distortion is it when Ps turn all difficulties into disaster - everything seems extreme?

A

Exaggeration / Catastrophising

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18
Q

What is the thought distortion when Ps make broad statements that emphasise the negative? (e.g. nobody likes me)

A

Overgeneralisation

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19
Q

What is the thought distortion when Ps only remember and dwell on negative events and dismiss good experiences as unimportant?

A

Ignoring the positive

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20
Q

What thought distortion is it when Ps can only see things in black and white - when something falls short of perfection it is a failure.

A

All or nothing thinking

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21
Q

What thought distortion is it when Ps interpret something automatically in a negative way without any facts to support their view?

A

Jumping to conclusions

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22
Q

What thought distortion is it when Ps deal with mistakes by using general labels (Im a bad mother)?

A

Labelling

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23
Q

What thought distortion is it when Ps assume responsibility for things that arent really under their control?

A

Personalisation

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24
Q

What thought distortion is it when Ps tell themselves how they ought to act, feel or think?

A

Should or shouldn’t thoughts

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25
Q

What does the stepped care model perceive about Ps at Step 1?

A

That they will have relatively mild symptoms which should improve with minimal intervention and not progress to Stage 3 or 4.

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26
Q

Which initiative has helped in responding appropriately to the mental health needs of Ps in primary care?

A

IAPT (Improve Access to Psychological Therapies)

27
Q

Which psychological therapy has the most extensive evidence base?

A

CBT

28
Q

What is the most widely used treatment for anxiety and depression?

A

Antidepressants (SSRIs)

29
Q

What did SSRIs replace?

A

Tricylcli antidepressants (TCAs) and MAO inhibitors (MAOIs)

30
Q

What are the common adverse effects of SSRIs?

A

GI upset
Temporary increase in anxiety
Sexual dysfunction

31
Q

How long should SSRIs be continued for at a minimum?

A

6 months

32
Q

Over what period should SSRIs be stopped? Why?

A

4 weeks - to prevent discontinuation syndrome (dizziness, headache, nausea & lethargy)

33
Q

What diagnosis can be given to Ps who have persistent problems in social relations and social functioning?

A

Personality disorder

34
Q

Which personality disorder is characterised by unstable and intense interpersonal relationships, self-perception and moods?

A

Borderline Personality Disorder

35
Q

What is it important to remember as a GP for patients who have BPD (borderline)?

A

Often these Ps have suffered trauma and abuse - can take changes as rejection or abandonment - can have very high expectations of their GP and can get very angry and upset when their expectations are not fulfilled.

36
Q

What is low mood?

A

Can include symptoms such as
- Sadness
- Anxiety / Worrying
- Tiredness
- Low self-esteem
- Frustration & anger

37
Q

How can you differentiate between grief and depression?

A

Grieving Ps usually also have positive memories of the deceased, not just sad ones.

Depressed Ps often have worthlessness & self-loathing - grieving Ps have preserved self-esteem

Grief has no association with psychotic features

38
Q

What are the symptoms of bipolar Ps?

A

Depressive phases interspersed with manic or hypomanic phases

39
Q

What are the symptoms of mania?

A

Pressured speech & “flight of ideas”
Inflated self-esteem
Reduced sleep
Reduced inhibitions & rationalising of consequences
May have psychotic symptoms (hallucinations and delusions)

40
Q

How can you differentiate between mania and hypomania?

A

Mania = impacts on function & has severe symptoms

Hypomania = less severe symptoms, not impacting function, no psychotic features

41
Q

What are the negative symptoms of schizophrenia?

A

Low motivation
Social withdrawal
Emotional flattening
Self neglect

42
Q

What percentage of ppl in UK experience SAD?

A

6%

43
Q

Which medicines can cause low mood?

A

Central acting antihypertensives
Lipid-soluble β-blockers
Benzos & CNS depressants
Contraceptives containing progesterone (esp Depo-Provera)

44
Q

What are the categories of depression according to DSM-5?

A

Minor / sub-threshold
Mild
Moderate
Severe

45
Q

What is minor depression according to DSM5?

A

Less than 5 symptoms - doesn’t meet threshold criteria

46
Q

What is mild depression according to DSM5?

A

Very few more than 5 symptoms + mild functional impairment

47
Q

What is moderate depression according to DSM5?

A

Number of symptoms and impairment is between mild and severe

48
Q

What is severe depression according to DSM5?

A

Most / all symptoms + severe functional impairment

49
Q

How does NICE categorise depression?

A

Less severe depression (minor and mild from above - <16 on PHQ9 scale)

More severe depression (moderate or severe - equal or greater to 16 on PHQ9 scale)

50
Q

Name one limitation of the PHQ9 assessment

A

That suicidal thoughts carry the same score as any other symptoms.

51
Q

How much greater is the risk of suicide in population who have mental health disorders?

A

x5-x15 higher

90% of Ps who commit suicide have an underlying mental health diagnosis

52
Q

What are the common side effects of SSRIs?

A

Nausea. dry mouth, reduced appetite, insomnia, loss of libido, agitation, anxiety, headaches

Rarely - inc risk of suicide

53
Q

Why should you closely monitor a P starting SSRIs?

A

Increased risk of suicide - especially in younger Ps.

54
Q

What is an SNRI?

A

Serotonin & Noradrenaline Reuptake Inhibitor

55
Q

Which Ps shouldn’t have SNRIs?

A

Those with uncontrolled hypertension

56
Q

Which Ps should not have citalopram or escitalopram?

A

Ps who have a prolonged QT interval (or on meds which prolong the QT interval)

57
Q

Which electrolyte abnormality is associated with SSRIs?

A

Hyponatremia - dont give if P has history of hyponatremia or if they are on drugs which cause it (e.g. PPIs)

58
Q

Name 4 types of anxiety disorders

A

Generalised anxiety disorder
Panic disorder
Specific phobias
Social anxiety disorder

59
Q

Name two conditions that are often put under the anxiety umbrella but are actually distinct conditions.

A

Post-Traumatic Stress Disorder
OCD

60
Q

What physical symptoms can present in Ps with anxiety?

A

Dizziness
Faintness
Inc Urinary frequency
Diarrhoea
SOB
Hyperventilation
Palpitations
Chest Pain
Sweating
Feeling hot
Tingling

61
Q

How can physical symptoms impact on Ps?

A

Ps with anxiety can fixate on the physical symptoms and worry more - leading to more anxiety = cycle of anxiety

62
Q

How does anxiety as a cycle cause social problems in Ps?

A

Ps undergo physical symptoms in certain situations - leads them to avoid that situation (short term relief) but in long term this increases the anxiety which then increases physical symptoms leading to more coping behaviours and loss of confidence

63
Q

Name a self-rating scale for anxiety

A

Generalised Anxiety Disorder Assessment 7 - GAD7

CPCP (6 decks)

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