Darryl psychological medicine

Question 1

Describe depression

Answer 1

• most common mental illness
• earlier onset in females
• 50% recurrence after single episode

Question 2

What are some risk factors for depression

Answer 2

• prior history of depression
• family history of depression
• chronic or severe illness
• recent stressful event
• lack of social support
• childhood trauma or abuse
• post partum

Question 3

What are DSM-5 criteria for depression (5 or more over 2wk period)

Answer 3

• Depressed mood
• Anhedonia
• Weight changes
• Appetite changes
• Insomnia or hypersomnia
• Decreased energy
• Impaired concentration
• Worthlessness/guilt
• Psychomotor retardation or agitation
• Thoughts of suicide or death

Question 4

Suicidal ideation vs suicidal intent

Answer 4

Ideation: any though abt suicide regardless of how fleeting or persistent- recurrent thoughts focussed on active plans to kill oneself
Intent: a clear desire and plan to complete suicide- patient must have made active preparations for death: collecting pills, buying a gun

Question 5

Depression differential diagnoses

Answer 5

• Subdtance abuse
• Other psychiatric illnesses
• Dementia
• General medical conditions and meds
• Grief reaction
• Adolescent negative self image

Question 6

Describe management of depression

Answer 6

• Establish therapeutic relationship
• Safety of pt and others
• Lifestyle changes
• Family
• Education
• Psychological therapies
• Drug therapy
• ECT for severe depression

Question 7

Describe ECT treatment for depression

Answer 7

• very severe cases
• electrically induced generalised seizure under GA
• used when need for rapid treatment response (suicide risk, not eating/drinking)

Question 8

What are some common antidepressant classes

Answer 8

• Selective serotonin reuptake inhibitors (SSRIs)
• Serotonin noradrenaline reuptake inhibitors (SNRIs)
• Noradrenaline-dopamine reuptake inhibitors (NDRIs)
• Tricyclic antidepressants

Question 9

How do seratonin reuptake inhibitors work

Answer 9

• Blocks reuptake of serotonin
• increased levels of serotonin in CNS
• side effects: initial anxiety 1st 2 weeks, insomnia, headache, GI upset, sexual dysfunction

Question 10

what are some examples of SSRIs

Answer 10

escitalopram, citalopram, fluoxetine, sertraline

Question 11

Describe serotonin syndrome

Answer 11

• Serotonin toxicity from use of SSRIs, overdose, or drug interactions
• Potentially life-threatening
• Altered mental status
• Autonomic dysfunction
• Neuromuscular excitation
• Discontinue meds and manage symptoms