Depression Flashcards
Depression due to Another medical condition examples
Stroke
Parkinson’s
Endocrine: thyroid and adrenal
Autoimmune: lupus
Viral: hiv hepatitis
Cancer: pancreatic
Metabolic:b12
4 ways of diagnosing depression
And preferred method
-exclusive: neroveg symptoms not included
-substitutive: neuroveg replaced by psychological symptoms (like guilt)
-etiologic: each symptom evaluated separately
-inclusive: all included, picks up the most patients
Preferred is inclusive
Why under detection of depression
Medical conditions confuse diagnosis
Present with somatic symptoms
Less likely to use word depressed
Ad vs depression
Apathy, agitation vs anhedonia and anxiety
Sundowning va insomnia
Weight loss and no loss of appetite vs weight loss and loss of appetite
Minimizing cognitive def vs subjective complaints
Guessing during testing vs “I don’t know”
Aphasia/apraxia vs language and motor skills intact
Positive predictors of response
Female gender
Less severe symptoms
No substance use
Good social supports
Religion/faith
Self-efficacy
Factors associated with longer times to response when treating depression
-poor adherence
-duration of depressive ep
-severity of depressive ep
-comorbid anxiety
-Comorbid substance
-Comorbid physical Illness
-failure to respond to a previous antidepressant
As per ccsmh guidelines for depression, what is universal vs selective vs indicated prevention
-general public, regardless of risk status
-targets those at higher risk
-identified as having prodrome symptoms/ markers however don’t meet criteria
As per ccsmh guidelines what are the interventions that reduce social isolation
Primarily group based and in long term care settings
Reminiscence therapy
Physical exercise programs
Videoconferences with family
Horticultural therapy
Gender based social groups
As per ccsmh depression, when do you consider ECt?
In MDD, single or recurrent ep, severe with no psychosis
-previously had good response to ECT
-failed to respond to 1 or more adequate med trials plus psychotherapy
- rapidly deteriorating health due to depression
As per ccsmh dep guidelines what are clinicians supposed to screen for when managing partial response or tx resistant depression
-MEDICATION ADHERENCE
-use of substances
-use of medications that cause depression
-review medical conditions (rule out hyponatremia)
-review working diagnosis
As per ccsmh guidelines for depression what are the core elements for treating late Life depression in primary care
-patient education
-incorporating inter professional staff as depression care managers
-utilizing a stepped care approach
- as needed psychiatric consultation
As per textbook, what are the systemic limitations for suicide in geri
-do not directly assess mental healthcare, downplay symptoms
-long waits to see free therapists
-demands on fam docs great, low number of providers
-primary care system is not designed for assessment and treatment of mental health issues
Resilience factors for suicide (as per textbook)
As per guidelines
-religious or spiritual practice
-perception of meaning and purpose
-sense of hope or optimism
-active social networks
-positive help seeking behaviours
-engagement in activities of personal interest
-better health care practices
-connect with family and friends
-active interests
Religious practices
-openness, extravrrsion, conscientiousness
As per textbook, what are the therapies that have the most evidence for suicidal older adults
-PST and antidepressants
-IPT and antidepressants
Seizure threshold determinants
-age (older>younger)
-male>female
-BF placement > BT >RUL
-concurranrs meds
Anesthetic dose
Anesthetic agents
