Depression

Question 1

_______ is the
leading cause of disability for all conditions among
both sexes, both in Australia and worldwide

Answer 1

depression

Question 2

Depression is a chronic relapsing organic brain
disease. Its mean onset is at _____years of age. However,
40% of sufferers present by _____ years of age

Answer 2

27

20

Question 3

Stress will also lead to a decrease in the protective
_______ which
can result in neuronal death—also referred to as
‘glional dropout

Answer 3

brain-derived neurotrophin factor (BDNF),

Question 4

the reason why there is a slow response to antidepressants

Answer 4

poorly understood
biochemical cascade that occurs ‘beyond the receptor’
is the reason for the slow response to antidepressants

Question 5

The DSM-5 classification divides depressive

disorders into

Answer 5

1. major depressive disorder
(MDD),
2,  disruptive mood dysregulation
disorder, 
3. persistent depressive disorder (PDD)
4 premenstrual dysphoric disorder

Question 6

_________refers to
long-standing (2 years or more) depression of
mild severity.

Answer 6

Persistent depressive disorder (PDD)

Question 7

_________ is a
less severe form of depression without sufficient
criteria for major depression

Answer 7

Adjustment disorder with depressed mood

Question 8

Adjustment disorder duration

Answer 8

Its duration is usually no longer than 6 months

Question 9

The two key criteria for major depressive disorder

(MDD) in the DSM-5 are a _____ and _______ persisting for at least 2 weeks

Answer 9

pervasive depressed mood
and marked loss of interest or pleasure (otherwise
referred to as anhedonia)

Question 10

2 important questions in screening depression:

Answer 10

• In the past month, have you been bothered by the
fact that you feel down, depressed or hopeless?

• In the past month, have you often been bothered
by the fact that you have little interest or
pleasure in doing things

Question 11

DSM-5 diagnostic criteria for major
depressive disorder

At least five of the following symptoms nearly every
day for 2 weeks (criterion 1 or 2 essential):

Answer 11

1 depressed mood (subjective or objective)
2 loss of interest or pleasure
3 change in weight (5% change over 1 month) or
appetite
4 insomnia or hypersomnia
5 psychomotor agitation or retardation
6 loss of energy or fatigue
7 worthlessness or guilt
8 impaired concentration or indecisiveness
9 recurrent thoughts of death or suicide ideation or
any suicide attempt

Question 12

Depression scales

Scales commonly used include ___ and ____

Answer 12

K10 (a distress score) and DASS 21 or 42 (for depression and anxiety symptoms).

Question 13

The rate of antidepressant prescribing for Australians
over ______ of age is higher than for any other age
group.

Answer 13

80 years

Question 14

________ is the most frequent
type of depression in the aged. Features may include
histrionic behaviour, delusions and disordered thinking

Answer 14

Agitated depression

Question 15

Sadness is common in children, but depression, although
not as common, does occur and is characterised by
feelings of ______, _______, ______

Answer 15

helplessness, worthlessness and despair

Question 16

What differentiates depression in children?

Answer 16

In children, irritability may be more

prominent than sadness.

Question 17

In children, Although suicidal thoughts are

common, suicide is rare before______

Answer 17

adolescence

Question 18

This term refers to depression occurring either in the

antenatal period or in the 12 months after delivery

Answer 18

Perinatal depression

Question 19

depression scale use of perinatal depression

Answer 19

Edinburgh Postnatal Depression Scale (EPNDS

Question 20

If perinatal depression is identified, the GP should
take into account the individual woman’s context, her
family and cultural setting, and use a______

Answer 20

family-centred

approach.

Question 21

Questions to ask about suicide

Answer 21

• plan
• lethality
• means
• past history
• suicide of family member or peer

Question 22

What is low risk of suicide

Answer 22

fleeting thoughts of self-harm

or suicide but no current plan or means

Question 23

Mx of low risk of suicide

Answer 23

• Discuss availability of support and treatment
options.
• Arrange follow-up consultation (timing of this
will be based on clinical judgment).
• Identify relevant community resources and
provide contact details.

Question 24

What risk of suicide?

suicidal thoughts and intent
but no current plan or immediate means

Answer 24

Medium

Question 25

Mx of medium risk of suicide

Answer 25

• Discuss availability of support and treatment options. • Organise reassessment within 1 week. • Have contingency plan in place for rapid reassessment if distress or symptoms escalate. • Develop a safety plan (a prioritised written list of coping strategies and sources of support to use when experiencing suicidal thinking).

Question 26

What is HR of suicide?

Answer 26

continual/specific suicidal | thoughts, intent, plan and means

Question 27

Mx for HR of suicide

Answer 27

• Ensure that the person is in an appropriately safe and secure environment. • Organise reassessment within 24 hours and monitoring for this period. • Follow-up outcome of assessment

Question 28

The basic treatments are outlined by the acronym | _____

Answer 28

PACE (which purposefully places priority on the | psychological treatments—

Question 29

_______involves teaching patients new ways of positive thinking, which have to be relevant and achievable for the patient

Answer 29

CBT

Question 30

________is useful in moderate to severe depression , or when depression has an anxiety disorder codiagnosis.

Answer 30

antidepressant medication

Question 31

Antidepressant therapy should be avoided if ______ is suspected, and screening should be actively conducted for symptoms of past or previous mania

Answer 31

bipolar disorder

Question 32

______ are considered to have the most favourable balance of benefit to harm in moderate to severe depression

Answer 32

selective serotonin reuptake inhibitors | SSRIs

Question 33

SE of SSRI

Answer 33

Sexual dysfunction and gastrointestinal side effects are common.

Question 34

Other first line antidep

Answer 34

reboxetine and mirtazepine

Question 35

common side effects include | hypersomnia, fatigue and nausea

Answer 35

reboxetine

Question 36

can cause weight gain | and drowsiness)

Answer 36

mirtazepine

Question 37

T or F SSRIs have a relatively flat dose response curve, but dose increase within the recommended range is reasonable if there is a partial response at a lower dose and no troublesome side effects

Answer 37

T

Question 38

____________ appear to be more effective in treating severe depression symptoms (and may be a suitable first-line option here) but otherwise adverse effects may limit them to second-line treatment

Answer 38

Seretonin and noradrenaline reuptake | inhibitors (SNRIs)

Question 39

____ and _______ are considered second-line because of their side effect profiles.

Answer 39

Tricyclic antidepressants (TCAs) and monoamine oxidase inhibitors (MAOIs)

Question 40

The benefit of medication in moderate depression is equivalent to psychological therapies such as CBT/ IPT and both of them are around _____ more likely to achieve remission than placebo

Answer 40

20%

Question 41

________ is defined as having minimal or no symptoms of depression, 7 and a good way of asking patients about this is to ask ‘Do you think you are back to your normal self?’.

Answer 41

Remission

Question 42

When using antidepressants, if a response is not evident in the first ____ weeks or there is an inadequate response in___ weeks, then it is unlikely that this medication will work for this patient, and a treatment change is recommended

Answer 42

2 6

Question 43

______ is a relatively safe and effective therapy for severe or resistant depression

Answer 43

ECT (electroconvulsive therapy)

Question 44

Cx of ECT

Answer 44

There is some risk of transient short-term cognitive impairment and long-term memory impairment, and this therapy is reserved for severe depression when pharmacotherapy has faile

Question 45

_______ where no anaesthetic is required, is a procedure being explored as a less invasive alternative to ECT.

Answer 45

Transcranial magnetic stimulation,

Question 46

Mild depression: _____ * Moderate depression: _______ * Severe depression:__________

Answer 46

psychological therapy psychological therapy and/ or antidepressants antidepressants, and consider addition of psychological therapy to maintain remission

Question 47

One of the more commonly used and extensively researched alternative therapies for depression is ____________which has had mixed results in the research on its effectiveness. One review of the literature suggests it is effective in mild to moderate depression, 20 though two others suggest it is not

Answer 47

St John’s wort | ( Hypericum perforatum ),

Question 48

Interactions with St Johns Wort

Answer 48

HIV medicines, warfarin, digoxin, anticonvulsants, oral contraceptives and triptans.

Question 49

Symptoms must coincide with the introduction | or dose increase of a serotonergic agent

Answer 49

Serotonin syndrome

Question 50

3 impt symptoms of Serotonin syndrome

Answer 50

— mental status/behaviour changes (e.g. agitation, confusion, hypomania, seizures) — altered muscle tone (e.g. tremor, shivering, myoclonus, hyper-reflexia) — autonomic instability (e.g. hypertension or hypotension, tachycardia, fever, diarrhoea

Question 51

If antidepressant medication is used and remission achieved, it is recommended that it be continued for a minimum of ______ for an initial episode, and for ____ in subsequent episodes or in those at high risk of relapse

Answer 51

12 months 2–3 years

Question 52

What are the RF for relapse in depression?

Answer 52

• residual depressive symptoms • 2 or more prior episodes in the past 5 years • 3 or more prior episodes • history of severe or prolonged depression (especially with psychosis or attempted suicide) • comorbid medical problems • life stressors