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PAN- Psychiatry > Depression > Flashcards

Depression Flashcards

(47 cards)

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1
Q

What are the core symptoms of depression according to the ICD-10?

A

Anhedonia
Depressed Mood
Fatigue

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2
Q

What is anhedonia?

A

Loss of interest or pleasure in daily life, especially in things that previously were enjoyable. May be subjective or observed

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3
Q

How often must symptoms be present for a diagnosis of depression according to the ICD-10?

A

Everyday or nearly everyday without significant change throughout the day for at least 2 weeks

Must not be attributable to psychoactive substance use or to organic mental disorder

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4
Q

What are some typical symptoms of depression?

A 
Early waking
Disturbed and poor quality
Loss of appetite
Weight loss
Psychomotor retardation
Difficulty concentrating
Decreased libido
Ideas or acts of self harm or suicide
Feelings of worthlessness or guilt
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5
Q

What must always be asked about in a patient presenting with depression?

A

Self harm

Thoughts of suicide

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6
Q

How many of each symptom does mild depression have?

A

2 core

2 typical

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7
Q

How many of each symptom does moderate depression have?

A

2 core

3+ typical

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8
Q

How many of each symptom does severe depression have?

A

3 core

4+ typical

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9
Q

What are some medical issues that can cause depression?

Biological causes

A

Hypothyroidism (hyper is associated with mania)
Heart Disease- Post MI and During Recovery
Parkinsons Disease
Multiple Sclerosis
Alzheimers Disease
Hunnington’s Disease
Excess Cortisol- Cushing Disease

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10
Q

What are some psychological causes of depression?

A

Low self esteem
Personality traits
Psychological trauma
Temperament

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11
Q

What are some social causes of depression?

A

Stress
Isolation
Poor housing

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12
Q

When considering a diagnosis of depression what are some differentials you may have?

A

Bipolar- Ask about fluctuating mood
Anxiety- Leading to -Ve feelings
Dysthmia- state of chronic depression that persists for atleast 2 years
Dementia
Substance misuse
Side effect of some medications- e.g beta blockers
Physical causes of depression (thyroid function, CVD, MS, PD)

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13
Q

Describe the stepwise approach for the management of depression

A

Step 1- Recognition and diagnosis
Step 2- Treatment of mild depression in primary care
Step 3- Treatment of moderate to sever depression in primary care
Step 4- Treatment by specialist mental health services

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14
Q

What are some good general measures that should be told to depressed patients?

A 
Good sleep hygiene
Increase physical activity
Methods to reduce anxiety and stress
Mindfullness
Spend more time outdoors
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15
Q

Describe what is included in step 2 of the stepwise approach for the treatment of depression? Mild to moderate depression.

A

NOT SSRI routinely

Sleep and anxiety management advice

Low intensity pyschosocial interventions:

  • Self help e.g. headspace, books, apps
  • Computerised CBT programme
  • Group exercise
  • CBT therapy if above declined

Anti-depressants if persist for more than 8 weeks or previous hx of moderate/severe depression

Follow up the patient within 2 weeks and call if don’t attend follow up

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16
Q

Describe what is included in step 3 of the stepwise approach for the treatment of depression? Moderate to severe depression (or no response to step 2)

A
  • Anti- depressant therapy (1st line is SSRI)

- High intensity psychosocial therapy such as CBT, IPT, Behavioural couples therapy,

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17
Q

What must you discuss with patients when starting them on an anti-depressant medication?

A

There is a delay to it’s effect
Do not stop abruptly
Side effects

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18
Q

What are some side effects of SSRIs?

A 
GI disturbance
Impotence
Sweating
Agitation
Decreased seizure threshold
Discontinuation syndrome- warn not to stop abruptly
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19
Q

Give two examples of SSRIs?

Study These Flashcards
A

Fluoxetine
Sertraline
Citalopram
Paroxetine

20
Q

What is included in step 4 of the stepwise approach for the management of depression? (severe depression, risk to life or severe self neglect)

Study These Flashcards
A

Refer to specialist mental health services
Consider inpatient treatment if significant risk of suicide, self harm or neglect
Continue with antidepressant therapy and high intensity psychosocial interventions
Offer ECT

21
Q

For which patients should ECT be offered?

Study These Flashcards
A

Severe depression
A prolonged or severe manic episode
Catatonia

(Consider for patients with mild depression if all else failed)

22
Q

What is the mechanism of tryptophan?

Study These Flashcards
A

Increased synthesis of NA/5-HT

23
Q

What in the mechanism of MAOIs?

Study These Flashcards
A

Reduce breakdown of 5-HT and NA

24
Q

What is the mechanism of SSRI, SNRI, TCAs?

Study These Flashcards
A

Prevent re-uptake of 5-HT and NA

25
What is a side effect of citalopram?
Increases QT interval
26
Why should patients of SSRIs not stop them acutely?
Discontinuation syndrome- Flu like symptoms Sleep disturbance Sensory and movement disturbances- imbalance, tremors, vertigo, brain zaps
27
What is the mechanism of venlafaxine?
SNRI- Serotonin and noradrenaline re-uptake inhibitor (SNRI). It is helpful in more resistant disease.
28
What is the mechanism of reboxetine?
NA Re-uptake inhibitors | Its not a very good anti-depressant
29
What are two common side effects of mirtazepine?
Sedation and Weight Gain | It is an alpha 2 antagonist
30
How do tricyclic anti-depressants work?
Inhibit the uptake of 5HT and NA
31
Give some examples of TCA
Amitryptyline Imipramine Lefepramine
32
What is a big risk of TCAs in depressed people?
Dangerous in overdose
33
What are some side effects of TCAs?
``` Anticholinergic- dry mouth, constipation, blurred vision Histamine- Sedation Alpha 1- Postural hypotension, impotence Quinidine like- ECG Changes, Arrhythmias NA- Tremor 5-HT- GI Upset, Sweating ``` Now only used in resistant illness and are prescribed by specialists in the area
34
What is a risk factor of MAOIs?
Cheese reaction- it is a hypertensive crisis, risk of stroke and death This is because they prevent the breakdown of tyramine which is found in lots of food, including cheese.
35
What medications should be offered for depression first line?
Fluoxetine Sertraline Mirtazapine
36
What investigations need to be done before starting patients on a TCA or venlafaxine?
ECG/ BP - Do not prescribe if recent MI or history of severe arrhythmia - Do not use venlafaxine in uncontrolled HTN
37
After how long should it be considered to switch anti-depressants?
If no response at four weeks consider switching to a different anti-depressant If partial response consider switching if partial response by 6 weeks
38
What are some second line anti-depressants?
Second SSRI Venlafaxine (SNRI) Mirtazapine (alpha 2 antagonist)
39
When should augmentation be considered?
Partial response to first line treatment Good tolerability of existing treatment Switching to different anti-depressant agents was unsuccessful
40
What agents may be added in for augmentation?
Lithium Anti-psychotic (esp. if psychotic depression)- olanzapine, risperidone, aripiprazole SSRI/Venlafaxine (SNRI) + Mritazapine (Alpha 2 antagonist which enhances NA and 5-HT transmission)
41
What are the indications for ECT?
Depression- Severe or resistant Mania Schizophrenia- catatonia
42
Are there any contra-indications to ECT?
No, there are not absolute contra-indications but there are some relative CIs
43
What are some relative CIs to ECT?
``` CVD- Recent MI, IHD, HF Uncontrolled HTN Aneurysms- Cerebral, AAA Raised ICP Head injury Issues with anaesthetic agents used ```
44
What should be prescribed to patients taking a SSRI and also taking an NSAID?
PPI | Due to risk of GI bleeding
45
How long should be taken to stop an SSRI?
When stopping and SSRI the dose should be gradually reduced over 4 weeks (not with fluoxetine as it has a longer half life)
46
For which type of ECT is more memory impairment seen? Is it more or less effective
Bilateral is associated with more memory impairment than unilateral Bilateral is also more effective
47
Can ECT be given to detained patients?
Yes if informed consent or a second opinion by an approved doctor

PAN- Psychiatry (7 decks)

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