Depression and insomnia Flashcards
(116 cards)
1
Q
What is mild depression?
A
Four symptoms
2
Q
What is moderate depression?
A
Five to six symptoms
3
Q
What is severe depression?
A
Seven or more symptoms with or without psychotic symptoms
4
Q
How long should symptoms be present for in order to diagnose depression?
A
A month or more and every symptom should be present for most of every day
5
Q
What are the two questions you should ask someone if you think they could be depressed?
A
During the last month, have you often been bothered by feeling down, depressed or hopeless?
During the last month, have you often been bothered by having little interest or pleasure in doing things?
6
Q
Diagnosis of depression is performed using what?
A
ICD-10
7
Q
What are the key symptoms of depression (ICD-10(?
A
Persistent sadness or low mood
Loss of interest and pleasure
Fatigue or low energy
8
Q
What are the associated symptoms with depression?
A
Disturbed sleep Poor concentration and indecisiveness Low self confidence Poor or increased appetite Suicidal thoughts or acts Agitation or slowing of movement Guilt or self blame
9
Q
What are the symptoms reported by at least 90% of people with depression?
A
Less enjoyment from usual activities Hopelessness Disappointment with self Irritability Difficulty sleeping
10
Q
How many hours of sleep should a 15 year old have?
A
8 hours
11
Q
How many hours of sleep should a 20 year old have?
A
7.5 hours
12
Q
How many hours of sleep should a 40 year old have?
A
6.8 hours
13
Q
How many hours of sleep should a 60 year old have?
A
6.3 hours
14
Q
How many hours of sleep should a 80 year old have?
A
5.8 hours
15
Q
How many weeks is short term insomnia?
A
Less than 4 weeks
16
Q
How many weeks is long term insomnia?
A
More than 4 weeks
17
Q
How long should you avoid caffeine, nicotine, and alcohol before going to bed? (to help with sleep)
A
6 hours
18
Q
How long before bed should you avoid exercise for?
A
4 hours
19
Q
What is the maximum length of time to treat short term insomnia pharmacologically?
A
3 weeks
20
Q
What is preferred for insomnia treatment, short acting benzodiazepines or zopiclone?
A
There is no firm evidence of differences between the two
21
Q
What is recommended for the long-term management of insomnia?
A
Pharmacological therapy is generally not recommended.
Referral to a specialist would be needed.
22
Q
When should pharmacological treatment be used to treat depression?
A
For moderate or severe depression or mild with previous moderate/severe episode
23
Q
What drug class is used first line to treat depression?
A
SSRIs
24
Q
Which SSRIs should be considered first line to treat depression?
A
Sertraline and escitalopram
25
Which SSRI has a QT prolongation warning?
Escitalopram
26
What drug class is sertraline?
SSRI
27
What drug class is escitalopram?
SSRI
28
What drug class is Citalopram?
SSRI
29
What drug class is Fluoxetine?
SSRI
30
What drug class is Paroxetine?
SSRI
31
What antidepressant may be an option if sedation is desired or where hyponatraemia or an increased bleeding risk is a concern?
Mirtazepine
32
When should patients receiving pharmacological treatment for short term insomnia be reviewed?
after 2 weeks of treatment
33
When should people on mirtazapine be assessed for response?
4 weeks for adults or 6 weeks for over 65 year olds
34
For people who are not considered to be at increased risk of suicide, when should they normally be reviewed for their depression treatment?
2 weeks
35
For people who are younger than 30 years, when should you normally review them for their depression treatment?
1 week
36
What adverse effects should you monitor for when SSRIs are prescribed?
GI upset
Bleeding
Hyponatraemia
37
What period of time should an antidepressant be stopped over?
4 weeks
38
Does paroxetine have a long or short half life?
Short
39
Does fluoxetine have a long or short half life?
Long
40
How long should antidepressants be continued if it is the patients first episode?
6 months
41
How long should antidepressants be continued if it is the patient's second episode?
2-3 years
42
How long should antidepressants be continued if it is the patient's 3rd episode?
5 years
43
How long should antidepressants be continued if is it the person's 4th or more episode?
Lifelong
44
What is transient insomnia?
Lasts a few days and is usually a result of a stressful situation
45
What is short term insomnia?
Lasts 1-4 weeks. Typically due to emotional trauma or physical illness
46
What is chronic insomnia?
Lasts more than one month
47
Benzodiazepine withdrawal syndrome can occur up to how long after discontinuation?
3 weeks
48
What are the predominant signs and symptoms of benzodiazepine withdrawal symptom?
```
Insomnia
Anxiety
Loss of appetite and body weight
Tremor
Perspiration
Tinnitus
Perceptual disturnaces
```
49
What are the common side effects of benzodiazepines?
Drowsiness, light headedness, confusion, ataxia and amnesia
50
What may be useful for people who fall asleep easily but then wake up in the early hours and find it difficult to fall back asleep?
Zaleplon
51
Are TCAs licensed for use as hypnotics?
No
52
Are sedative anthistamines licensed for short term use as hypnotics?
Yes
53
What are the three 'Z' drugs?
Zaleplon
Zolpidem
Zopiclone
54
If a person does not respond to one hypnotic drug, should another be prescribed?
No they should not be prescribed any of the others
55
The prevalance of insomnia is higher in who?
Women
| Older people
56
What are the 6 hypnotics the BNF lists?
```
Nitrazepam
Flunitrazepam
Flurazepam
Loprazolam
Lormetazepam
Temazepam
```
57
Which two hypnotics are blacklisted and cannot be prescribed on the NHS?
Flunitrazepam
| Flurazepam
58
What two benzodiazepines are licensed for insomnia and anxiety?
diazepam
| lorazepam
59
Which 4 benzodiazepines have a shorter duration of action?
Loprazolam
Lorazepam
Lormetazepam
Temazepam
60
Which benzodiazepines have a longer elimination half life?
Diazepam
| Nitrazepam
61
Which benzodiazepine is associated with a greater risk of withdrawal symptoms?
Lorazepam
62
What is the elimination half life of zaleplon?
1 hour
63
What is the elimination half life of zolpidem?
2.5 hours
64
What is the elimination half life of zopiclone?
3.5-6.5 hours
65
What are the recommended pharmacological treatments of insomnia?
Short acting benzos: temazepam, loprazolam, lormetazepam
Non-benzos: Zopiclone, Zolpidem and Zaleplon
66
When is diazepam useful?
If insomnia is associated with daytime anxiety
67
Why are diazepam, nitrazepam and flurazepam generally not recommended for insomnia?
Their long half lives commonly gives rise to next day residual effects
68
NICE guidelines on depression use which criteria for diagnosis of depression?
DSM-4
69
According to DSM-4, which are the core features that should be present for depression to be considered?
A low or depressed mood
| Loss of interest or pleasure in activities that the person would otherwise enjoy (anhedonia)
70
For a diagnosis of depression to be made against DSM-4 criteria, how many symptoms must have been present during the same two week period?
Five or more
71
According to DSM-4, how many symptoms are present for mild depression?
Few (if any) in excess of the five required to make the diagnosis
72
According to DSM-4, how many symptoms are present for severe depression?
Most symptoms should feature
73
When can antidepressants be used in people with mild depression?
When there is a previous history of moderate or severe depression.
Subthreshold symptoms have been present for 2 years.
Other interventions have been tried and have not been successful.
74
Why are SSRIs the mainstay of antidepressant treatment?
Because of their relatively tolerable side effect profile and safety in overdose compared with other antidepressant classes
75
What age range are most likely to be at risk of suicide in the first few weeks of antidepressant treatment?
adolescents- 25 years
76
How long should antidepressants be taken for before considering their full efficacy?
at least 4 weeks
77
Discontinuation symptoms usually occur within how many days of stopping antidepressants?
5 days
78
Which SSRI has an association with QT-interval prolongation?
Citalopram
79
Which is considered an antidepressant of choice in those with diabetes?
Fluoxetine
80
What are the side effects of fluoxetine?
Tremor, nausea, sweating and anxiety
81
Why might SSRIs increase bleeding times?
They cause decreased platelet activation
82
What antidepressant should be considered in people at risk of GI bleeding?
Mirtazapine
83
Which SSRIs are considered to have the lowest propensity for interaction via CYP450?
Citalopram
| Sertraline
84
What medicines commonly cause or exacerbate depression?
Methyldopa, corticosteroids, benzodiazepines. levodopa, some anticonvulsants. isotretinoin, CCBs-nifedpine, lipophilic beta blockers- propranolol
85
Which antidepressant class are less dangerous if taken in overdose?
SSRIs
86
What should be avoided if taking MAOIs?
Tyramine containing foods
87
What are common SEs of TCAs?
antimuscarinic
histaminergic
cardiovascular
88
After how many weeks could a change to another antidepressant be warranted?
6 weeks
89
How many symptoms must be present for mild depression according to ICD-10?
4 and 2 must be key symptoms
90
How many symptoms must be present for moderate depression according to ICD-10?
6 but 2 must be key
91
How many symptoms must be present for severe depression according to ICD-10?
8 but at least 3 must be key
92
What are they key symptoms of depression according to ICD-10?
depressed mood
anhedonia
lack of energy
93
What was the SAD Personas scale developed for?
Identify people at risk of suicide
94
What does SAD PERSONAS stand for?
```
Sex
Age
Depression
Previous attempt
Ethanol abuse
Rational thought loss
Social supports lacking
Organised plan
No spouse
Access to lethal means
Sickness
```
95
What drug class is amitriptyline?
TCA
96
What drug class is dosulepin?
TCA
97
What drug class is lofepramine?
TCA
98
What are TCAs contra-indicated in?
Recent MI, arrhythmias, manic phase of bipolar disorder
99
When should TCAs be taken and why?
Bedtime because they have sedative properties
100
Which two TCAs have the least sedative profile?
Lofepramine
| Nortriptyline
101
When should SSRIs be taken?
With or after food
102
Which are considered safer in overdose, TCAs or SSRIs?
SSRIs
103
What drug class is Moclobemide under?
Reversible inhibitor of monoamine oxidase type a
104
What drug class are venlafaxine and duloxetine?
serotonin and norepinephrine reuptake inhibitors
105
At low doses (75mg) what does venlafaxine mainly act on?
5-HT receptor
106
At medium doses (150mg) what does venlafaxine mainly act on?
NE reuptake
107
What are SNRIs contra-indicated in?
Patients with conditions associated with high risk of cardiac arrhythmia and uncontrolled hypertension
108
What drug class is mirtazepine?
Norepinephrine and specific serotonin antidepressant (NASSA)
109
What drug class is mirtazapine?
Norepinephrine reuptake inhibitor
110
How is SSRI treated?
Discontinuation of the SSRI, IV fluids, cyproheptadine, activiated charcoal, benzodiazepines
111
SSRIs should not be taken with NSAIDs, true or false?
True
112
What are the 3 depression questionnaires used in primary care?
PHQ-9
HADS
BDI-II
113
Section 2 of the mental health act allows compulsory admission for how long?
28 days
114
Section 3 of the mental health act allows compulsory admission for how long?
6 months
115
Section 4 of the mental health act allows compulsory admission for how long?
72 hours
116
Are SSRIs sedating or do they have more of a stimulant effect?
Stimulant
