Depression as a Human Experience--Schwenk

Question 1

T/F Physical and social functioning are impaired by depression to a greater degree than by hypertension, diabetes, angina, arthritis, GI diseases, lung problems, or low back pain.

Answer 1

True.

Question 2

Which areas of function are impacted by depression?

Answer 2

Work and home roles
Cognition, memory, concentration
Sleep, sex, food
Motivation, energy

Question 3

T/F In order to be considered depressed, the patient must report a decreased mood.

Answer 3

False. Depressed w/o being sad & sad w/o being depressed.

Question 4

How do depressed patients usu present?

Answer 4

chronic pain-acute back, GI etc.

Question 5

Describe the comorbidity of depression.

Answer 5

independent risk factor for poor prognosis following a procedure
can cause poor adherence to meds & treatments
reduced function

Question 6

Describe the following statement:

Reciprocal and synergistic impact on morbidity and mortality

Answer 6

If you have a medical condition increased risk of depression that could increase mortality.
If you have depression–worse mortality associated w/ an associated medical condition.

Question 7

What are some myths surrounding depression?

Answer 7

Expected reaction to life stresses and losses
Normal part of life
Failure of willpower
Feelings of inadequacy causing guilt
Should be solved alone
Seek help outside mental health and medical care system
Not as important as “real” disease

Question 8

What are some clues for depression in a primary care setting?

Answer 8

Multiple organ system involvement
Dysfunction—emotional, sleep, cognitive
Multiple patient-initiated visits
“Difficult”
Family history
Chronic pain—IBS, chronic pelvic pain, LBP, HA
Co-morbid medical conditions—CHF, DM, HTN, CAD

Question 9

Red flags for depression?

Answer 9

Verbally unproductive
Flat, “energy sump”
“Problem” patient
Multiple complaints, systems, visits
Symptom-sign mismatch
Physician dysphoria when with patient

Question 10

What proportion of depressed patients seek out help from their primary care physician?

Answer 10

1/3
41% of these patients get antidpressants
1/2 of all antidepressants prescribed by PCPs

Question 11

T/F More than half of antidepressants prescribed for reasons other than depression

Answer 11

True.

Question 12

What are reasons for referral to psychiatrist?

Answer 12

severe suicidal thinking
psychosis, bipolar disorder
complicated substance abuse
poor psychosocial support
disorganized, rapid deterioration
failed treatment

Question 13

What are the 10 rules for caring for depressed patients?

Answer 13

Dispel myths
Use epidemiology 
Indirect markers and clues 
Focus on functional impairment
Counter competing priorities
Co-morbidity 
Psychopharmacology
Education and supportive counseling
Treat as a chronic disease
 Psychiatric consultation

Question 14

When does severe depression peak? When do suicidal ideations peak in medical students?

Answer 14

severe depression peaked in 2nd year

suicidal ideation in 4th year

Question 15

Who has the higher risk of suicide in gen pop & in medical students? GENDER?

Answer 15

gen pop: men higher

med: women

Question 16

What is the prevalence of depression in medical students? Excessive alcohol use?

Answer 16

depression: 12-18%

excessive alcohol: 20%

Question 17

T/F More students are coming into med school with depression hx.

Answer 17

T

Question 18

What are some med school risk factors for depression?

Answer 18

women
unmarried
children
hispanic

Question 19

How many physicians commit suicide each year?

Answer 19

250 (maybe closer to 400)

Question 20

How do depressed physicians seek care?

Answer 20

Avoid seeking care d/t privacy concerns/stigma
Prescribe own antidepressant (30% vs. 9.9%)
Seek care outside community and/or pay cash for care
Not seek care d/t concern about medical staff privileges or licensing

Question 21

WHat are some of the barriers for medical students to seek treatment?

Answer 21

telling a counselor risky
means coping skills inadequate
feel less intelligent
unable to handle responsibilities
opinions respected less
seek treatment (those depressed are less likely to seek than those who aren't)

Question 22

What are 5 scary factors that prevent treatment?

Answer 22

Depression as personal weakness
Social/professional discrimination
Devaluation of depressed students
Perceptions of poor performance by depressed medical students
Need for secrecy