Low Mood - Effective consulting Flashcards
(27 cards)
How do patients with depression present to doctors?
- feeling low
- lost interest
- tired all the time (somatic syndromes)
- stomach pain/ headaches
What can depression lead to?
- weight loss
- lack of self care
- not taking medication
- unexplained symptoms
- disturbed sleep
- fatigue
- poor concentration
- suicidal thoughts
What are core symptoms?
(one must be present >2 weeks affecting patients life for a diagnosis of depression)
eg, persistent low mood, loss of interest/ pleasure
What areas of sleep might be affected?
- initial or middle insomnia
- early morning waking
- over sleeping
What family history might lead to mental illnesses?
- schizophrenia
- bipolar disorder
- major depression
What is the spectrum of risk to self?
- self harm can be physical self abuse to engaging in risky behaviour
- self harm and suicidal thinking can be a coping mechanism
What are some red flags for suicidial thoughts?
- clear and detailed plan
- social isolation
- hopelessness
- chronic illness
- background risk factors
- severity of psychiatric state
How to examine a patient with potential mental health issues?
- appearance
- behaviour
- speech
- mood and affect
- thought
- perception
- cognition
- insight and judgement
What is the human condition?
- stress, anxiety, worry, guilt, remorse
- fluctuations in mood
- fluctuations in energy, motivation and sleep
- normal response to distressing external events eg. loss, illness, traumatic events
What is grief?
- distressing normal reaction to intense emotional pain
- numbness, unreality, yearning, anger
- impact on appetite and sleep
How to diagnose depression?
- not attributable to other causes
- causing significant distress or functional impairment
What is severe depression?
has most of the 9 symptoms including one of the core symptoms
-symptoms interfere with functioning
What is depressive symptoms?
lasting 2 years or more
What is the subthreshold for depression?
at least 2, less than 5 symptoms
What is used to assess the severity of depression?
PHQ-9 questionnaire
What is atypical depression?
present with reactive mood, weight gain, increased appetite and excessive sleepiness
Why is depression still underdiagnosed? (patient factors)
- stigma/ embarrassment/ shame
- fear
- doesn’t fit with socio cultural perspective
- thinking no one can help
Why is depression underdiagnosed? (doctor factors)
- more pressing problems
- missed (lack of recognition, hidden or time pressure)
What are some specific risks for depression?
- social problems eg. unemployment
- psychiatric problems eg. substance misuse
- physical disorders eg. diabetes, CHD
- drugs that cause symptoms of depression eg. beta blockers
What are the options to treat depression?
- lifestyle
- therapy
- pharmacological
What lifestyle changes can be done?
- establish routines
- eat well
- exercise
- re-engage
- sleep hygiene
- avoid alcohol and mood depressants
What are some supportive interventions?
- therapeutic conversations/ brief interventions
- self help programmes eg. books
- counselling
What are some therapy interventions?
- CBT/ psychological interventions
- therapeutic services eg. RELATE, CRUSE, trauma focused, sexual assault
What is CBT?
Cognitive behavioural therapy