Primary Care Management of Common Mental Health Disorders Flashcards
(65 cards)
How common is mental illness?
1 in 4
What majority of GP consultations have a mental health component?
40%
What factors predispose a patient to depression?
1 - PMH of depression
2 - Significant illnesses causing disability
3 - Other mental health problems, e.g. dementia
What 2 key questions can asked to screen patients for depression?
1 - During the last month have you often been bothered by feeling down, depressed or hopeless?
2 - During the last month, have you been bothered by having little interest or pleasure in doing things?
What are the key symptoms of depression and how many of these must be present for a diagnosis of depression to be made?
- Persistent sadness or low mood
- Loss of ineterest or pleasure
- Fatigue or low energy
At least 1 of these symptoms must be present
What are the associated symptoms of depression?
1 - Disturbed sleep
2 - Poor concentration
3 - Low self-confidence
4 - Poor or increased appetite
5 - Suicidal thoughts or acts
6 - Slowing of movements
7 - Feelings of guilt
How many symptoms define mild depression?
4
How many symptoms define moderate depression?
5-6
How many symptoms define severe depression?
7 or > with or without psychosis
How long should symptoms have been present for in order to be diagnosed as depression?
2 weeks
What is the commonly used screening tool for depression in primary care?
PHQ-9
How many points must be scored on the PHQ-9 for a diagnosis of mild depression to be made?
0-5
How many points must be scored on the PHQ-9 for a diagnosis of moderate depression to be made?
6-10
How many points must be scored on the PHQ-9 for a diagnosis of moderately severe depression to be made?
11-15
How many points must be scored on the PHQ-9 for a diagnosis of severe depression to be made?
16-20
What are the depression guidelines used in primary care?
DSM-IV
What are the DSM-IV assessment criteria for diagnosing depression?
Depression:
Key symptoms:
1 - Depressed mood
2 - Anhedonia
Additional symptoms:
1 - Sleep difficulties
2 - Fatigue
3 - Reduced concentration
4 - Thoughts of suicide or death
5 - Psychomotor retardation
6 - Feelings of guilt
7 - Changes in appetite
Criteria:
- Must have at least 1 of the Key symptoms AND a total of 5 out of 9 of the criteria in total
What is the name given to the condition when patients have < 5 of the DSM IV symptoms?
Subthreshold depressive symptoms
Using the diagnostic criteria of DSM-IV (5 or > symptoms), how is severity assessed in patients with depression?
Mild depression = 5 or > symptoms plus mild functional impairment
Severe depression = 5 or > symptoms plus marked functional impairment
Moderate depression = between mild and severe
What questions must be asked during a suicide risk assessment?
- Have you had suicidal thoughts?
- Have you had any thoughts or ideas about comitting suicide?
- Have you made any plans to commit suicide?
- Have you made any previous attempts to commi suicide?
- Do you have enough social support?
- Are you aware of sources of help?
According to the NICE 2018 guidelines, what is STEP ONE in the STEPPED CARE MODEL of depression?
Recognition, assessment and initial management
What options might be suggested for initial management of depression?
1 - Psycho-education
2 - Lifestyle advice
According to the NICE 2018 guidelines, what is STEP TWO in the STEPPED CARE MODEL of depression?
Recognised depression - persistent subthreshold depressive symptoms or mild to moderate depression
In a patient with mild to moderate depression, antidepressants shouldn’t be used unless what criteria are met?
1 - They have a past history or moderate or severe depression
OR
2 - They present with subthreshold symptoms that have been present for 2 years or more
OR
3 - They have threshold symptoms for < 2 years but they don’t respond to other interventiosn
