Year 2 - Week 2 - Low Mood

Question 1

According to the DSM5 - what 3 features must be present to diagnose a major depressive episode?

Answer 1

Depressed mood or loss of interest/pleasure in daily activities for more than 2 weeks.

The mood change is a change from the P’s baseline

Should be impaired function - social, occupational or educational.

Question 2

According to DSM5 - what are the 9 specific symptoms that Ps need to have 5 of each day to be diagnosed with a major depressive illness?

Answer 2

Depressed / irritable most of day, nearly every day.

Decreased interest or pleasure in activities

Significant weight change or change in appetite

Change in sleep

Change in activity

Fatigue or loss of energy

Guilt / worthlessness

Concentration impaired

Suicidality

Question 3

What is it called when a P cannot (a) sleep or (b) sleeps too much.

Answer 3

(a) Insomnia

(b). Hypersomina

Question 4

Which is the most prevalent anxiety?

Answer 4

Generalised anxiety disorder (GAD)

Question 5

How long does anxiety have to prevail to be diagnosed with GAD?

Answer 5

6 months

Question 6

How many men v. women get diagnosed with depression and anxiety?

Answer 6

1 : 2

Question 7

What age to common mental disorders peak?

Answer 7

45-54

Question 8

Which people are at higher risk for developing anxiety or depression?

Answer 8

Ps in care homes
Poorer Ps
Long-term sick or physically impaired
Unemployed

Question 9

What can Ps who are suffering with medically unexplained symptoms actually have?

Answer 9

Depression and anxiety

Question 10

What can cause a variation in presentation of depression?

Answer 10

Culture
Age

Question 11

What symptoms are older Ps with depression more likely to have?

Answer 11

Agitation
Somatic symptoms

Question 12

What symptoms are younger Ps with depression more likely to have?

Answer 12

Guilt
Loss of libido

Question 13

What can you use to assess whether a P presenting has depression?

Answer 13

Biopsychosocial assessment questionnaire - e.g. PHQ9

Question 14

What is the management of depression and anxiety in UK primary care based on?

Answer 14

Stepped-care model

Question 15

What is the underlying principle of the stepped-care model?

Answer 15

Intervention offers should be the least intrusive and appropriate to the severity of the illness.

Question 16

What treatment is suggested for Ps with all known and suspected presentations of depression?

Answer 16

Assessment
Support
Psychoeducation
Active monitoring
Referral for further assessment / interventions

Question 17

What thought distortion is it when Ps turn all difficulties into disaster - everything seems extreme?

Answer 17

Exaggeration / Catastrophising

Question 18

What is the thought distortion when Ps make broad statements that emphasise the negative? (e.g. nobody likes me)

Answer 18

Overgeneralisation

Question 19

What is the thought distortion when Ps only remember and dwell on negative events and dismiss good experiences as unimportant?

Answer 19

Ignoring the positive

Question 20

What thought distortion is it when Ps can only see things in black and white - when something falls short of perfection it is a failure.

Answer 20

All or nothing thinking

Question 21

What thought distortion is it when Ps interpret something automatically in a negative way without any facts to support their view?

Answer 21

Jumping to conclusions

Question 22

What thought distortion is it when Ps deal with mistakes by using general labels (Im a bad mother)?

Answer 22

Labelling

Question 23

What thought distortion is it when Ps assume responsibility for things that arent really under their control?

Answer 23

Personalisation

Question 24

What thought distortion is it when Ps tell themselves how they ought to act, feel or think?

Answer 24

Should or shouldn’t thoughts

Question 25

What does the stepped care model perceive about Ps at Step 1?

Answer 25

That they will have relatively mild symptoms which should improve with minimal intervention and not progress to Stage 3 or 4.

Question 26

Which initiative has helped in responding appropriately to the mental health needs of Ps in primary care?

Answer 26

IAPT (Improve Access to Psychological Therapies)

Question 27

Which psychological therapy has the most extensive evidence base?

Answer 27

CBT

Question 28

What is the most widely used treatment for anxiety and depression?

Answer 28

Antidepressants (SSRIs)

Question 29

What did SSRIs replace?

Answer 29

Tricylcli antidepressants (TCAs) and MAO inhibitors (MAOIs)

Question 30

What are the common adverse effects of SSRIs?

Answer 30

GI upset Temporary increase in anxiety Sexual dysfunction

Question 31

How long should SSRIs be continued for at a minimum?

Answer 31

6 months

Question 32

Over what period should SSRIs be stopped? Why?

Answer 32

4 weeks - to prevent discontinuation syndrome (dizziness, headache, nausea & lethargy)

Question 33

What diagnosis can be given to Ps who have persistent problems in social relations and social functioning?

Answer 33

Personality disorder

Question 34

Which personality disorder is characterised by unstable and intense interpersonal relationships, self-perception and moods?

Answer 34

Borderline Personality Disorder

Question 35

What is it important to remember as a GP for patients who have BPD (borderline)?

Answer 35

Often these Ps have suffered trauma and abuse - can take changes as rejection or abandonment - can have very high expectations of their GP and can get very angry and upset when their expectations are not fulfilled.

Question 36

What is low mood?

Answer 36

Can include symptoms such as - Sadness - Anxiety / Worrying - Tiredness - Low self-esteem - Frustration & anger

Question 37

How can you differentiate between grief and depression?

Answer 37

Grieving Ps usually also have positive memories of the deceased, not just sad ones. Depressed Ps often have worthlessness & self-loathing - grieving Ps have preserved self-esteem Grief has no association with psychotic features

Question 38

What are the symptoms of bipolar Ps?

Answer 38

Depressive phases interspersed with manic or hypomanic phases

Question 39

What are the symptoms of mania?

Answer 39

Pressured speech & "flight of ideas" Inflated self-esteem Reduced sleep Reduced inhibitions & rationalising of consequences May have psychotic symptoms (hallucinations and delusions)

Question 40

How can you differentiate between mania and hypomania?

Answer 40

Mania = impacts on function & has severe symptoms Hypomania = less severe symptoms, not impacting function, no psychotic features

Question 41

What are the negative symptoms of schizophrenia?

Answer 41

Low motivation Social withdrawal Emotional flattening Self neglect

Question 42

What percentage of ppl in UK experience SAD?

Answer 42

6%

Question 43

Which medicines can cause low mood?

Answer 43

Central acting antihypertensives Lipid-soluble β-blockers Benzos & CNS depressants Contraceptives containing progesterone (esp Depo-Provera)

Question 44

What are the categories of depression according to DSM-5?

Answer 44

Minor / sub-threshold Mild Moderate Severe

Question 45

What is minor depression according to DSM5?

Answer 45

Less than 5 symptoms - doesn't meet threshold criteria

Question 46

What is mild depression according to DSM5?

Answer 46

Very few more than 5 symptoms + mild functional impairment

Question 47

What is moderate depression according to DSM5?

Answer 47

Number of symptoms and impairment is between mild and severe

Question 48

What is severe depression according to DSM5?

Answer 48

Most / all symptoms + severe functional impairment

Question 49

How does NICE categorise depression?

Answer 49

Less severe depression (minor and mild from above - <16 on PHQ9 scale) More severe depression (moderate or severe - equal or greater to 16 on PHQ9 scale)

Question 50

Name one limitation of the PHQ9 assessment

Answer 50

That suicidal thoughts carry the same score as any other symptoms.

Question 51

How much greater is the risk of suicide in population who have mental health disorders?

Answer 51

x5-x15 higher 90% of Ps who commit suicide have an underlying mental health diagnosis

Question 52

What are the common side effects of SSRIs?

Answer 52

Nausea. dry mouth, reduced appetite, insomnia, loss of libido, agitation, anxiety, headaches Rarely - inc risk of suicide

Question 53

Why should you closely monitor a P starting SSRIs?

Answer 53

Increased risk of suicide - especially in younger Ps.

Question 54

What is an SNRI?

Answer 54

Serotonin & Noradrenaline Reuptake Inhibitor

Question 55

Which Ps shouldn't have SNRIs?

Answer 55

Those with uncontrolled hypertension

Question 56

Which Ps should not have citalopram or escitalopram?

Answer 56

Ps who have a prolonged QT interval (or on meds which prolong the QT interval)

Question 57

Which electrolyte abnormality is associated with SSRIs?

Answer 57

Hyponatremia - dont give if P has history of hyponatremia or if they are on drugs which cause it (e.g. PPIs)

Question 58

Name 4 types of anxiety disorders

Answer 58

Generalised anxiety disorder Panic disorder Specific phobias Social anxiety disorder

Question 59

Name two conditions that are often put under the anxiety umbrella but are actually distinct conditions.

Answer 59

Post-Traumatic Stress Disorder OCD

Question 60

What physical symptoms can present in Ps with anxiety?

Answer 60

Dizziness Faintness Inc Urinary frequency Diarrhoea SOB Hyperventilation Palpitations Chest Pain Sweating Feeling hot Tingling

Question 61

How can physical symptoms impact on Ps?

Answer 61

Ps with anxiety can fixate on the physical symptoms and worry more - leading to more anxiety = cycle of anxiety

Question 62

How does anxiety as a cycle cause social problems in Ps?

Answer 62

Ps undergo physical symptoms in certain situations - leads them to avoid that situation (short term relief) but in long term this increases the anxiety which then increases physical symptoms leading to more coping behaviours and loss of confidence

Question 63

Name a self-rating scale for anxiety

Answer 63

Generalised Anxiety Disorder Assessment 7 - GAD7