Fatigue And Depression

Front 1

What are the 3 types of fatigue?

Back 1

- Lack of energy.
- Tired/sleepy.
- Weakness/lack of muscle strength.

Often mixed patterns.

Front 2

What percentage of GP patients present with fatigue?

Back 2

1-3%.

Front 3

What percentage of fatigue is of psychological origin?

Back 3

50-80%.

Front 4

What is the probability diagnosis of fatigue?

Back 4

- Stress and anxiety.
- Depression.
- Viral/post-viral.
- Sleep related.

Front 5

What percentage of fatigue patients would have a significantly abnormal pathology result?

Back 5

3%.

Front 6

What serious causes of fatigue must not be missed?

Back 6

- Malignancy.
- Cardiac.
- HIV.
- Anaemia.
- Hepatitis.
- Haemochromatosis.

Front 7

What are some of the pitfalls of fatigue?

Back 7

- Coeliacs.
- Endocrine.
- Drugs.
- Autoimmune.
- Infectious (e.g. TB, FUO).
- Renal.
- Fibromyalgia.
- Metabolic.

Front 8

What is the most consistent hormonal feature in major depression?

Back 8

Hypercortisolism (50%).

Front 9

What is the response to stress (general adaptational syndrome)?

Back 9

1. Alarm reaction.
2. Resistance.
3. Exhaustion.

Front 10

How many days of sleep deprivation might cause similar neurotransmitter changes as seen in depression?

Back 10

10 days.

Front 11

What precipitating factors are associated with major depression?

Back 11

- Stressful life events.

Front 12

What predisposing factors are associated with major depression?

Back 12

- Self-esteem.
- Social support.
- Temperament.
- Interpersonal skills.
- Anger.

Front 13

What perpetuating factors are associated with major depression?

Back 13

- Chronic stress response.
- Sleep deprivation.
- NA, 5HT deficiency.
- Pessimism and negativity.
- Interpersonal conflict.

Front 14

What factors are protective against depression and improves prognosis?

Back 14

- Seeks support.
- Anti-depressant medication.
- Compliance to medication.
- Interpersonal skills.
- Effective problem solving.
- Increased insight/self-understanding.
- Cognitive and emotional skills.
- Less stressors, more supportive environment.

Front 15

What are the behaviour changes/states of change required for improving the prognosis of major depression?

Back 15

Knowledge - Psychoeducation, MH literacy.

Attitude - Motivation, accepting responsibility.

Skills - Behavioural, CBT, IPT, NLP.

Front 16

What are the 4 A's of treating psychiatric problems?

Back 16

- Acknowledge.
- Accept.
- Aim.
- Action plan.

Front 17

Describe the 'stepped' approach of mental health treatment.

Back 17

- Start with brief interventions, e.g. problem solving, support.
- Skills based therapy e.g. CBT, assertion training, conflict resolution, self esteem, etc.
- Insight therapy e.g. Gestalt, psychotherapy.
- Patient's preference/motivation/ability important.

Front 18

Why shouldn't St John's Wort be used in conjunction with antidepressants?

Back 18

Risk of serotonin syndrome.

Front 19

Sedating antihistamines may be used as a hypnotic. What problem might they pose?

Back 19

They might cause daytime sedation.

Front 20

What patients suffering from depression should be followed up after 1 week?

Back 20

- Increased risk of suicide.
- Younger than 30 years.

Front 21

Antidepressant medication effect begins around ______ and is maximally effective around week ____.

Back 21

Antidepressant medication effect begins around 2-3 weeks and is maximally effective around week 6.

Front 22

There is a hierarchy of despair symptoms that
can be used to get a better idea of a patient's depression. What are they?

Back 22

- Has she lost CONFIDENCE in herself?
- Is she feeling HOPELESS? Is she thinking she is WORTHLESS?
- Has she had thoughts of SELF-HARM, etc?

Front 23

Which SSRIs have the fewest drug interactions?

Back 23

Citalopram, sertraline.

Front 24

What are the common adverse effects of SSRIs?

Back 24

Nausea, agitation, insomnia,
drowsiness, tremor, dry mouth,
diarrhoea, dizziness, headache, sweating, asthenia, anxiety, weight gain or loss, sexual dysfunction, rhinitis, myalgia, rash.

Front 25

What are the common side effects of TCAs?

Back 25

Sedation, dry mouth, blurred vision, constipation, weight gain, orthostatic
hypotension, urinary hesitancy or retention, reduced GI motility,
anticholinergic delirium, impotence, loss of libido, other sexual adverse effects,
tremor, dizziness, sweating, agitation, insomnia.

Front 26

How long should a patient stay on antidepressants if they 2 previous epides within 5 years or 3 previous episodes?

Back 26

Guidelines suggest that 2 episodes of major depression within 5 years or 3 prior episodes may indicate a need for maintenance treatment of
3–5 years.

Front 27

What advice should you give patients starting on an anti-depressant?

Back 27

- Adverse effects may occur —what these are and their expected duration.
- Mood may not improve immediately.
- Not all people respond to the first drug chosen,
and there are other treatment options.
- Missing doses may reduce effectiveness.
- Even when they feel better, they should continue drug treatment.
- for at least 6 months
drugs should not be ceased abruptly, but tapered gradually because of possible
‘rebound’ symptoms.

Front 28

Specific cognitive therapies have been shown to prevent relapse...

Back 28

- After successful acute treatment with cognitive therapy.
- In those with residual symptoms after a period of optimum drug treatment.
- And in patients with a high risk of recurrence.

Front 29

The elderly are vulnerable to hyponatremia with SSRIs and venlafaxine by what mechanism?

Back 29

SIADH secretion.

Front 30

What elderly patients are more at risk of SIADH from SSRI use?

Back 30

- Female.
- Low BMI.
- Lower baseline sodium level.

Front 31

What are the risk factors for suicide?

Back 31

- Previous suicide attempt or acts of self-harm.
- Being male.
- Access to means of suicide.
- Social isolation.
- Chronic medical illness.
- Young people and older people have higher rates.