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31 Cards in this Set

  • Front
  • Back
What are the 3 types of fatigue?
- Lack of energy.
- Tired/sleepy.
- Weakness/lack of muscle strength.

Often mixed patterns.
What percentage of GP patients present with fatigue?
What percentage of fatigue is of psychological origin?
What is the probability diagnosis of fatigue?
- Stress and anxiety.
- Depression.
- Viral/post-viral.
- Sleep related.
What percentage of fatigue patients would have a significantly abnormal pathology result?
What serious causes of fatigue must not be missed?
- Malignancy.
- Cardiac.
- HIV.
- Anaemia.
- Hepatitis.
- Haemochromatosis.
What are some of the pitfalls of fatigue?
- Coeliacs.
- Endocrine.
- Drugs.
- Autoimmune.
- Infectious (e.g. TB, FUO).
- Renal.
- Fibromyalgia.
- Metabolic.
What is the most consistent hormonal feature in major depression?
Hypercortisolism (50%).
What is the response to stress (general adaptational syndrome)?
1. Alarm reaction.
2. Resistance.
3. Exhaustion.
How many days of sleep deprivation might cause similar neurotransmitter changes as seen in depression?
10 days.
What precipitating factors are associated with major depression?
- Stressful life events.
What predisposing factors are associated with major depression?
- Self-esteem.
- Social support.
- Temperament.
- Interpersonal skills.
- Anger.
What perpetuating factors are associated with major depression?
- Chronic stress response.
- Sleep deprivation.
- NA, 5HT deficiency.
- Pessimism and negativity.
- Interpersonal conflict.
What factors are protective against depression and improves prognosis?
- 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.
What are the behaviour changes/states of change required for improving the prognosis of major depression?
Knowledge - Psychoeducation, MH literacy.

Attitude - Motivation, accepting responsibility.

Skills - Behavioural, CBT, IPT, NLP.
What are the 4 A's of treating psychiatric problems?
- Acknowledge.
- Accept.
- Aim.
- Action plan.
Describe the 'stepped' approach of mental health treatment.
- 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.
Why shouldn't St John's Wort be used in conjunction with antidepressants?
Risk of serotonin syndrome.
Sedating antihistamines may be used as a hypnotic. What problem might they pose?
They might cause daytime sedation.
What patients suffering from depression should be followed up after 1 week?
- Increased risk of suicide.
- Younger than 30 years.
Antidepressant medication effect begins around ______ and is maximally effective around week ____.
Antidepressant medication effect begins around 2-3 weeks and is maximally effective around week 6.
There is a hierarchy of despair symptoms that
can be used to get a better idea of a patient's depression. What are they?
- Has she lost CONFIDENCE in herself?
- Is she feeling HOPELESS? Is she thinking she is WORTHLESS?
- Has she had thoughts of SELF-HARM, etc?
Which SSRIs have the fewest drug interactions?
Citalopram, sertraline.
What are the common adverse effects of SSRIs?
Nausea, agitation, insomnia,
drowsiness, tremor, dry mouth,
diarrhoea, dizziness, headache, sweating, asthenia, anxiety, weight gain or loss, sexual dysfunction, rhinitis, myalgia, rash.
What are the common side effects of TCAs?
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.
How long should a patient stay on antidepressants if they 2 previous epides within 5 years or 3 previous episodes?
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.
What advice should you give patients starting on an anti-depressant?
- 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.
Specific cognitive therapies have been shown to prevent relapse...
- 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.
The elderly are vulnerable to hyponatremia with SSRIs and venlafaxine by what mechanism?
SIADH secretion.
What elderly patients are more at risk of SIADH from SSRI use?
- Female.
- Low BMI.
- Lower baseline sodium level.
What are the risk factors for suicide?
- 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.