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5 Cards in this Set
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Mrs. Jane Norman, 50yr old, comes into clinic C/o low mood, insomnia, lack of appetite, loss of interest and overwhelmingly tired all the time. This has been going on for 3 months. What are your initial thoughts? What is her condition? What are the main symptoms? |
Depression DSM-IV (5/9 symptoms to diagnosis depression) Key symptoms include: (atleast one of these, most days for atleast 2/52) 1. Persistent low mood/ sadness and/or; 2. Marked loss of interest/ pleasure Other symptoms to ask about: 1. Disturbed sleep (more/less) 2. Appetite (more/less) 3. Fatigue/ loss of energy 4. Agitation / slowing of movements 5. Poor concentration 6. Feeling worthless Most importantly ......??? SUICIDAL THOUGHTS... don’t forget! |
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What other factors play into starting active treatment? 1. Family history 2. Past psychiatric history 3. Recent stressors/ identifier 4. Social support available? 5. Suicidal idealisations Start active treatment ....?? |
DSM-IV depression severity: Sub threshold depression: <5 symptoms Mild depression: few, if any symptoms in excess of 5 required to make diagnosis Moderate depression: symptoms or functional impairment between “mild” and “severe” Primary care treatment: 1. 5 or more Symptoms 2. Persistent/ long standing symptoms 3. Personal/family h/o depression 4. Low social support 5. Occasional suicidal thoughts Referral to mental health team: 1. Inadequate/ incomplete response to questions 2. Recurrent episode within 1 year 3. Hx suggestive of bipolar disorder 4. Persistent suicidal thoughts 5. Self- neglect Urgent referral to mental health services 1. Actively suicidal 2. Psychotic symptoms 3. Severe agitation 4. Severe self- neglect What is dysthymia? |
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Dysthymia: chronic depressive state (>2 yrs) Questionnaire for depression (screening tool) PHQ-9 (9 questions , total of 27: 0-4= none, 5-9= mild, 10-14= moderate, 15-19= moderately severe, 20-27= severe) - self completed questionnaire |
Management 1. Self help (self referral - health care professionals to provide more information as required) - CBT, talking therapies, group therapy, psychotherapy etc. 2. Medication - SSRIs (citalopram, sertraline, fluoxetine), TCAs etc. (Refer local guidelines)
Don’t forget to r/v in 2 weeks.. explain side effects and limitations of medication therapy. Eg. Citalopram: takes 4-6 weeks to work, side effects such as tiredness, dry mouth and sweating are common- they are mild and will go in a couple of weeks. Warn against using during pregnancy or if trying to get pregnant. Citalopram can cause withdrawal symptoms - don’t stop without consulting doctor. |
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Affective disorders: consists of major depressive disorder, dysthymia and bipolar disorder Types: 1. Unipolar depression (+variants) 2. Postpartum depression 3. Atypical depression 4. Seasonal affective disorder 5. Bipolar disorder 6. Panic disorder 7. GAD 8. Phobias 9. OCD 10. PTSD
What are the symptoms of affective mood disorders? |
Symptoms include: Major depression/ feelings of low/ sadness, loss of interest, change in appetite and sleep, problems with concentrations, episodes of mania, inflated/ deflated self- esteem etc. |
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Obesity How to calculate BMI? |
Body mass index: kg/m(squared) Overweight: BMI 25-29.9kg/m2 Obesity I: 30-34.9 kg/m2 Obesity II: 35-39.9 kg/m2 Obesity III: >40 kg/m2 |
