Psych- Depression

Front 1

Minimum duration of symptoms needed to diagnose depression

Back 1

Two wks

Front 2

Core symptoms of depressive episode according to ICD-10

Back 2

Low mood

Anhedonia( lack of pleasure)

Fatiguability/ lack of energy

Front 3

How many DSM criteria should be there to diagnose depression

Back 3

5/9

Front 4

What is recurrent depressive dx

Back 4

Repeated episodes of mild/moderate/severe Depression without manic episodes with complete recovery in btwn episodes

Front 5

Bipolar depression in comparison to unipolar depression.

1. Duration

2. Response to treatment

3. Previous hx of manic or hypomanic episodes

Back 5

1. Long duration

2. Poor

Front 6

Rate of major depression in community samples

Back 6

2-5%

Front 7

Life time rate of major depression

Back 7

10-20%

Front 8

Major depression M:F ratio

Back 8

1:2

Front 9

Mean age of onset

Back 9

27 yrs

Front 10

Duration of a depressive episode

Back 10

1-6 months

Front 11

Percentage getting chronic lasting depression more than two years

Back 11

10-20%

Front 12

Percentage experiencing more than one episode

Back 12

85%

Front 13

Minor symptoms of depression- first three

Back 13

Reduced concentration and attention

Reduced self esteem and self confidence

Ideas of guilt amd unworthiness

Front 14

Minor symptoms of depression- last 4

Back 14

Bleak and pessimistic view about future

Ideas or acts of self harm and suicide

Disturbed sleep

Diminished appetite.

Front 15

How to differentiate grief from depression

Back 15

Grief- no low self esteem

Front 16

Pseudodementia vs dementia

Back 16

Pseudodementia- more acute in onset, other symptoms of depression, respond to antidepressants

Front 17

Common somatic symptoms of depression

Back 17

Body aches

Back pain

Burning sensation

Fatigue

Front 18

Differentiating depression vs schizophrenia,

1. Mood-

2. Delusions

3. Thought related-

Back 18

1. Low mood prominent( depression), psychotic symptoms prominent( schizophrenia)

2. Mood incongruent delusions( schizophrenia), mood congruent delusions- nihilism, guilt( depression)

3. Thought insertion, withdrawal, broadcasting, passivity( schizophrenia)

Front 19

Depression vs schizophrenia

4. PPHx

5. FMHx

Back 19

4. Depressive or manic episodes( depression), psychotic episodes(schizophrenia)

5. Depressive or bipolar illness( depression), schizophrenia( schizophrenia)

Front 20

To determine the severity of illness, number of symptoms as well as_______is important

Back 20

Degree of functional imapirment

Front 21

Mild depression- diagnostic criteria

Back 21

2+2

None should be present to a severe degree

Front 22

Functional level of mild depression

Back 22

Usually distressed by symptoms,

Some diffculty in continuing ordinary work

But do not cease to function completely.

Front 23

Diagnostic criteria for moderate depression

Back 23

2+3/4

Several symptoms- at a marked degree.

Front 24

Functional level of moderate depression

Back 24

Considerable difficulty in continuing social, work and domestic activity

Front 25

Causes of depression- three main categories

Back 25

Bio

Psycho

Social

Front 26

Biological causes of depression

Back 26

Genetic

Physical

Endocrine dx

Medications

Substance use

Front 27

Psychological causes of depression

Back 27

Personality

Relationship issues.

Front 28

Social causes of depression

Back 28

Financial

Marital

Workplace

Other stressors

Front 29

Biological causes of depression- family hx

Back 29

Fmhx of depression, bipo dx, suicide

Front 30

Biological causes of depression. Pmhx

Back 30

Any chronic illness

( malignancy, mi, stroke, epilepsy, parkinson dx, renal and liver dx, chronic pain, DM, SLE)

Front 31

Biological causes of depression- medications

Back 31

Analgesics usage

Antibiotics

Antihypertensives

chemo

Steroid

Immunosupressants

Front 32

Biological causes of depression- substance use hx

Back 32

Alcohol

Cannabis

Heroine

(/quantity. Frequency and duration of use)

Front 33

Biological causes of depression- physical examination

Back 33

Features of physical illness and endocrine dx

Front 34

Biological causes of depression-lab ix

Back 34

Relevant ix according to hx

Urine for drug screen

Front 35

Diagnostic criteria for severe depression

Back 35

3+4

Some symptoms- to a severe degree

Front 36

Can diagnosis of severe depression made if duration less than 2 wks

Back 36

Yes. If symptoms are very severe nd of rapid onset

Front 37

Functional level of severe depression

Back 37

Unable to continue activity

Front 38

Delusions of gult inoves ideas of

Back 38

Sin

Poverty

Imminent disasters

Responsibility for bad things

Front 39

Examples of delusions of nihilism

Back 39

Internal organs are destroyed.

Dead

Lost all possessions

Front 40

Examples of auditory hallucinations in depression

Back 40

defamatoryAccusatory

Front 41

Examples of olfactory hallucinations in depression

Back 41

Rotten flesh etc.

Front 42

Examples of long term relationship problems leading to depression-

Relationship with mom- role in depression.?

Social stressors leading to depression-

Positive events that can lead to depression-

Back 42

Front 43

Risks to self-

Risk to others-

Back 43

Front 44

Indicators of high suicidal risk

1. Thoughts- 4

2. Past hx

3. Lack of-2

4. Availability-1

5. Habits-1

Wherw do you get info to assess risk-2

Back 44

Front 45

How to assess the risk of self neglect

1. Hx

2. Examination-

Back 45

Front 46

Psychosocial Aetiology of depression.

Current stressors-

Personality assessment-

1. Coping strategies-

2. Relationship-

3. Personality-

Back 46

Front 47

4 endocrine dx well lnown to cause depression

Back 47

Front 48

How family members and workmates give social support

Back 48

Front 49

Details about previous episodes

1. Frequency-

2. Details of individual episodes-

3. Treatment-

4. Response to treatment-

5. Interepisode period-

6. Precipitated factors-

Back 49

Front 50

Goals of treatment- first 4

Goals of treatment- second 4

Indications for admission-

Outpatient mx- two things done at each clinic review.

Front 51

Education of pt and family

1. What is depression-

2. Rx options-

3. Time taken to respond-

4. SE

5. How long to continue-

How to respond to their cultural views?

Front 52

Steps to provide supportive environment-

In ward-

Outpatient-

Front 53

Minimizing harms-

1. In a psych ward-

2. If sent to a non psych ward-

Front 54

1. How to minimize harm at home-

2. If trying to harm others better to-

3. Which groups are vulnerable to self neglect-

4._______ preferred in self nglect risk

Front 55

1. Psychotic depression- combination of_________ better than antidepressants.

2. BP depression- drug classes

3. Efficacy of TCA vs SSRI?

(Then why SSRI preferred?)

Front 56

Factors affecting medication choice?

2 most effective SSRI s?

Fluoxetine more effective in______

SSRIs should be used cautiously in children and adolescents bcz________

TCA- effective in severe depression, but not the first choice why?

____________more effective than ssri for severe depression.

Front 57

SNRI- CVS se?

Why MAOI rarely used?

TCA contraindications-

TCA best avoided in bcz of-

Front 58

Rare fatal se of antidepressants in elderly-

TCA overdose se-

TCA in pt with suicidal risk?

SNRI safety?

Cheapest antidepressant class

Cheapest SSRI?

Front 59

Previous Rx hx in choice of antidepressants-

Role of pt preferance in choice?

Front 60

Time to appear se?

Time taken to give response?

SSRI starting dose( concept)

Why lower doses of SSRI for elderly?

Why not to stop abruptly?

Withdrawal symptoms of SSRI?

How TCA started?

Why slow dose titration with TCA?

If poor response after two wks?

When to change drugs?

Which symptoms improve earlier than others?

Front 61

Structure to analyse info during assessment- 2

Back 61

Risk assessment

Identifying social support

Reasons for relapse

Details of previous episodes.

Front 62

SSRIs- why to carefully use when there are physical comorbidities

Back 62

Bcz enzyme inhibition

Poor elimination in hepatic failure

Front 63

SSRIs- the most potent cyt p450 inhibitors

Back 63

Fluoxetine

Paroxetine

Front 64

SSRI- least potent cytp450 inhibitors

Back 64

Citalopram

Sertraline

Front 65

Steps-to ensure safe antidepressant use when there are physical comorbidities

Back 65

Laise with physician

Start lower doses and slowly titrate

Front 66

How to minimize risk of relapse

Back 66

After first episode- rx at least 6 months

Recurrent episodes- long term Rx

If recurrent- Lithium, CBT- reduce risk of relapse

Front 67

Indications for ECT

Back 67

Psychotic features

Stupor

Risk of self harm, self neglect

Postpartum depression

Poor response to meds

Front 68

No. Of ECT cycles/ wk

Back 68

2-3

Front 69

Total number of ECT cycles/ per cycle

Back 69

6-12