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AmyCarter-LowMood Atutorial by KalistaLamToday’stutorial Diagnosis Management Data significanceDiagnosis Pre reading Depression • Persistently sad for weeks/months • Higher risk if FHx,particular triggers • Helped with lifestyle changesDSM-Vcriteria Key symptoms (most days, most of the time, at least 2 weeks) 1. Low mood 2. Anhedonia ≥1 key symptom Associated symptoms AND ≥5 total symptoms 1. Sleep disturbed 2. Appetite/ weight changes 3. Fatigue/ anergia 4. Agitation/ slowing of movements 5. Poor concentration/ indecisiveness 6. Feelings of worthlessness/ excess/ inappropriate guilt 7. Suicidal thoughts/ actionsPrecipitatingFactors Riskassessment Selfharm (females17-19) 1. Affect regulation- coping withfeelings 2. Communication- visualsigns Suicide(males40-59) 3. Control/punishment Harmtoothers Harmfrom othersACE • Potentiallytraumatic events thatcan have negative, lasting effects on health and well- being before the age of 18 Takenfrom Aoife’sslidesPatientX isa 23 year old female who presented with tiredness.She has noticed an increased in weightas she is constantfeeling hungry. She gets easily distracted at work(more so than usual)andhasbeen feeling like she is not worth being partof the team,although she recently got promoted. WouldpatientX be diagnosed with depression? Howmany symptoms does she have?PatientXisa23 yearold femalewho presentedwith tiredness. Shehasnoticed an increased inweight asshe is constant feelinghungry. Shegets easily distractedat work (moresothanusual)and has beenfeelinglike sheis not worthbeing partofthe team,althoughsherecentlygot promoted. 4Management-biologicalAdvicetoptsabouttostartantidepressants •Drugstake several weeks towork •Symptomsmay worsen initially •Continuefor around 6 months afterremission •Weandrugs gradually •Check druginteractionsMAOi • Prevent breakdown of NTs in presynaptic cleft • Affectsadrenaline, NA, serotonin, dopamine • E.g. Moclobemide, Izoniazid Sideeffects • Systemicside effects!! • Many interactionsandside ©2024 the studioof Kalista Lam effectsTCAs • Inhibitsserotoninreuptake intopresynapticcleft • AffectsNA and serotonin • e.g. Imipramine Sideeffects • Dizziness-adrenergic • Memoryimpairment-muscarinic • Drowsiness-histaminergic ©2024 the studioofxicity athigher levels Kalista LamSSRI • Inhibitsserotoninreuptake intopresynapticcleft • Affectsserotonin • E.g. Fluoxetine, Sertraline, Citalopram Sideeffects • weight gain • sexual dysfunctions • sleeping disturbances ©2024 the studioof Nausea Kalista Lam • Serotonin syndrome**Serotoninsyndrome • Increase inserotonininthe synapticcleft,toadangerouslevel • Developsquickly overHOURS • Due tomedications,interactions,overdose,recreationaldrug use Alteredmentalstatus Neuromuscular excitationAutonomicDysregulation *** SSRIs+ triptan(migraines) ishighriskPatientY is a40yo male who presented to the GP with forgetfulness.He is worriedaboutAlzheimer’s, although he doesnothave a family historyof dementia. Upon checking his records yousee thathe has been diagnosed with depression 2years ago. What could be the cause of his symptoms? Andwhy? receptorsription,acts onmuscarinicManagement-social Post-readingSocialprescribing • Mainly GPs • Refer people to a range of local,non clinicalservices • Social,economic andenvironmentalsupport • Supports individuals to take greater controlof own health- holisticCBT • Howwethinkaffectstheway wefeeland behave Trigger Thoughts Behaviours FeelingsPatientA isan 18year old femalewhopresentsto A&Ewithexcessivevomiting, "red wee", feelingsthat herheart isracing with fast, shallow breathing. Shedenies everhaving consumed alcohol, smokedortakenrecreational drugs. Shedoesnot haveanysignificanttravelhistory andrecallseating anaubergine saladforlunch. PMH:50mg Sertraline(OD), 25mg Sumtriptan(OD) (startedearlier today) BP:156/94,HR: 108,RR:28, O2:98% on room air Toxicology screenwasnegative, urine dip waspositiveforblood, neurological examination revealedankleclonus. What isthisindicativeof? SerotoninsyndromeYOUGUYS BETTERFILLIN FEEDBACK!! OR ELSEScientificvsClinical significanceA study comparedthe effectiveness of two inhaled steroids (Aand B)of reducing dyspneain COPD patients. 87% of patients reported that drug Awas“noticeably”better at reducing their breathlessnessthan drug B (p=0.067). The currenttreatmentis to use drug B. Mrs X is a 73yo woman with a history of COPD and worsening breathlessness. Based on the study, which drug should the GP prescribe? and why? Statistical significance Clinical significance Clinician's opinion on whether Reliability of studythrough the the findings are appropriate in numbers and statisticaltests practice P value Subjective Ihaven’t forgottenSmart peoplefillin feedback Thank you! Any questionsplease feelfreetoemail kl1522@ic.ac.uk