04b_Major Depressive Disorder

Question 1

Major Depressive Disorder:

Duration criteria

Answer 1

Nearly every day for at least 2 weeks

Question 2

Major Depressive Disorder:

Symptom Criteria

Answer 2

5+ symptoms of a major depressive episode

*1 symptom = depressed mood or a loss of interest or pleasure

Question 3

Major Depressive Disorder:

Symptoms

Answer 3

Depressed mood

Loss of interest or pleasure in most or all activities

Significant weight loss when Not Dieting

Weight gain

Change in appetite

Insomnia or hypersomnia

Psychomotor agitation or retardation

Fatigue or loss of energy

Feelings of worthlessness or excessive guilt

Diminished ability to think or concentrate

Recurrent thoughts of death, suicidal ideation, suicide attempt

Question 4

Depressed Mood symptom alternative in children and adolescents

Answer 4

depressed mood can present as irritable mood

Question 5

Major Depressive Disorder with Periartum Onset:

Diagnostic Criteria

Answer 5

Onset during pregnancy or within four weeks postpartum

Anxiety and preoccupation with infant’s well-being

Delusional thoughts about infant

Question 6

Major Depressive Disorder with Peripartum Onset:

Prevalence

Answer 6

10-20%

Question 7

Postpartum psychosis:

Prevalence

Answer 7

0.1-0.2%

Question 8

Major Depressive Disorder with Seasonal Pattern:
[Seasonal affective disorder (SAD)]

Symptoms

Answer 8

Hypersomnia

Increased appetite and weight gain

Craving for carbohydrates

Question 9

Seasonal affective disorder (SAD):

Effective Treatment

Answer 9

Phototherapy

Question 10

Major Depressive Disorder:

Associated features related to Sleep

Answer 10

Early-morning awakening

Reduced slow wave sleep

Decreased REM latency & Increased duration
(sooner and longer)

Question 11

Major Depressive Disorder:

Prevalence

Answer 11

7%

3x higher for 18-29yo compared to 60+yo

2-3x higher for females post-puberty

Question 12

Major Depressive Disorder:

Course

Answer 12

Peak age of onset is mid-20s

Initial episodes may be precipitated by severe psychosocial stressor

Number of previous episodes increases the risk for subsequent episodes

Question 13

Major Depressive Disorder:

Pseudo-dementia

Answer 13

Symptoms of depression in older adults that can be confused with Major and Mild neurocognitive disorder:

Memory loss

Distractibility

Disorientation

Question 14

Pseudodementia Vs. Neurocognitive disorder

Answer 14

Pseudodementia = abrupt onset, concern about impairment

Neurocognitive disorder = gradual onset, denial/unawareness of impairments

Question 15

Major Depressive Disorder:

Etiology

Answer 15

Strong genetic component

Catecholamine hypothesis (norepinephrine)

Indolamine hypothesis (serotonin)

Elevated levels of cortisol (shrinkage of hippocampus)

Question 16

Major Depressive Disorder:

Concordance Rates

Answer 16

MZ = .50

DZ = .20

1.5-3x higher for first-degree biological relatives

Question 17

Three Cognitive behavioral theories of depression

Answer 17

Behavioral theory of depression

Learned helplessness

Beck’s Cognitive Triad

Question 18

Behavioral theory of depression

Answer 18

Low rate of response-contingent reinforcement for social and other behaviors

Question 19

MDD Differential Diagnosis:

Adjustment disorder

Answer 19

Depressive symptoms differs in terms of severity

Adjustment with depressed mood does NOT meet criteria for MDD

Question 20

MDD Differential Diagnosis:

Uncomplicated Bereavement

Answer 20

Experience of mood as normal

Predominant mood = emptiness or loss

Occurs in waves

Tends to decrease over days to weeks

Question 21

Classic Depression

Answer 21

Vegetative (bodily) symptoms

Worse in the morning

Acute onset and short duration of symptoms

Moderate severity

Question 22

MDD Treatment:

Classic Depression

Answer 22

Tricyclics

Question 23

MDD Treatment:

Moderate to severe depression

Answer 23

SSRIs

Question 24

Four Atypical depression symptoms

Answer 24

Anxiety

Hypersomnia

Hyperphagia

Interpersonal sensitivity

Question 25

MDD Treatment:

Atypical Depression

Answer 25

MAOIs

Question 26

MDD Treatment Efficacy:

CT v IPT v TCAs

Answer 26

All three treatments are effective

Imipramine slightly better for patients with severe symptoms

Question 27

MDD Treatment:

Most effective treatment

Answer 27

CBT + Pharmacotherapy is better than any one modality alone

Question 28

MDD Treatment associated with lowest risk for relapse

Answer 28

CBT has lower risk of relapse than pharmacotherapy

Question 29

MDD Treatment:

ECT Indications

Answer 29

Severe endogenous forms of depression

Delusions, suicidal ideation

Depression that has not responded to antidepressants

Question 30

MDD Treatment:

ECT side effects

Answer 30

Temporary anterograde and retrograde amnesia

Confusion

Disorientation

*Effects reduced by administering ECT unilaterally to right hemisphere