52 Depressive Disorders, Bipolar & Related Disorders Flashcards
1
Q
describe diagnosis of MDD
A
- a person must experience ≥ 1 major depressive episode (MDE) for a diagnosis of MDD
- the person can’t have a history of mania or hypomania
- the person never swings to the opposite “pole” of mood
- if the person does swing, then the diagnosis is not MDD
- also known as “unipolar” depression
2
Q
describe the graph of MDD
A
3
Q
describe a major depressive episode
A
- at least 2 weeks of ≥ 5 of the following, one of which MUST be 1 or 2
- depressed mood
- anhedonia
- significant weight change
- insomnia/hypersomnia
- loss of energy
- psychomotor changes
- feeling guilty/worthless
- decreased concentration
- thoughts of death/suicidal ideation
4
Q
mnemonic for MDE?
A
SIG: Energy CAPSules
- sleep change
- interest loss
- guilt
- energy problem
- concentration poor
- appetite change
- psychomotor changes
- suicidal ideation
5
Q
describe MDD specifiers (melancholic features)
A
- MDD with melancholic features
- severe anhedonia, lack of mood reactivity, profound despondency and guilt
- depression worse in the mornings
- early-morning awakenings
- significant appetite loss
6
Q
describe MDD specifiers (with atypical features)
A
- mood reactivity
- weight and sleep increase
- leaden paralysis
7
Q
describe MDD specifiers (with psychotic features)
A
-
with psychotic features: hallucinations and/or delusaion are evident
- with mood-congruent psychotic features
- the content of delusions/hallucinations is consistent with typicall depressive themes
- with mood-incongruent psychotic features
- the content of delusions/hallucinations does NOT involve typical depressive themes
- with mood-congruent psychotic features
8
Q
describe MDD specifiers (with catatonia)
A
- mutism
- immobility
- waxy flexibility
- odd posturing
9
Q
describe MDD specifiers (with anxious distress)
A
- MDE associated with
- feeling tense
- restless
- fearful
10
Q
describe MDD specifiers (with peripartum onset)
A
- MDE onset is during pregnancy or within 4 weeks post-delivery
11
Q
describe the general course of MDD
A
- although the diagnosis of MDD requires only 2 weeks of an MDE, the MDE usually lasts 6-12 months if untreated
- MDEs are likely recurrent
- some patients develop mania/hypomania after several MDEs (diagnosis of MDD then changes)
12
Q
contrast MDD and bereavement
A
- the normal grief response to death of a loved one (bereavement) may include depressive symptoms resembling a MDE and be present for many months
- a bereaved person has:
- depressed mood characterized by emptiness.loss that occurs in waves when reminded of deceased person (in a MDE, sadness is persistent and pervasive)
- thoughts of death relating to possibly reuniting with the deceased (in a MDE, thoughts relate to ending worthless feelings)
13
Q
describe common findings in MDD neurobiology
A
14
Q
give a summary of pathophysiological mechanisms in MDD
A
- reduced monoaminergic transmission
- hyperactivity of the HPA axis and the inflammatory response system
- inability of prefrontal cortex to inhibit overactivity of limbic regions
15
Q
describe MDD treatments
A
- psychotherapy
- a variety of psychotherapies (especially CBT, cognitive behavioral therapy) may help to address some depressive symptoms, especially in milder depressions
- cognitive: changing maladaptive thoughts
- behavioral: changing maladaptive behaviors
- a variety of psychotherapies (especially CBT, cognitive behavioral therapy) may help to address some depressive symptoms, especially in milder depressions
- antidepressant drugs (ADs)
- increase the monoamines (esp. serotonin and norepi) to varying extents
- often take 4-6 weeks before observable therapeutic effect
