Adjustment and Depressive Disorder

Question 1

What is the most common psychiatric disorder in the general population?

Answer 1

Depression

Question 2

True/False
Major depression ranks 2nd among all injuries and illnesses as cause of disability in the United States.

Answer 2

True

Question 3

What issue?
Variable presentation
(1) Changes in mood
-(a) Sadness, distress, numbness, anxiety, irritability
(2) Cognitive problems
-(a) Changes in work performance
(3) Neuro-vegetative symptoms
-(a) Loss of energy, changes in sleep, appetite, or weight gain
(4) Somatic symptoms
-(a) Headache, abdominal pain, pelvic pain, back pain, other physical complaints

Answer 3

Depression

Question 4

What does the “SIGECAPS” stand for and what is it used to screen for?

Answer 4

S- Sleep changes: Increased during day or decreased at night
I- Interest (loss): Of interest in activities that used to interest them
G- Guilt (worthless): Depressed people tend to devalue themselves
E- Energy (lack): Common presenting symptom is fatigue
C- Concentration: Reduced concentration and cognition
A- Appetite: Usually declined appetite. Sometimes also increased
P- Psychomotor agitation: Anxious feelings or lethargic feelings
S- Suicide/death preoccupation
-quickly screen for depression when forms such as PHQ-9 are not utilized or available

Question 5

What is the most feared and important complication of depression

Answer 5

suicide

Question 6

Inquire about suicide ideation and behavior. Follow up any positive remarks
(a) Specific nature of the ______
(b) Intent, plans, ability to carry out those plans
–1) Access to _____
(c) Personal history of ______
(d) Family history of suicide attempts or suicide

Answer 6

a) ideation
1) firearms
c) suicide attempts

Question 7

What is the Basic lab evaluation for new onset depression?

Answer 7

CBC,
Chemistry,
urinalysis,
thyroid function test,
urine HCG

Question 8

The mainstays of therapy for depression is what?

Answer 8

psychotherapy, pharmacotherapy, or both

Question 9

Treatment of depression

Answer 9

psychotherapy, pharmacotherapy, or both
-Pharmacotherapy
1) SSRIs: Selective Serotonin Reuptake Inhibitors
-a) Fluoxetine, paroxetine, sertraline, escitalopram, citalopram
2) SNRIs: Serotonin- Norepinephrine Reuptake Inhibitors
-a) Venlafaxine, duloxetine

Question 10

What issue?
1) Commonly seen in the Navy
2) May look similar to a major depressive disorder but does not meet criteria
3) Occurs in the context of a recent stressor
-a) Deployment, marital problem, recruit training, financial concerns, increasing responsibilities with rank
-b) Specifically NOT diagnosed in the context of bereavement
4) Resolves within six months when the stressor is removed

Answer 10

Adjustment Disorder

Question 11

Adjustment Disorder often resolves after how long when the stressor is removed?

Answer 11

6 months

Question 12

SSRI’s May have an increased incidence of suicide in patients in what age bracket?

Answer 12

18-24 y/o

Question 13

What issue?
1) Very common
2) Occurs in the context of childbirth
3) Usually occurs within 12 months after delivery
4) Same diagnostic criteria as depression
5) Likely due to genetic susceptibility and hormonal changes in addition to increased stressor

Answer 13

Post-Partum Depression