Adjustment/Depressive Disorder

Question 1

What is the most common psychiatric disorder in the general population and 2nd in the United states among all injuries and illnesses as cause of disbility

Answer 1

Depression

Question 2

What are risk factors for depression

Answer 2

• Family history
• Female gender
• Childbirth (postpartum depression)
• Childhood trauma
• Stressful life events
• Poor social support
• Serious medical illness
• Substance abuse

Question 3

Clinical presentation:
- Changes in mood
Sadness, distress, numbness, anxiety, irritability
- Cognitive problems
Changes in work performance
- Neuro-vegetative symptoms
Loss of energy, changes in sleep, appetite, or weight gain
- Somatic symptoms
Headache, abdominal pain, pelvic pain, back pain, other physical complaints

Answer 3

Depression

Question 4

What is the PHQ-9

Answer 4

One of many depression screening templates

Question 5

If the PHQ-9 is unavailable, what other screening should be done

Answer 5

SIGECAPS
- Sleep Changes
- Interest (loss)
- Energy (lack)
- Concentration
- Appetite
- Psychomotor agitation
- Suicide/death preoccupation

Question 6

What is the most feared complication of depression?

Answer 6

Suicide

Question 7

What should you inquire about suicide ideation

Answer 7

Follow up any positive remarks:
- Specific nature of the ideation
- Intent, plans, ability to carry out those plans
- Access to firearms
- Personal history of suicide attempts
- Family history of suicide attempts or suicide

Question 8

What should also be screened for that can contribute to depression?

Answer 8

General medical conditions and drugs

Question 9

What labs should be done for new onset depression?

Answer 9

Basic lab evaluation
CBC, Chemistry, urinalysis, thyroid function test, urine HCG

Question 10

What are the mainstay treatments for depression

Answer 10

psychotherapy, pharmacotherapy, or both

Question 11

What medications are typically given for depression?

Answer 11

• SSRIs: Selective Serotonin Reuptake Inhibitors
  Fluoxetine, paroxetine, sertraline, escitalopram, citalopram
• SNRIs: Serotonin-Norepinephrine Reuptake Inhibitors
  Venlafaxine, duloxetine

Question 12

Common side effects of depression medications

Answer 12

Sexual dysfunction
Drowsiness
Weight gain
Insomnia
Anxiety
Dizziness
Headache
Dry mouth
Blurred vision
Nausea
Rash
Tremor
Constipation
Abdominal pain/stomach upset

Question 13

• Commonly seen in the Navy
• May look similar to a major depressive disorder but does not meet criteria
• Occurs in the context of a recent stressor
• Specifically NOT diagnosed in the context of bereavement
• Resolves within six months when the stressor is removed

Answer 13

Adjustment Disorder

Question 14

• Very common
• Occurs in the context of childbirth
• Usually 12 months after delivery
• Same diagnostic criteria as depression
• Likely due to genetic susceptibility and hormonal changes in addition to increased stressor

Answer 14

Post-Partum Depression