Ajustment and Depressive Disorder

Question 1

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

Answer 1

Depression

Question 2

What are the risk factors for depression?

Answer 2

1) Family history
2) Female gender
3) Childbirth (postpartum depression)
4) Childhood trauma
5) Stressful life events
6) Poor social support
7) Serious medical illness
8) Substance abuse

Question 3

What are the common presentations for a patient with depression?

Answer 3

1) Sad/Irritable
2) Changes in work performance
3) Loss of energy/sleep/appetite or weight gain
4) Somatic Symptoms: Head/Abdominal/Pelvic/Back Pain

Question 4

What form is used as a depression screening template?

Answer 4

PHQ-9

Question 5

What is the pnuemonic that is used when screening for depression when a PHQ-9 form isn’t available?

Answer 5

S- Sleep changes
I- Interest (loss)
G- Guilt (worthless)
E- Energy (lack)
C- Concentration
A- Appetite
P- Psychomotor Agitation/Retardation
S- Suicide/death

Question 6

What is the most important complication of depression?

Answer 6

Suicide

Question 7

What should be done if a patient does state that they are suicidal?

Answer 7

Follow up questions:

1) Specific nature of the ideation
2) Plan/Ability to carry out suicide
3) Access to firearms
4) Suicide attempts
5) Family history of suicide/attempts

Question 8

What labs should be taken/ordered for new onset depression?

Answer 8

1) CBC
2) Chem panel
3) UA
4) Thyroid Function Test
5) HCG

Question 9

What are the mainstays of therapy for depression?

Answer 9

1) Psychotherapy

2) SSRI/SNRI

Question 10

What are common side effects of SSRIs/SNRIs?

Answer 10

a) Sexual dysfunction
b) Drowsiness
c) Weight gain
d) Insomnia
e) Anxiety
f) Dizziness
g) Headache
h) Dry mouth
i) Blurred vision
j) Nausea
k) Rash
l) Tremor
m) Constipation
n) Abdominal pain/stomach upset

Question 11

What is not a common side effect of SSRIs?

a) Sexual dysfunction
b) Dry mouth
c) Anxiety
d) Suicidal ideation

Answer 11

d) Suicidal ideation

No clear evidence that SSRIs have any impact on suicidality

Question 12

What is “depression” that occurs due to a recent stressor (Divorce, Deployment, Financial) that resolves in 6 months when the stressor is removed?

Answer 12

Adjustment Disorder

Question 13

Adjustment Disorder is specifically NOT diagnosed in the context of _____________.

Answer 13

Bereavement (Death or unexpected loss of a loved one)

Question 14

For general depression, what is the “determining” factor for MEDEVACING or not?

Answer 14

Suicidal Ideation

Question 15

When does Post-partum depression normally occur?

Answer 15

Within 12 months after delivery

Question 16

What is the gold-standard of treatment for Depressive Disorders?

Answer 16

SSRIs

Question 17

What is the time requirement for Adjustment Disorder?

Answer 17

There isnt one