BMB 3 - Depressive Disorders; Bipolar Disorder

Question 1

Clinical depression is diagnosed with presence of depression or loss of interest and at least ___ other SIG-E-CAPS symptoms present every day for at least 2 weeks.

Answer 1

Clinical depression is diagnosed with presence of depression or loss of interest and at least 4 other SIG-E-CAPS symptoms present every day for at least 2 weeks.

Question 2

List the S/Sy of SIG-E-CAPS.

Answer 2

Sleep disturbances

Interest changes

Guilt

Energy changes

Concentration changes

Appetite changes

Psychomotor agitation

Suicidality

Question 3

Major depressive disorder is a diagnosis made when a patient has ≥ _____ of the following S/Sy for at least 2 weeks:

• Depressed mood • Loss of interest or pleasure in activities • Weight loss or gain (5%) or appetite change from normal • Sleep disturbance from normal • Psychomotor retardation/agitation noted by others • Fatigue/loss of energy • Sense of worthlessness/guilt • Concentration problems/Indecisiveness • Recurrent thoughts of death or suicide

Answer 3

Major depressive disorder is a diagnosis made when a patient has ≥ 5 of the following S/Sy for at least 2 weeks:

• Depressed mood • Loss of interest or pleasure in activities • Weight loss or gain (5%) or appetite change from normal • Sleep disturbance from normal • Psychomotor retardation/agitation noted by others • Fatigue/loss of energy • Sense of worthlessness/guilt • Concentration problems/Indecisiveness • Recurrent thoughts of death or suicide

Question 4

Which S/Sy MUST be present for a diagnosis of major depressive disorder to be made?

Answer 4

Depressed mood

AND

Loss of interest or pleasure in activities

Question 5

Name some of the risk factors for major depressive disorder.

Answer 5

Female,

20-40 year old,

family history,

separated/divorced,

6 months postpartum,

loss of parent before age 11,

previous depressive episodes

Question 6

What is the definition of persistent depressive disorder?

Answer 6

Predominantly depressed mood for 2 years, never without symptoms for > 2 months

(not characterized by hypomanic or manic episodes)

Question 7

Make the diagnosis: A woman presents with ≥ 5 of the following S/Sy in the week preceding the majority of her menstrual cycles:

• Marked affective lability • Marked irritability or anger • Marked depressed mood; feelings of hopelessness • Marked anxiety, tension, or feelings of being on edge • Decreased interest in usual activities • Subjective difficulty in concentration • Lethargy, easy fatigability, or marked lack of energy • Marked change in appetite; overeating; or specific food craving • Hypersomnia or insomnia • Sense of being overwhelmed or out of control • Physical symptoms such as breast tenderness or swelling, joint or muscle pain, a sensation of bloating or weight gain

Answer 7

Premenstrual dysphoric disorder

Question 8

How is premenstrual dysphoric disorder is best treated?

Answer 8

SSRIs

Question 9

A patient develops symptoms of depression criteria during or soon after substance intoxication or withdrawal after exposure to a medication.

What is the diagnosis?

Answer 9

Substance-induced depressive disorder

Question 10

Name a screening tool used for clinical diagnosis of depression.

Answer 10

The PHQ-9 Screening Survey

Question 11

Name some of the conditions associated with mood disorders.

Answer 11

Substance abuse, medications, medical disorders, non-mood psychiatric disorders, grief reactions

Question 12

True/False.

Suicide risk is significantly increased in cancer patients, AIDS patients, and the psychiatrically ill.

Answer 12

True.

Question 13

True/False,

The aim of treatment for depressive disorders is complete symptom remission, and once it has been treated, risk of recurrence is low.

Answer 13

False,

The aim of treatment for depressive disorders is complete symptom remission, but risk of recurrence is significant.

Question 14

Name some of the acute therapies for depression.

Answer 14

• Patient education/reassurance
• Psychotherapy
• Medication
• ECT
• Light–Seasonal Affective Disorder

Question 15

Describe the three phases of treatment for depression:

1. Acute treatment
2. Continuation treatment
3. Maintenance treatment

Answer 15

Describe the three phases of treatment for depression:

1. Acute treatment (meds take 6 to 12 weeks to work) - aims at remission of symptoms
2. Continuation treatment (4 to 9 months) - aims at prevention of relapse
3. Maintenance treatment - aims at prevention of recurrence in patients with prior episodes

Question 16

True/False.

Medication and CBT are 50 to 70% effective at achieving complete remission for mild-to-moderate depression.

Answer 16

True.

Question 17

How should depression be treated if it results as a side effect to some medical etiology?

Answer 17

Treat the underlying medical illness

Question 18

How should depression be treated if the patient results as a side effect to some medication?

Answer 18

Adjust/discontinue the medication

Question 19

What is an important consideration in treating depressed patients who also have substance abuse issues?

Answer 19

Avoid benzodiazepines (and other medications of potential abuse)

Question 20

How should depression be treated in a patient who also has cardiac illness?

Answer 20

Avoid tricyclics (and other medications with adverse cardiac effects)

Question 21

How should depression be treated in a patient who also has respiratory illness?

Answer 21

Avoid benzodiazepines (and other medications that cause respiratory depression)

Question 22

How should depression be treated in a patient who also has underlying liver disease?

Answer 22

Be cautious in using benzodiazepines (which are metabolized by the liver)

Question 23

Name the first-, second-, and third-line medications that are useful in treating both depression and anxiety.

Answer 23

First-line: SSRIs, SNRIs

Second-line: Tricyclic antidepressants (potential for overdose)

Third-line: MAOIs

Question 24

What should be considered in pharmacological treatment of elderly patients with depression?

Answer 24

• Begin with low doses
• Monitor closely for response, side effects, and compliance

Question 25

What should be considered in work-up of mood disorders in elderly patients?

Answer 25

• Use an objective geriatric scale
• Include cognitive screens with work-up (e.g. an MMSE)