BMB 3 - Depressive Disorders; Bipolar Disorder Flashcards
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.
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.
List the S/Sy of SIG-E-CAPS.
Sleep disturbances
Interest changes
Guilt
Energy changes
Concentration changes
Appetite changes
Psychomotor agitation
Suicidality
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
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
Which S/Sy MUST be present for a diagnosis of major depressive disorder to be made?
Depressed mood
AND
Loss of interest or pleasure in activities
Name some of the risk factors for major depressive disorder.
Female,
20-40 year old,
family history,
separated/divorced,
6 months postpartum,
loss of parent before age 11,
previous depressive episodes
What is the definition of persistent depressive disorder?
Predominantly depressed mood for 2 years, never without symptoms for > 2 months
(not characterized by hypomanic or manic episodes)
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
Premenstrual dysphoric disorder
How is premenstrual dysphoric disorder is best treated?
SSRIs
A patient develops symptoms of depression criteria during or soon after substance intoxication or withdrawal after exposure to a medication.
What is the diagnosis?
Substance-induced depressive disorder
Name a screening tool used for clinical diagnosis of depression.
The PHQ-9 Screening Survey
Name some of the conditions associated with mood disorders.
Substance abuse, medications, medical disorders, non-mood psychiatric disorders, grief reactions
True/False.
Suicide risk is significantly increased in cancer patients, AIDS patients, and the psychiatrically ill.
True.
True/False,
The aim of treatment for depressive disorders is complete symptom remission, and once it has been treated, risk of recurrence is low.
False,
The aim of treatment for depressive disorders is complete symptom remission, but risk of recurrence is significant.
Name some of the acute therapies for depression.
- Patient education/reassurance
- Psychotherapy
- Medication
- ECT
- Light–Seasonal Affective Disorder
Describe the three phases of treatment for depression:
- Acute treatment
- Continuation treatment
- Maintenance treatment
Describe the three phases of treatment for depression:
- Acute treatment (meds take 6 to 12 weeks to work) - aims at remission of symptoms
- Continuation treatment (4 to 9 months) - aims at prevention of relapse
- Maintenance treatment - aims at prevention of recurrence in patients with prior episodes
True/False.
Medication and CBT are 50 to 70% effective at achieving complete remission for mild-to-moderate depression.
True.
How should depression be treated if it results as a side effect to some medical etiology?
Treat the underlying medical illness
How should depression be treated if the patient results as a side effect to some medication?
Adjust/discontinue the medication
What is an important consideration in treating depressed patients who also have substance abuse issues?
Avoid benzodiazepines (and other medications of potential abuse)
How should depression be treated in a patient who also has cardiac illness?
Avoid tricyclics (and other medications with adverse cardiac effects)
How should depression be treated in a patient who also has respiratory illness?
Avoid benzodiazepines (and other medications that cause respiratory depression)
How should depression be treated in a patient who also has underlying liver disease?
Be cautious in using benzodiazepines (which are metabolized by the liver)
Name the first-, second-, and third-line medications that are useful in treating both depression and anxiety.
First-line: SSRIs, SNRIs
Second-line: Tricyclic antidepressants (potential for overdose)
Third-line: MAOIs
What should be considered in pharmacological treatment of elderly patients with depression?
- Begin with low doses
- Monitor closely for response, side effects, and compliance
What should be considered in work-up of mood disorders in elderly patients?
- Use an objective geriatric scale
- Include cognitive screens with work-up (e.g. an MMSE)
