Chap. 7 - MDD demographics and assessment Flashcards
__% of (or __ million) adults have MDD at any given time
5%, or 10 million
MDD is the # __ cause of disability in the US
1
The most common psych do seen in primary care is…
MDD
Average age of onset of MDD
Mid - 20’s
Gender distribution of risk of MDD:
Pre-pubertal
Reproductive years
Over 50
Pre-pubertal = equal risk
Reproductive years = women 25% vs men 12% risk
Over 50 = equal risk
__% of those with MDD will commit suicide
15%
People with MDD have __x greater risk of premature death
4 times
After one year of treatment, __% will continue to meet full criteria, __% will meet partial criteria, and __% will be asymptomatic
40
20
40
Prior episodes are or are not predictive of future episodes?
They are
Top five risk factors for MDD
Family history Prior episode Female Post-partum Medical comorbidity
Initial presentation is often _____ _____ complaints like _____ and _____, or _____.
Vague somatic complaints
Aches and pains, or lethargy
SIGEMCAPS
Sleep disturbance Interests decrease Guilt Endergy deficit Mood changes (remember irritability) Concentration impaired Appetite changes Psychomotor agitation or blunting Suicidality
MDD dx must include _____ or _____ _____.
Anhedonia
Depressed mood
Overdosing on toxic agents like ASA or sleeping pills is considered to be of high, moderate, or low lethality?
Moderate
Four labs to order when suspicious of MDD:
CBC
CMP
B12
Thyroid function tests
MDD is a greater source of _____ for women than any other illness.
Morbidity
Untreated MDD typically lasts _____ months or longer
Four
Endocrine differentials for MDD
Hypothyroid
DM
Hyperaldosteronism
Neuro differentials for MDD
Stroke Dementia Sleep apnea TBI Parkinson's
Infectious differentials for MDD
AIDS
Lupus
Other differentials
Fibromyalgia/chronic fatigue syndrome
Electrolyte imbalance
Top priority of MDD treatment
Safety
Top two rule-outs for MDD (and for any disorder, really)
Medical conditions
Substance induced
SSRIs - 6 of them
Celexa Lexapro Prozac Paxil Luvox Zoloft
SSRIs - two common SEs
GI upset
Sexual dysfunction
TCAs - 2 common suffixes for this class
-ipramine
-triptyline
(and Doxepin)
TCAs - most common SE profile
Anticholinergic (can’t see, can’t pee, can’t spit, can’t shit)
When eating foods containing _____ and taking MAOIs, you are at risk for irreversible _____ _____.
Tyramine
Hypertensive crisis
Combining MAOIs with the drug classes of ____, ____, and ____ puts you at risk for irreversible _____ _____.
SSRIs, TCAs, and Antipsychotics
Risk for hypertensive crisis
Three common MAOIs are:
Nardil
Parnate
Selegiline
Foods that contain tyramine include
Pork, alcohol, chocolate, cheese, and anything smoked or fermented.
SNRIs - Name three
Effexor (venlafaxine)
Pristiq (desvenlafaxine)
Cymbalta (duloxetine)
NDRI - Name one
Wellbutrin (bupropion)
1 non-pharm, non-therapy treatment for MDD
ECT
Other non-pharm, non-therapy treatments for MDD
Transcranial Magnetic Stimulation (TMS)
Vagal Nerve Stimulation (VNS)
Phototherapy
Therapies for MDD
CBT
SFT (or, brief therapy)
A single white male over 45 who recently lost his dog and drinks every night is about the highest possible risk for…
Suicide
The elderly require what kind of assessment?
A functional assessment
Three components of a functional assessment
ADLs (eating, bathing, toileting)
IADLs (shopping, cooking, driving)
Executive functioning (balancing the checkbook, keeping appointments)
The drug class of ____ + the drug class of ____ = serotonin syndrome
MAOIs + SSRIs
