Chapter 4 pt 2 Flashcards
what is the Hamilton Depression Rating Scale
measures the severity of depression and is used in research to assess the effectiveness of therapies
what is the depression screening often used in primary care setting
PHQ-9
loss of parent before what age is associated with later development of MDD
11
what are the side effects of SSRIs
headache
GI
SEXUAL DYSFUCNTION
rebound anxiety
what are the side effects of TCAs
lethal cardiac arrhythmia sedation weight gain orthostatic hypotension anticholinergic effects QTc prolongation
what are the side effects of MAOIs
hypertensive crisis when used with sympathomimetics or tyramine
Serotonin Syndrome with SSRIs
what is seen in serotonin syndrome
autonomic instability
hyperthermia
hyperreflexia (myoclonus)
seizure
what period conveys an elevated risk of depression in women
postpartum
what medication is considered particularly useful for “atypical depression”
MAOIs
what psychotherapy is used in MDD
COGNITIVE-BEHAVIORAL THERAPY (CBT)
interpersonal
when is electroconvulsive therapy (ECT) indicated in MDD
pt is unresponsive to pharmacotherapy
if the patient cannot tolerate pharmacotherapy (pregnancy, etc)
rapid reduction of symptoms is desired (immediate suicide risk, refusal to drink/eat, catatonia)
primary risk of ECT is from what
anesthesia
what medication is typically used before ECT
ATROPINE
then anesthesia (methohexial)
and then muscle relaxant (succinylcholine)
how many ECT treatments are required for MDD
usually 6-12 (average of 7) over 2-3 week period
what are common side effects of ECT
retro and anterograde amnesia (resolved in 6 months usually)
headaceh, nausea, muscle soreness
what are melancholic features of a depressive disorder
present in approx 25-30% of MDE
more likely in severely ill inpatients, including those with psychotic features
ANHEDONIA, early morning awakenings, depressing WORSE IN MORNING, psychomotor disturbance, excessive GUILT, and ANOREXIA
what are atypical features of a depressive disorder
HYPERSOMINA HYPERPHAGIA REACTIVE mood LEADEN PARALYSIS hypersensitive to interpersonal rejection
what are mixed features of a depressive disorder
manic.hypomanic symtoms present during the majority of days during MDE
elevated mood, grandiosity, talkativeness/pressured speech, flight of ideas/racing thoughts, increased energy/goal directed activity, excessive involvement in dangerous activities, decreased need for sleep
what are cataonia features of a depressive disorder
catalepsy (immobility) purposeless motor activity extreme negativism or mutism bizarre postures echolalia especially responsive to ECT
what are psychotic features of a depressive disorder
presence of delusions and/or hallucinations
24-53% of older, hospitalized patients with MDD
what are anxious distress features of a depressive disorder
feeling keyed up/tense restless difficulty concentrating fears of something bad happening feelings of loss of control
what are PERIpartum onset features of a depressive disorder
onset of MDD symptoms occur during pregnancy or FOUR WEEKS following delivery
what are seasonal pattern features of a depressive disorder
terminal relationship between onset of MDD and particular time of the year (most commonly the winter)
fall-onset responds really well to light therapy
what is the triad for seasonal affective disorder
irritability
carbohydrate craving
hypersomnia
what is bereavement
simple greif- reaction to a major loss, usually of a loved one (not a mental illness)
usually self-limited and only last for several months
if individual meets criteria for MDE he or she has MDD
