Class 3

Question 1

More common: mood congruent or mood incongruent

Answer 1

mood congruent

Question 2

Only antidepressants that lowers seizure threshold

Answer 2

bupropion

Question 3

epidemiology of depression in the elderly

Answer 3

+M, 15%. More chronic course, higher relapse rate. Higher rate of depression in late life. More common: Chronic medical illness, widow.

Question 4

Risk factors depression in the elderly

Answer 4

loss & financial difficulties, could also be: physical illness, functional disability, cognitive impairment

Question 5

Suicide in the elderly

Answer 5

: 15%. More white men, increasing age (84+), single, divorce, ROH, chronic pain, social isolation, poor physical health or belief that their ill, hopelessness, helplessness, loss of health and/ status, depression, fear of being forced to be put into a nursing home. More violent. Loneliness. 75% visit a physician in the previous month before committing. Higher rate of suicide. Completed suicide: 1 in 4 (gen pop: 1 in 25), higher rate of completion, especially older than 85 = highest rate of completed rate. Why: more frail, more easily injured, more socially isolated = less chance of rescue, use more lethal methods, stronger intent. May look like an accident but it’s not. 50% don’t leave a suicide note = sudden decision out of desperation/ protection of family/ can’t express themselves, don’t have family

Question 6

Diff dx depression in the elderly

Answer 6

vascular depression because decrease 02 to brain, increase of dep when u have diabetes, cancer, heart disease, Parkinson. AntiHTA can cause dep. Prodrome to dementia

Question 7

What type of depression is more common in the elderly

Answer 7

Somatic symptoms and melancholic type more common

Question 8

Pseudodementia

Answer 8

attention and concentration more variable, not a global impairment, less likely to develop language difficulties and confabulations more likely to answer: I don’t know. Will get better with treatment. Do a MOCA. Dementia: slow cog process, intellectual global, will make up stories, cover it up more, CONSISTANT.

Question 9

True or false: efficacy for psychotherapy in the elderly

Answer 9

true

Question 10

How might depression presentation in a child differ from the depression presentation in an adult

Answer 10

Irritable mood can replace depressed mood. Not weight loss but don’t meet normal growth curve. Somatic symptoms, agitation, less anhedonia, less psychomotor retardation. Harder time talking about their emotions. Depends on their developmental stage. Ado: more hypersomnia, fewer appetite and weight changes, more apathy.

Question 11

What is the prevalence rate of depression in children

Answer 11

2-3% children, 8% adolescents

Question 12

suicide in children and adolescents

Answer 12

Universal features in adolescents who resort to suicidal behaviors are the inability to synthesize viable solutions to ongoing problems and the lack of coping strategies to deal with immediate crises. Therefore, a narrow view of the options available to deal with recurrent family discord, rejection, or failure contributes to a decision to commit suicide.

Question 13

Treatment of MDD in children/ ado

Answer 13

Mild-mod dep: 1st line is psychotherapy (CBT/ interpersonal)
Severe: fluoxetine 1st line. Over 12: cipralex and fluoxetine. In practice, use sertraline also. Follow weekly for first month and then every 2 weeks. 1st episode: 6-12 months after remission. 1,5-2,5 times more risk for suicidal ideation.

Question 14

Medical conditions that can have depression as a symptom

Answer 14

cardiovascular accident, brain tumor, alzheimers, parkinsons, Huntington’s, MS, hypercalcemia, hyper sodium carbonate, hypomg, hypoNa, increased or decreased K, addisons, cushings, hypoparathyroidism, hypothyroidism, hyperthyroidism, nutrition deficiencies: B1, B6, B12, niacin, vitamin C, iron, folic acid, zinc, Ca, K. SLE, polyartertis nodesa, cardiovascular disease, encephalitis, mononucleosis, hepatitis, pneumonia, syphilis, diabetes, porphyria, chronic pain, anemia, cancer, stroke, MPOC, obstructive sleep apnea, chronic kidney disease, dementia

Question 15

Subs that can have depression as a symptom

Answer 15

acutane, prednisone, hormonal agents (estrogen), antiviral agents, immunological agents, anti migrane triptans, opioids, retininoc acid derivatives, anti HTA

Question 16

Hypothyroidism

Answer 16

increasing weight, psychomotor retardation, difficulty concentrating, low mood, constipation, slowness, dry skin, being cold, brain fog, goiter, hair loss, sore msucles and joints, slow heart rate. More common with W, prev increases with age, 1/5 by the age of 60. Pituitary controls thyroid makes TSH= Thyroid makes T3 and T4 regulates metabolism= general slow down. If thyroid isn’t working well = feedback to pituitary = make more =pituitary stimulates thyroid by making more TSH= tsh high

Question 17

Perimenopause can add what as an adjunct in MDD

Answer 17

estrogen

Question 18

What would help you differentiate a personality disorder from an episode of major depressive disorder

Answer 18

Perso disorder: enduring pattern of inner exp and behave that deviates markedly from the person’s cultures, manif in 2 or more areas: cognition (way of perceiving self and other and events), affect (range, intensity, lability, appropriateness), interpersonal, impulse control. Pattern in inflexible and pervasive across broad range of interpersonal and social relationships. Leads to sig distress and impairment in functioning. Stable and of long duration.

Question 19

childhood predisposing factors for major depression

Answer 19

bullying, social isolation, family history

Question 20

adulthood predisposing factors for major depression

Answer 20

substance use, family history, childhood abuse, low socioeconomic status, chronic pain, physical illness, mental illness, immigration, caregiver strain

Question 21

What other psychiatric disorders are commonly co-morbid with major depressive disorder

Answer 21

Anx, perso, SUD