Depression 1

Question 1

Two categories of mood disorders

Answer 1

1. Depression
2. Bipolar

Question 2

Major depressive disorder (MDD) lifetime prevalence

Answer 2

• Women: 10 to 15%
• Men: 5 to 12%

(4th greatest cuase of global illness burden)

Question 3

Major depressive disorder (MDD) Point prevalence

Answer 3

• Women: 5 to 9 %
• Men: 2 to 3%

Question 4

MDD is most likely to be treated in the ______ setting

Answer 4

primary care

Question 5

COVID risks for patients with psychiatric disorders

Answer 5

• About 1.5 times the risk of getting COVID, being hospitalized or dying from COVID.
• Risk of getting COVID: 1.6 times
• Risk of hospitalization: 1.3 times
• Risk of death: 1.5
• Risk of developing psych disorder after COVID 18%

(they should be considered high risk for vaccines)

Question 6

MDD is not always a ________ .

Answer 6

environmental stressor (it can’t always be prevented)

Question 7

Only _____ of patients with depression are diagnosed and treated

Answer 7

one-third

Question 8

___% of patients in primary care clinics are depressed but only half are diagnosed by a physician

Answer 8

20

Question 9

Reasons for under-recognition of major depressive disorder

Answer 9

1. Present as somatic complaints
2. Difficult to separate depression from normal ups and downs
3. Stigma: fear, criticism or ignoring mental illness

Question 10

Mortality rate for major depressive episode

Answer 10

Up to 15% (if they died by suicide)

(Individuals over 55 have for fold mortality)

Question 11

Depression: DSM-V dx criteria

Answer 11

****At least 5 of the following symptoms (and the first 2) during the same 2 week period (sig:ecaps)****

1. Increased or decreased Sleep
2. Loss of Interest in activities
3. Inappropriate Guilt
4. Decreased Energy
5. Trouble Concentrating
6. Increased or decreased Appetite
7. Psychomotor agitation or retardation
8. Suicidal ideation

Question 12

Major depressive disorder exclusionary criteria (3)

Answer 12

1. No manic, mixed or hypomanic episodes
2. Symptoms not exclusively caused by a substance or another medical condition
3. Episodes must not be better accounted for by psychotic illness

Question 13

Depression: DSM-V criteria in children (9):

Answer 13

At least 5 of the following symptoms during the same 2 week period (out of norm):

1. Depressed or irritable mood*
2. Loss of interest or pleasure*
3. Change in appetite and/or weight or failure to make expected weight gains
4. Insomnia or hypersomnia
5. Psychomotor agitation or retardation
6. Fatigue / loss of energy
7. Feelings worthlessness or guilt
8. Poor concentration or indecisiveness
9. Suicidal ideation

Question 14

Symptoms of major depressive episode (outside of sig:ecaps) (7)

Answer 14

1. Tearfulness
2. Irritability
3. Brooding or Obsessive Rumination
4. Anxiety or Phobias
5. Excessive worry over physical health
6. Difficulties in sexual functioning
7. Complaints of pain (HA, abdominal, joint, etch)

Question 15

Mental status finding in depression: speech

Answer 15

slow or soft

Question 16

Mental status findings in depression: mood

Answer 16

Depressed or irritable

Question 17

Mental status findings in depression: affect

Answer 17

• Normal range in mild cases
• Blunted or labile in severe cases

Question 18

Mental status findings in depression, and thought process (severe cases)

Answer 18

Blocking

(tangential in bipolar depression)

Question 19

Mental status findings in depression : thought content

Answer 19

• Suicide ideation
• Delusions or hallucinations in severe cases

Question 20

Mental status findings in severe depression: memory

Answer 20

Impaired (pseudodementia)

Question 21

Mental status findings in depression: judgment for self-preservation

Answer 21

• Often impaired in moderate to severe cases (“nothing matters”)
• Passive wish for death (in absence of suicide ideation)

Question 22

Mental status findings in depression: insight

Answer 22

• Usually intact in mild cases
• Impaired in severe cases

Question 23

Cognition problems and depression

Answer 23

• Perception and thoughts are best retained when they are associated with a strong emotional memory
• Filter distorts normal perceptions and memories

(this filtering can dramatically affect the mood and feelings of self-worth)

Question 24

Define self-esteem

Answer 24

How positively a person feels about themselves (evaluation of the self)

(most people in the U.S. think they have “low self-esteem”, but our idea of this is inflated)

Question 25

Define self confidence

Answer 25

Belief that you can do certain things or bring about certain outcomes

Question 26

People that have a history of primarily acceptance tend to have a _____ self-esteem.

Answer 26

higher (people who have been neglected, shown disinterest or rejection have lower self-esteem)

Question 27

Low self-esteem often leads to:

Answer 27

Negative emotions→ precipitates rejection (therapy involves helping patients to improve the quality of social lives→ adequate support of relationships to maintain self-esteem)

Question 28

When is a major depressive disorder episode over?

Answer 28

Two months from the time of their last symptom (pts may have a single episode or recurrent epidodes)

Question 29

Grading scales for major depressive disorder (4)

Answer 29

1. **Hamilton Depression Rating Scale (HAM-D)** 2. **Geriatric Depression Scale (GDS)** 3. Montgomery-Asberg Depression Rating Scale (MADRS) 4. Zung Self-Rating Scale (ZSRDS)

Question 30

Most commonly used depression rating scale in the US

Answer 30

Hamilton Depression Rating Scale (HAM-D) (also, the geriatric scale is used)

Question 31

Genetic predisposition for major depressive disorder

Answer 31

Serotonin transporter gene (short allele increases risk, 2 short alleles greatly increases risk, 2 long alleles = hardiness)

Question 32

Effective Early Childhood trauma on MDD (5)

Answer 32

1. More severe illness course 2. Early age of onset 3. More hospitalizations 4. More suicide attempt and completion 5. More resistant to treatment

Question 33

Psychosocial effects of major depressive disorder

Answer 33

1. Difficulty in Intimate Relationships and marital problems 2. Occupational problems 3. Academic problems (sexual dysfunction as well)

Question 34

Greater than ____ physical symptoms may indicate likelihood of major depressive episode

Answer 34

nine

Question 35

Typical age of onset of depression

Answer 35

Late twenties (twice as common in females than men)

Question 36

Puberty onset increases and ____ is associated with the development of depression

Answer 36

BMI (pre-pubertal boys and girls are equally affected)

Question 37

Left untreated, major depressive episodes can last for \_\_\_\_\_\_.

Answer 37

6 months or longer

Question 38

If a patient has had one major episode, the probability that they will have another one is \_\_\_\_\_\_%. 2 episodes? 3 episodes?

Answer 38

* 50-60% * 70% * 90% (5-10% first episodes may develop bipolar disorder)

Question 39

\_\_\_\_\_\_ factors play a greater role in precipitating Major Depressive Episode in the first and second episodes.

Answer 39

Psychosocial (one year after mood disorder diagnossi: 40% no mood disorder, 20% do not meet criteria, 40% still meet criteria)

Question 40

Lab findings for depression: (plasma)

Answer 40

* Challenge test: blunted growth hormone, prolactin and TSH * elevated glucocorticoid secretion (in urine)

Question 41

Sleep study findings in depression (6)

Answer 41

1. Prolonged sleep latency 2. Increased wakefulness 3. Early morning Awakening 4. Reduced stage 3/4 slow-wave sleep 5. Decrease the REM latency 6. Increased early REM sleep

Question 42

Lab findings associated with psychotic features and more severe depression

Answer 42

* Glucocorticoid levels * EEG sleep disturbances (not necessary for dx)

Question 43

Describe the "sick behavior" of depressive symptoms

Answer 43

Activation of microglia (involved in pruning process) → excess inflammatory cytokines → impaired synaptic plasticity → neuronal dysfunction/mental disorder (usually activated by cytokines (macrophages) or increased level of glutamate due to acute stress)

Question 44

Conditions with high rates of depression (6)

Answer 44

1. Thyroid disease 2. Cancer 3. Cardiovascular disease & stroke 4. Autoimmune & inflammatory disorders 5. Huntington’s, Parkinson’s, MS 6. COPD

Question 45

Major depressive disorder: effect on associated medical conditions

Answer 45

* Less favorable prognosis & recovery from medical conditions (25% w/serious medical conditions will develop depression)

Question 46

Depression decreases life expectancy by \_\_\_\_\_.

Answer 46

8 years

Question 47

Patients with depression are at twice the risk of:

Answer 47

1. Chronic daily headache 2. Non-cardiac chest pain (atypical) 3. MSK pain / fibromyalgia 4. Low back pain / chronic radiculopathy (60% of patients report pain)