Depression 1 Flashcards
Two categories of mood disorders
- Depression
- Bipolar
Major depressive disorder (MDD) lifetime prevalence
- Women: 10 to 15%
- Men: 5 to 12%
(4th greatest cuase of global illness burden)
Major depressive disorder (MDD) Point prevalence
- Women: 5 to 9 %
- Men: 2 to 3%
MDD is most likely to be treated in the ______ setting
primary care
COVID risks for patients with psychiatric disorders
- 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)
MDD is not always a ________ .
environmental stressor (it can’t always be prevented)
Only _____ of patients with depression are diagnosed and treated
one-third
___% of patients in primary care clinics are depressed but only half are diagnosed by a physician
20
Reasons for under-recognition of major depressive disorder
- Present as somatic complaints
- Difficult to separate depression from normal ups and downs
- Stigma: fear, criticism or ignoring mental illness
Mortality rate for major depressive episode
Up to 15% (if they died by suicide)
(Individuals over 55 have for fold mortality)
Depression: DSM-V dx criteria
****At least 5 of the following symptoms (and the first 2) during the same 2 week period (sig:ecaps)****
- Increased or decreased Sleep
- Loss of Interest in activities
- Inappropriate Guilt
- Decreased Energy
- Trouble Concentrating
- Increased or decreased Appetite
- Psychomotor agitation or retardation
- Suicidal ideation
Major depressive disorder exclusionary criteria (3)
- No manic, mixed or hypomanic episodes
- Symptoms not exclusively caused by a substance or another medical condition
- Episodes must not be better accounted for by psychotic illness
Depression: DSM-V criteria in children (9):
At least 5 of the following symptoms during the same 2 week period (out of norm):
- Depressed or irritable mood*
- Loss of interest or pleasure*
- Change in appetite and/or weight or failure to make expected weight gains
- Insomnia or hypersomnia
- Psychomotor agitation or retardation
- Fatigue / loss of energy
- Feelings worthlessness or guilt
- Poor concentration or indecisiveness
- Suicidal ideation
Symptoms of major depressive episode (outside of sig:ecaps) (7)
- Tearfulness
- Irritability
- Brooding or Obsessive Rumination
- Anxiety or Phobias
- Excessive worry over physical health
- Difficulties in sexual functioning
- Complaints of pain (HA, abdominal, joint, etch)
Mental status finding in depression: speech
slow or soft
Mental status findings in depression: mood
Depressed or irritable
Mental status findings in depression: affect
- Normal range in mild cases
- Blunted or labile in severe cases
Mental status findings in depression, and thought process (severe cases)
Blocking
(tangential in bipolar depression)
Mental status findings in depression : thought content
- Suicide ideation
- Delusions or hallucinations in severe cases
Mental status findings in severe depression: memory
Impaired (pseudodementia)
Mental status findings in depression: judgment for self-preservation
- Often impaired in moderate to severe cases (“nothing matters”)
- Passive wish for death (in absence of suicide ideation)
Mental status findings in depression: insight
- Usually intact in mild cases
- Impaired in severe cases
Cognition problems and depression
- 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)
Define self-esteem
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)
Define self confidence
Belief that you can do certain things or bring about certain outcomes
People that have a history of primarily acceptance tend to have a _____ self-esteem.
higher
(people who have been neglected, shown disinterest or rejection have lower self-esteem)
Low self-esteem often leads to:
Negative emotions→ precipitates rejection
(therapy involves helping patients to improve the quality of social lives→ adequate support of relationships to maintain self-esteem)
When is a major depressive disorder episode over?
Two months from the time of their last symptom
(pts may have a single episode or recurrent epidodes)
Grading scales for major depressive disorder (4)
- Hamilton Depression Rating Scale (HAM-D)
- Geriatric Depression Scale (GDS)
- Montgomery-Asberg Depression Rating Scale (MADRS)
- Zung Self-Rating Scale (ZSRDS)
Most commonly used depression rating scale in the US
Hamilton Depression Rating Scale (HAM-D)
(also, the geriatric scale is used)
Genetic predisposition for major depressive disorder
Serotonin transporter gene
(short allele increases risk, 2 short alleles greatly increases risk, 2 long alleles = hardiness)
Effective Early Childhood trauma on MDD (5)
- More severe illness course
- Early age of onset
- More hospitalizations
- More suicide attempt and completion
- More resistant to treatment
Psychosocial effects of major depressive disorder
- Difficulty in Intimate Relationships and marital problems
- Occupational problems
- Academic problems
(sexual dysfunction as well)
Greater than ____ physical symptoms may indicate likelihood of major depressive episode
nine
Typical age of onset of depression
Late twenties
(twice as common in females than men)
Puberty onset increases and ____ is associated with the development of depression
BMI
(pre-pubertal boys and girls are equally affected)
Left untreated, major depressive episodes can last for ______.
6 months or longer
If a patient has had one major episode, the probability that they will have another one is ______%. 2 episodes? 3 episodes?
- 50-60%
- 70%
- 90%
(5-10% first episodes may develop bipolar disorder)
______ factors play a greater role in precipitating Major Depressive Episode in the first and second episodes.
Psychosocial
(one year after mood disorder diagnossi: 40% no mood disorder, 20% do not meet criteria, 40% still meet criteria)
Lab findings for depression: (plasma)
- Challenge test: blunted growth hormone, prolactin and TSH
- elevated glucocorticoid secretion (in urine)
Sleep study findings in depression (6)
- Prolonged sleep latency
- Increased wakefulness
- Early morning Awakening
- Reduced stage 3/4 slow-wave sleep
- Decrease the REM latency
- Increased early REM sleep
Lab findings associated with psychotic features and more severe depression
- Glucocorticoid levels
- EEG sleep disturbances
(not necessary for dx)
Describe the “sick behavior” of depressive symptoms
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)
Conditions with high rates of depression (6)
- Thyroid disease
- Cancer
- Cardiovascular disease & stroke
- Autoimmune & inflammatory disorders
- Huntington’s, Parkinson’s, MS
- COPD
Major depressive disorder: effect on associated medical conditions
- Less favorable prognosis & recovery from medical conditions
(25% w/serious medical conditions will develop depression)
Depression decreases life expectancy by _____.
8 years
Patients with depression are at twice the risk of:
- Chronic daily headache
- Non-cardiac chest pain (atypical)
- MSK pain / fibromyalgia
- Low back pain / chronic radiculopathy
(60% of patients report pain)
