Depression 2 Flashcards
Neurochemical link between emotional and painful physical symptoms in depression
5-HT & NE are involved in pain perception → depression decreases these → more pain is preceived
Link between depression and cardiovascular disease
- Increase risk of development
- Worse prognosis
(possible increase in platlet activation & reactivity)
Depression and risk of death in congestive heart failure
(less likely to recover from MI as well. They can’t take care of themselves)
Depression and platelet activation link (in comorbid pts w/depression & ischemic heart dz).
- Enhance his baseline platelet activation & responsiveness
(Platelet Factor 4 & beta-thromboglobulin)
Depression and diabetes link
- Increase risk of diabetes 20%
- Pts w/diabetes 30% risk of depression, 50 % if on insulin
(association not causation)
Why do patients with develop (3)?
- Diabetic management is stressful
- Depression may interfere with blood sugar monitoring
- Patients feel bad when they don’t comply with doctor’s instructions
(to help them, it is important to guide them away from negative thinking, i.e. “one more sign that I’m a failure”)
Depression and anxiety increase the risk of hypertension by ____.
~ 1.8 xs
How does depression hinder self-management of medical illness?
- 40% less likely to quit smoking
- Coronary artery disease patients less likely to take low-dose aspirin
- Post MI patients less likely to stick w/exercise program
Immunologic effects of depression (3).
- Reduce natural killer cell activity
- Decrease in adaptive immune measures
- Decreased CD4 T-cells (HIV pts)
(Increased mortality for patients in skilled nursing facility & post-strok)
Comorbidities with depression more common in men
Alcohol & substance use disorder
(ex: stim, weed, hallucinogens)
Comorbidities with depression more common in women
- Panic disorder
- Generalized Anxiety Disorder
- Social phobia
- Bulimia
- Thyroid disease
- Migraine
- Fibromyalgia
- Chronic fatigue syndrome
Depression: differential diagnosis: bereavement, dementia, _____(4).
- Schizophrenia
- Anxiety
- Substance abuse
- Bipolar disorder
If a bereft person meets the criteria for major depressive disorder after _______, they are likely to develop depression.
2 months time
What is the link between long-term brain injury and depression?
Prolonged depression may results in progressive and cumulative brain damage
(this may indicate that chronic depression may not be a fully reversible disorder)
When do symptoms of seasonal affective disorder emerge?
fall and winter
Symptoms of seasonal affective disorder
- Lethargy
- Fatigue
- Hypersomnia
- Overeating
Persistent depressive disorder (dysthymia) onset and duration criteria
Depressed mood most of the day, and more days than not for at least 2 years
Persistent depressive disorder (dysthymia) symptom criteria
Must have at least 2 of the following: (and not w/o sx > 2mo. out of the year)
- low self-esteem
- feelings of hopelessness
- insomnia or hypersomnia
- low energy or fatigue
- poor concentration or difficulty making decisions
- poor appetite or overeating
(low self-esteem & hopelessness aren’t in SIG:ECAPS; may also have had MDD in the past if it ended in remission)
What are the differences in the DSM-V diagnosis for dysthymia in children?
- Depressed or irritable mood most of the day, more days than not
- For at least 1 year
- Not w/o sx for 1 the year): Depressed + … 2 of the same symptoms seen in adults
(appetite, sleep, Energy, self-esteem, concentraion/decision making, hopelessness)
Two groups of children that present with Dysthymia (old term = “depressive neurosis”)
- Since childhood or late adolescence
- Those who appear healthy when young but experienced major loss and fall into a state of demoralization
(10% each year will develop MD episode)
Dysthymia (aka persistant depressive disorder) life prevalence
- Women: 4%
- Men: 2%
Disruptive mood dysregulation disorder behaviors: (3)
- Severe recurrent temper outbursts (verbal or physical)
- Inconsistent with developmental level
- 3 or more times per week
Disruptive mood dysregulation disorder onset and course
- Outburst is persistently irritable or angry most of the day, nearly every day
- Sx present 12 or more months without a period of 3 months or more w/o sx
- Age of onset before 10 y.o.
Diagnosis of Disruptive Mood Dysregulation Disorder should not be made before the age of ____ or after the age of _____.
- Six
- Eightteen
Premenstrual dysmorphic disorder symptoms
At least 5 symptoms must be present in the week before the onset of menses (in most cycles of the year):
- Labile Affect
- Irritability/ anger
- Depressed mood (feel hopelessness, self-deprecating thoughts)
- Anxiety/tension (feel on-edge)
-
AND one of the following:
- Sleep (too much/too little)
- decreased Interest in activity
- lethargy/fatigue
- feeling overwhelmed
- difficulty Concentrating
- change in Appetite
- physical symptoms: breast tenderness or swelling, joint or muscle pain, bloating or weight gain
Depression management: initial intake of patient
- YOU must have a good attitude (they are sad, you need to give them hope that you can help. They must believe in YOU)
- Assess symptom severity
- Assess risk of suicide (and reassess often)
(do not probe about childhood trauma. first establish rapport)
Treatment for mild depression
Psychotherapy or somatic therapy (medication)
(moderate to severe = somatic +/- psychotherapy)
Negative placebo effect
- Expectations for the treatment to fail (“I’ve tried everything, and nothing works”)
(As Physicians we can overcome this by the patient believing in our ability to help them)
Define response to treatment
50% Improvement of symptoms (via HAMD-17)
(does NOT mean remission)
Define relapse of depression
They have responded to treatment and symptoms have come back before remission (within 2 months of the last symptom)
(this is the same depressive episode)
Define recurrence of depressive state / episode
Patient has reached recovery (two months since their last symptoms) and their symptoms return → this is a new episode
Acute phase of depression: time frame & treatment goal
- 1-2 months
- Goal: achieve remission & restore baseline of symptomology and functioning
Continuation phase of depression: time frame & treatment goal
- 2-6+ months
- Goal is to prevent relapse of episode → Medication dose that achieved remission should remain the same
(in maintenance phase, the goal is to prevent recurrence)
Maintenance phase of depression management: time frame & treatment goals
(recovery has been reached)
- 6+ months
- Goal: prevent recurrence of new episode (in continuation phase, the goal = prevent relapse)
(this depends on the clinical condition of the patient: number and severity of prior episodes)
Patients not treated to remission of symptoms by_____ are 3 times more likely to have a relapse / recurrence at long-term follow-up
3 months
Depressed patients response to Physicians
- Guilt: expect to be criticized or punished
- Anger: feeling rejected
- Dependent: hope for rescue
(be careful when you hear a patient say “You’re the best and if anyone can help, its you!”. Take a professional approach: “I think I can help you and I’m going to do my very best.”)
Define remission of depression
Return to functional normality, indistinguishable from those without depression
(only half of depressed patients achieve remission)
HAMD17 (Hamilton Depression Scale) = severe MDD? moderate? mild?
- 28
- 20-28
- 15-19
Why is it important for patients with depression to achieve remission (other than the risk of other medical conditions)? (3)
- Greater risk of relapse / recurrence
- More chronic depressive episodes
- Continued impairment in work and relationships
