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depression Flashcards

1
Q

objectives of depression

A
  1. Diagnose depression related disorders using DSM-IV/5 criteria
  2. Recognize characteristics of depression
  3. Understand etiology and occurrence
  4. Learn about treatment options
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2
Q

A. Five (or more) of the following nine symptoms have been present during the same 2-week period and represent a change from previous functioning; at least one of the symptoms is either (1) depressed mood or (2) loss of interest or pleasure.

A
  1. Depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g., feels sad, empty, hopeless) or observation made by others (e.g., appears tearful). (Note: In children and adolescents, can be irritable mood.)
  2. Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (as indicated by either subjective account or observation).
  3. Significant weight loss when not dieting or weight gain (e.g., a change of more than 5% of body weight in a month), or decrease or increase in appetite nearly every day. (Note: In children, consider failure to make expected weight gain.)
  4. Insomnia or hypersomnia nearly every day.
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3
Q

SWAG

Used to differentiate between normal sadness and depression (have at least 1 of the following):

A
  1. Suicidality – serious thoughts (ideation) or attempts at killing oneself
  2. Weight Loss – >5% loss of body weight w/o medical cause
  3. Anhedonia – loss of pleasure/interest in previously enjoyable activities
  4. Guilt – feeling responsible for negative life events w/o reason
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4
Q

Atypical depression –

A

more likely to have weight gain and hypersomnia

Also leaden paralysis, carb cravings, rejection sensitivity

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5
Q

Pseudodementia –

A

cognitive symptoms in depressed elderly often misdiagnosed as “dementia”

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6
Q

Diurnal variation –

A

more depressed in AM, better in PM

–> Melancholic type depression

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7
Q

Psychomotor symptoms– physical complaints: body aches, headaches

A

Agitation vs. Retardation

Vegetative Depression

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8
Q

Mnemonic for MDD –> SIGECAPS

A 
Sleep disturbance
Interest/pleasure reduction
Guilt, feeling of worthlessness
Energy loss, fatigue
Concentration/attention impairment
Appetite changes
Psychomotor symptoms
Suicidal ideation
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9
Q

what is SWAG?

A

used to differentiate between normal sadness and depression (have at least 1 of the following):

  1. Suicidality
  2. Wight loss (5% loss of body weight w/o medical cause)
  3. Anhedonia
  4. Guilt
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10
Q

Psychomotor symptoms–

A

physical complaints: body aches, headaches
Agitation vs. Retardation
Vegetative Depression

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11
Q

Atypical depression –

A

more likely to have weight gain and hypersomnia

Also leaden paralysis, carb cravings, rejection sensitivity

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12
Q

Pseudodementia –

A

cognitive symptoms in depressed elderly often misdiagnosed as “dementia”

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13
Q

Diurnal variation –

A

more depressed in AM, better in PM

Melancholic type depression

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14
Q

Seasonal Affective Disorder (SAD)

A
  1. MDD usually associated with shorter days in winter
  2. Usually with atypical symptoms
  3. Treat with full-spectrum light exposure , psychotherapy, antidepressants
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15
Q

Masked Depression

A
  1. Depressed patients presenting with vague physical ailments but unaware/in denial of their depression
  2. Seem stoic
  3. Seek primary care for psychomotor or somatic symptoms instead
  4. Consider diagnosis only when no organic medical cause is identified and patient has other MDD symptoms
  5. More typically seen in elderly patients, obsessive-compulsive/narcisstic personalities
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16
Q

Possible medical causes of depressive symptoms:

A 
Hypothyroidism
Cushing’s Syndrome
Anemia
Brain injury, stroke
Vitamin deficiency (B12, Folate, Vit D)
Obstructive sleep apnea…
17
Q

Biological Factors (etiology)

A
  1. Monoamine Deficiency
    ↓levels of Dopamine (DA), Serotonin (SR), Norepinephrine (NE)
  2. Monoamine Receptor Excess Theory
  3. Loss of neurotrophic factors and degeneration?
  4. Genetics
    Serotonin transporter gene
18
Q

Psychosocial Factors (etiology)

A 
Ability to cope with life stressors – Resilience
Low self esteem, negative outlook
Personality traits
Addiction
Learned helplessness
Catastrophic loss
Anger turned inward?
Incapacity via hibernating?
Learned helplessness and automatic thoughts?
Social disconnect?
19
Q

Front line agents antidepressants that have less severe side effects?

A
  1. Selective SR Reuptake Inhibitors (SSRI)
  2. Selective NE, SR Reuptake Inhibitors (SNRI)
  3. NE, DA Reuptake Inhibitors (NDRI)
20
Q

Sedating Antidepressants (ex: Trazadone, mirtazapine)

A
  1. These block 5HT2 receptors, H1 receptors instead of SSRI mechanism
  2. Mirtazapine increase NE by blocking the alpha-2a NE receptor
21
Q

Augmenting Strategies (for when antidepressants alone aren’t enough):

A
  1. Lithium
  2. Thyroid hormone
  3. Atypical antipsychotic
22
Q

Electroconvulsive therapy (ECT)

A
  1. Shock Treatment
  2. Effective for severe depression, especially if non-responsive to meds
  3. Used when antidepressants cannot be used due to toxicity/side effects, or when antidepressants fail
  4. Also used when immediate resolution of symptoms is needed (i.e. patient is acutely suicidal or psychotic)
23
Q

Faster-acting Treatments?

A

Antidepressants can take up to 8 wks to work
Only 1/3 of patients respond per STAR*D study
Psychotherapy takes longer…
? Faster-acting pharmaceuticals include psychostimulants, ketamine IV
But can cause addiction…not proven as yet

24
Q

Occurrence of Depression

A
  1. Lifetime prevalence: Women > Men
  2. Women also more likely to seek help/treatment than men
  3. Higher risk for elderly who are widowed or chronically ill
  4. Co-morbidity of substance abuse, generalized anxiety
25
Q

High # of receptors and/or low # of transmitter =

A

Depression

26
Q

what are the two dysfunctional neuroanatomy in depressed state?

A
  1. hypoactive dorsolateral prefrontal cortex DLPFC

2. hyperactive amygdala

27
Q

Psychological Treatments

A 
1. Therapies include: 
Family
Interpersonal
Psychoanalytic/Psychodynamic
Behavioral
Cognitive
2. Some evidence claims psychological treatment + medication is more effective than either treatment modality on its own
3. New functional brain studies may suggest which patients respond to which treatment…
28
Q

genetic factors in depression is only

A

35%, whereas 65% has to do with environmental

29
Q

stress-cortisol-depression theory

A

stress –> increased glucocorticoids –> atrophy/death of neurons –> the brain does NOT recover

30
Q

in depressed state

A
  1. cold prefrontal cortex DLPFC and

2. hot amygdala (hyperactive amygdala)

31
Q

depression may be due to

A

Maybe it isn’t transmitters, receptors, growth factors, degeneration but neurocircuitry and connectivity

32
Q

etiology of depression

A
  1. Lifetime prevalence: Women > Men
  2. Women also more likely to seek help/treatment than men
  3. Higher risk for elderly who are widowed or chronically ill
  4. Co-morbidity of substance abuse, generalized anxiety
33
Q

Mirtazapine increase NE by

A

blocking the alpha-2a NE receptor

34
Q

raphe nuclei

A

serotonin

35
Q

other neurostimulation techniques

A
  1. Vagus Nerve Stimulation (VNS)
  2. Transcranial Magnetic Stimulation (TMS)
  3. Deep Brain Stimulation (DBS)
  4. Transcranial Direct Current Stimulation (TDCS)
36
Q

N2O?

A
  1. inorganic gas
  2. relatively insoluble in blood
  3. administered as an adjuvant to volatile agents, opioid
37
Q

what is the most potent volatile agent?

A

isoflurane

38
Q

what is the least soluble and least potent of the volatile agents?

A

desflurane

39
Q

what is the volatile agent that is less soluble, less potent, non-irritant?

A

sevoflurane

BS (15 decks)

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