Depression Flashcards
What must the diagnosis of all DSM-5 disorders require?
1) Significant impairment in social, occupational and relational arenas due to disorder symptoms
2) No explanation for condition by any other means (drugs, medical illness, another psych disorder)
Disruptive Mood Dysregulation d/o age of onset
6-10 yo
Disruptive Mood Dysregulation d/o symptoms
- severe temper outbursts out of proportion to situation or provocation
- shouting, screaming, disregard for others, reckless aggression
- irritable/angry/upset nearly every day
Possible cause of Disruptive Mood Dysregulation d/o
psychosocial adversity (ex. abuse)
Disruptive Mood Dysregulation d/o treatment
No validated tx; use symptomatic therapy
aggression - stimulant meds
irritability - SSRIs
behavioral management
definition of affect
expression of internal emotions or feelings; displayed through facial expressions, hand gestures, vocal tone, etc.
How is Major Depressive Disorder diagnosed?
5 or more of these sx’s during same 2 week period (* = required)
- *depressed mood most of day
- anhedonia most of day
- Unintentional weight loss/gain or appetite change
- Insomnia or hypersomnia
- Psychomotor agitation or retardation
- fatigue or loss of energy
- worthlessness or excessive guilt
- suicidal ideation
Major Depressive Disorder: timing of symptoms
- single (1 episode) or recurrent (2 months asx)
- episodes can last 5-6 months
- 20% become chronic (+2 yrs)
Major Depressive Disorder risk factors
- adverse childhood experience
- stressful life events
- genetic (1st degree relatives)
- neuroticism
Major Depressive Disorder treatment
1st line: anti-depressants (SSRI, SNRI, TCA); monitor med every 1-2 wks
Others: Psychotherapy, ECT, hospitalization if suicidal
dysthymia
persistent, mild depression, “bad mood” characterization
Persistant depressive disorder is presence of depressed mood for how long?
at least 2 years for most of the day and more days than not
Never asx for more than 2 months at a time
- 1 year for child/adolescent; seen as irritability
Persistant depressive disorder diagnosis
at least 2 of following most of the time: poor appetite/overeating, insomnia/hypersomnia, low energy, low self-esteem, poor concentration or indecisiveness, feeling hopeless
Persistant depressive disorder often diagnosed with what other disorder?
MDD
*treated same way but may add anti-anxiety
Premenstrual dysphoric disorder onset
any time after menarche
women often delay seeking tx until after 30 yo
Premenstrual dysphoric disorder diagnosis
Majority of menstrual cycles over preceding year, with at least 4 of these sx’s in week before onset of menses:
- Affective lability
- Irritability, anger, interpersonal conflicts
- Depressed mood, feelings of hopelessness, or self-deprecating thoughts
- Anxiety, tension and/or feelings of being on edge
PLUS 1 or more (to total 5):
- Decreased interest in usual activities
- Difficulty in concentration
- Lethargy, easy fatigued
- Change in appetite, overeating, specific food cravings
- Hypersomnia or insomnia
- Feel overwhelmed
- PE: breast tenderness, joint/muscle pain, “bloating”, weight gain
Premenstrual dysphoric disorder treatment
Lifestyle mods: limit caffeine, salt, alcohol, tobacco; regular exercise, relaxation, psychotherapy
Pharmacologic: SSRIs for week before menses onset
CBT helpful
What type of person has greatest risk for completed suicide?
male, single or living alone, prominent feelings of hopelessness
psychomotor agitation vs retardation
repetitive motion without thinking about it due to stress
retardation is just too much effort to do daily activities, slow movement
“double depression”
PDD also with a major depressive disorder
How long for antidepressants to take affect?
4-6 wks
**2-3 wks in Sommers notes
How should antidepressants be monitored?
patient should RTC every 1-2 weeks to check for suicidal ideation
affective lability
unpredictable and random expression of emotion
