Depression

Question 1

What must the diagnosis of all DSM-5 disorders require?

Answer 1

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)

Question 2

Disruptive Mood Dysregulation d/o age of onset

Answer 2

6-10 yo

Question 3

Disruptive Mood Dysregulation d/o symptoms

Answer 3

• severe temper outbursts out of proportion to situation or provocation
• shouting, screaming, disregard for others, reckless aggression
• irritable/angry/upset nearly every day

Question 4

Possible cause of Disruptive Mood Dysregulation d/o

Answer 4

psychosocial adversity (ex. abuse)

Question 5

Disruptive Mood Dysregulation d/o treatment

Answer 5

No validated tx; use symptomatic therapy

aggression - stimulant meds
irritability - SSRIs
behavioral management

Question 6

definition of affect

Answer 6

expression of internal emotions or feelings; displayed through facial expressions, hand gestures, vocal tone, etc.

Question 7

How is Major Depressive Disorder diagnosed?

Answer 7

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

Question 8

Major Depressive Disorder: timing of symptoms

Answer 8

• single (1 episode) or recurrent (2 months asx)
• episodes can last 5-6 months
• 20% become chronic (+2 yrs)

Question 9

Major Depressive Disorder risk factors

Answer 9

• adverse childhood experience
• stressful life events
• genetic (1st degree relatives)
• neuroticism

Question 10

Major Depressive Disorder treatment

Answer 10

1st line: anti-depressants (SSRI, SNRI, TCA); monitor med every 1-2 wks

Others: Psychotherapy, ECT, hospitalization if suicidal

Question 11

dysthymia

Answer 11

persistent, mild depression, “bad mood” characterization

Question 12

Persistant depressive disorder is presence of depressed mood for how long?

Answer 12

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

Question 13

Persistant depressive disorder diagnosis

Answer 13

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

Question 14

Persistant depressive disorder often diagnosed with what other disorder?

Answer 14

MDD

*treated same way but may add anti-anxiety

Question 15

Premenstrual dysphoric disorder onset

Answer 15

any time after menarche

women often delay seeking tx until after 30 yo

Question 16

Premenstrual dysphoric disorder diagnosis

Answer 16

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

Question 17

Premenstrual dysphoric disorder treatment

Answer 17

Lifestyle mods: limit caffeine, salt, alcohol, tobacco; regular exercise, relaxation, psychotherapy

Pharmacologic: SSRIs for week before menses onset

CBT helpful

Question 18

What type of person has greatest risk for completed suicide?

Answer 18

male, single or living alone, prominent feelings of hopelessness

Question 19

psychomotor agitation vs retardation

Answer 19

repetitive motion without thinking about it due to stress

retardation is just too much effort to do daily activities, slow movement

Question 20

“double depression”

Answer 20

PDD also with a major depressive disorder

Question 21

How long for antidepressants to take affect?

Answer 21

4-6 wks

**2-3 wks in Sommers notes

Question 22

How should antidepressants be monitored?

Answer 22

patient should RTC every 1-2 weeks to check for suicidal ideation

Question 23

affective lability

Answer 23

unpredictable and random expression of emotion