Depression Flashcards
Major Depressive Disorder - Lifetime prevalence of major depressive episode is __-___% for males and ___-___% for females.
Major Depressive Disorder - Lifetime prevalence of major depressive episode is 5-12% for males and 10-25% for females.
Criteria for Major Depressive Disorder
- depressed mood or loss of interest or pleasure most of the time for __ or more weeks plus ___ or more of the following:
SIG E CAPS
Sleep - ___ or ___ nearly ___ ___
Interest - Markedly diminished interest or pleasure in nearly all ___ most of the time
Guilt - Excessive feelings or ___ most of the time
Energy - Loss of ___ or fatigue most of the time
Concentration - Diminished ability to think or concentrate; indecisiveness most of the time
Appetite - Increase of decrease in appetite
Psychomotor - Observed psychomotor agitation/retardation
Suicide - Recurrent thoughts of death/suicidal ideation
Also, one of the symptoms must be depressed mood or ____ (loss of interest in pleasurable activities)
Criteria for Major Depressive Disorder
- depressed mood or loss of interest or pleasure most of the time for 2 or more weeks plus 5 or more of the following:
SIG E CAPS
Sleep - insomnia or parasomnia nearly every day
Interest - Markedly diminished interest or pleasure in nearly all activities most of the time
Guilt - Excessive feelings or guilt most of the time
Energy - Loss of energy or fatigue most of the time
Concentration - Diminished ability to think or concentrate; indecisiveness most of the time
Appetite - Increase of decrease in appetite
Psychomotor - Observed psychomotor agitation/retardation
Suicide - Recurrent thoughts of death/suicidal ideation
Also, one of the symptoms must be depressed mood or anhedonia (loss of interest in pleasurable activities)
Major Depressive Episode (we want to make sure that there are no other medical conditions that can cause depression):
- Not “____ caused” - i.e. caused by a body system other than the brain such as ____ (low) disease or due to ___ or other __/___.
- Not uncomplicated ____ (grief) -uncomplicated grief is NOT a mental disorder.
“____” means bereavement which has lasted too long or is too intense.
Major Depressive Episode (we want to make sure that there are no other medical conditions that can cause depression):
- Not “organically caused” - i.e. caused by a body system other than the brain such as thyroid (low) disease or due to medication or other alcohol/toxin
- Not uncomplicated bereavement (grief) -uncomplicated grief is NOT a mental disorder.
“Complicated” means bereavement which has lasted too long or is too intense.
Persistent Depressive Disorder (___ - “minor depression” that lasts longer than __ years).
Presentation: Persistent Depressive Disorder
E.H. CAPES
- Poor __-___
- Feelings of ____
- Poor ____
- ____ changes
- Persistent depressive disorder depression most of the day, more days than not for ___ years
- Decreased __
- ___changes
Persistent Depressive Disorder (dysthymia - “minor depression” that lasts longer than 2 years).
Presentation: Persistent Depressive Disorder
E.H. CAPES
- Poor self-esteem
- Feelings of helplessness
- Poor concentration
- Appetite changes
- Persistent depressive disorder depression most of the day, more days than not for 2 years
- Decreased energy
- Sleep changes
Pre-Menstrual Disorder
Presentation: ___ or more of the following during the menstrual cycle:
- Marked affective ___ (emotional unstability)
- Marked irritability or anger
- Marked depressed mood with feelings of helplessness or ___-___ thoughts.
___ or more:
- decreased __, concentration, energy
- change in ___
- change in ___
- feeling overwhelmed
- physical changes such as ___ or __ ___
Pre-Menstrual Disorder
Presentation: one or more of the following during the menstrual cycle:
- Marked affective lability (emotional unstability)
- Marked irritability or anger
- Marked depressed mood with feelings of helplessness or self-deprecating thoughts.
one or more:
- decreased interest, concentration, energy
- change in appetite
- change in sleep
- feeling overwhelmed
- physical changes such as bloating or breast tenderness
DMDD - __ __ ___ ___
Presentation:
- Severe recurrent __ outbursts manifested verbally and behaviorally
- ___ or more times per week
- Mood between outbursts is irritable
- Symptoms present for __ year
- Ages __ to ___.
DMDD - Disruptive Mood Dysregulation Disorder
Presentation:
- Severe recurrent temper outbursts manifested verbally and behaviorally
- Three or more times per week
- Mood between outbursts is irritable
- Symptoms present for 1 year
- Ages 6 to 18
Substance/Medication Induced Depressive Disorder:
What is it?
- A prominent and persistent disturbance in mood characterized by ___ mood or markedly ___ pleasure
- There is evidence that the symptoms developed during or soon after the ___ intoxication (like alcohol) or ____ or after exposure to a medication
- The involved medication/substance is capable of producing the ___.
Presentation: STINE DCC
Causes: (franken)STINE D(epressive) C(ondition) C(auses)
- ___ disorders
- ___ - alcohol, Barbiturates, benzodiazepines, steroids, anticonvulsants, diuretics, stimulants, PCP
- ___ - viral Illness (mononucleosis), syphillis, Lyme disease
- ____ - carcinoid Syndrome, lymphoma, pancreatic CA
- ____opathies
- Degenerative - ___ disease
- ____ vascular disease
- ___vascular disease
Substance/Medication Induced Depressive Disorder:
What is it?
- A prominent and persistent disturbance in mood characterized by depressed mood or markedly diminished pleasure
- There is evidence that the symptoms developed during or soon after the substance intoxication (like alcohol) or withdrawal or after exposure to a medication
- The involved medication/substance is capable of producing the symptoms
Presenation: STINE DCC
- Sleep disorders
- Toxins - alcohol, Barbiturates, benzodiazepines, steroids, anticonvulsants, diuretics, stimulants, PCP
- Infection - viral Illness (mononucleosis), syphillis, Lyme disease
- Neoplasm - carcinoid Syndrome, lymphoma, pancreatic CA
- Endocrinopathies
- Degenerative - Parkinson’s disease
- Collagen vascular disease
- Cerebrovascular disease
Suicide:
- More common in all psychiatric diagnoses; not just depression
- Dispel myths: talking about it probably makes it less likely to happen
- Symptom as well as outcome
- High risk groups (__, older, past __)
- Assess prohibitions to suicide
Q’s to Ask:
- When things have gotten really __?
- Have you had ___ thoughts about death and dying?
- Have you thought about ____ yourself?
- Have you ever ___ on those thoughts?
- Do you have __ to those means?
- What ___ you from doing this?
Management:
- Like angina management…not all chest pain goes to the ER
- Think through risk factors
- Assess acuity
- Access to means
- ___ history, _ History
- What prohibitions exist?
- Support, who are the partners in management
Suicide:
- More common in all psychiatric diagnoses; not just depression
- Dispel myths: talking about it probably makes it less likely to happen
- Symptom as well as outcome
- High risk groups (men, older, past history)
- Assess prohibitions to suicide
Q’s to Ask:
- When things have gotten really bad?
- Have you had increased thoughts about death and dying?
- Have you thought about hurting yourself?
- Have you ever acted on those thoughts?
- Do you have access to those means?
- What stops you from doing this?
Management:
- Like angina management…not all chest pain goes to the ER
- Think through risk factors
- Assess acuity
- Access to means
- family history, personal History
- What prohibitions exist?
- Support, who are the partners in management
Common Clinical Errors in Diagnosing Depression:
- Insufficient ___ - use SIG E CAPS!!
- Failure to consult a __ __ - Sometimes people mask how their feeling. A family member may be able to better tell you about their __ or ___ in behavior.
- Acceptance of diagnosis of mood disorder without adequate criteria – “__ ___” is not enough
- ___ rather than treating: “of course you are depressed who wouldn’t be in your situation?” - this normalizes it. Depression is not normal
Common Clinical Errors in Diagnosing Depression:
- Insufficient questioning - use SIG E CAPS!!
- Failure to consult a family member - Sometimes people mask how their feeling. A family member may be able to better tell you about their moods or changes in behavior.
- Acceptance of diagnosis of mood disorder without adequate criteria – “depressed mood” is not enough
- explaining rather than treating: “of course you are depressed who wouldn’t be in your situation?” - this normalizes it. Depression is not normal
Pitfalls
Antidepressants must be given in ____ doses for several __ for some patients to respond. Don’t start too ___ or __ too quickly. Particularly, the SNRIs and paroxetine have a ____ syndrome, so the drug must be ___. Antidepressants cannot be given on an “__ ___” basis. The patient needs to ____ to taking the medicine every day. Antidepressants must be given over a minimum __ to __ week period before they are rejected as efficacious. (In some cases ___ weeks is needed.)
Pearls
Use ___ initial doses for patients who are very sick. Use ___ doses for elderly patients. As a patient recovers from ___, they may become more ___ for a short time. Use __ of these drugs with great caution.
Pitfalls
Antidepressants must be given in small doses for several weeks for some patients to respond. Don’t start too low or start too quickly. Particularly, the SNRIs and paroxetine have a discontinuation syndrome, so the drug must be tapered. Antidepressants cannot be given on an “as needed” basis. The patient needs to commit to taking the medicine every day. Antidepressants must be given over a minimum 3 to 8 week period before they are rejected as efficacious. (In some cases 12 weeks is needed.)
Pearls
Use smaller initial doses for patients who are very sick. Use small doses for elderly patients. As a patient recovers from depression, they may become more suicidal for a short time. Use a combination of these drugs with great caution
Summary:
“Be ___ it to ___ it” – if you start an antidepressant, need to be on minimum of __ to ___ months
Adequate duration (one study showed only ___% of patients had adequate duration)
Treat towards ____, not ___
____ care improves outcomes
Summary:
“Be in it to win it” – if you start an antidepressant, need to be on minimum of 6 to 9 months
Adequate duration (one study showed only 45% of patients had adequate duration)
Treat towards remission, not response
Collaborative care improves outcomes
