Depression Flashcards
What is disruptive dysregulation mood disorder?
A. severe recurrent temper outburst manifested verbally and/or behaviorally that are way out of proportion in intensity/duration to the situation
B. on avg, 3 or more outburst/wk
C. outburst are inconsistent with developmental level
D. usually irritable/angry
(A-D present for 12 mo)
What is the age range for the first time dx of disruptive mood dysregulation disorder?
btwn age 1-18
onset before age 10
What other psychiatric disorders can disruptive mood dysregulation disorder co-exist with?
ADHD
major depressive disorder
disruptive mood dysregulation disorder course/prognosis?
chronic
high risk of progressing into major depressive disorder, dysthymic disorder and anxiety disorders
How do we treat disruptive mood dysregulation disorder?
treat sxs
If resembles depression/anxiety: SSRIs and stimulants
If resembles bipolar disorder: antipsychotic and mood stabilizer
+cognitive-behavioral therapy
Describe depressive disorder
depressed mood most of the time, diminished interest/pleasure, sig. weight loss when not dieting or weight gain, insomnia/hypersomnia, fatigue, diminished ability to concentrate, recurrent thoughts of death
Who is more likely to have a major depressive disorder?
women (2:1)
more often in ppl w/o close interpersonal relationships or are divorced/separated
What is the learned helplessness theory?
connects depression to experiencing uncontrollable events
those with depression may have internal causal explantations which produce self esteem loss after adverse external event
Who is generally effected by major depressive disorder?
76% americans >12 yrs
Female > male
What do pts with MDD usually present with?
some other complaint
don’t usually present with depression
How do you dx MDD?
based on hx and PE
Why do you need to perform a full medical evaluation on pts with MDD?
to r/o infection, medication effect, endocrine disorder, tumor, neurologic disorder
What might you see on PE for a pt with MDD?
decline in grooming/hygiene, weight can change, flat affect, psychomotor agitation
What screen tools can you use for MDD?
2-question test
Patient health questionnaire-9
Beck depression inventory
Work up for MDD?
lab study to r/o organic causes, neuroimaging
How can we treat MDD?
meds
psychotherapy
cognitive behavioral therapy
electroconvulsive therapy
bright light therapy
What medications can be used to treat MDD?
SSRIs, SNRIs, atypical antidepressants, SDAMs, tricyclic antidepressants, MOAIs, St. John’s Work
SSRI
Selective Serotonin Reuptake Inhibitor
Ex. Citalopram (Celexa), Escitalopram (Lexapro), Fluoxetin
SNRI
Serotonin/norepinephrine Reuptake Inhibitors
Ex. Venlafaxine, Desvenlafaxine, Duloxetine
Atypical antidepressants
Bupropion, Mirtazapine, Trazodone
SDAM
Serotin-Dopamine Activity Modulators
Ex. Brexpiprazole, Aripiprazole
Tricyclic Antidepressants (TCAs)
Ex. Amitriptyline, Clomipramine, Desipramine
MAOIs
Monoamine Oxidase Inhibitors
Ex. Isocarboxazid, Phenelzine, Selegiline
St. John’s Wort
Hypericum perforatum
herbal remedy OTC
may act as SSRI
mild - mod depression sxs
What is electroconvulsive therapy?
highly effective, rapid antidepressant response, used in pts who fail drug therapies
What is bright light therapy?
treats seasonal affective disorder
30-90 mins within 1 hr of awakening
often combined with conventional medical therapy
can precipitate manic or hypomanic episode
What is the most significant risk factor for suicide?
past suicide attempt
When should you hospitalize pts with MDD?
SI/HI, severe depression, gross thought disorganization, inability to care for self, failing medical status
Dysthymia aka…
Persistent depressive disorder
What is dysthymia?
depressed mood lasting most of the day and present almost continuously
feelings of inadequacy, guilt, irritability, anger, withdrawal from society, lack of production
“ill humored”
Characteristics of dysthymia
ongoing for at least 2 yrs
insidious onset (childhood/adolescence)
persistent
fam hx
If a pt has met the criteria for both MDD and dysthymia, which dx should they receive?
MDD
Dysthymia epidemiology
5-6% of gen pop
coexists with other psychiatric illness
no gender difference
How do we treat dysthymia?
pharmacotherapy and psychotherapy
What is Premenstrual Dysphoric Disorder (PMDD)
mood lability, irritability, dysphoria and anxiety sxs occurring repeatedly during time before onset of menstrual period
Treatment of PMDD?
support/education about disorder
treat sxs
SSRIs and benzodiazepines
What is substance/medication-Induced Depressive Disorder
depressed mood or markedly diminished interest or pleasure in all or almost all activities during or soon after substance intoxication or withdrawal or after exposure to a medication
What are some depression co-morbidities?
heart disease, breast CA, immunological disease, chronic pain, multiple psychical disorders
Pts with one lifetime episode of MDD who achieve remission on antidepressants should continue taking them for…
another 6-12 months
Pts with 2 or more lifetime episode of MDD who achieve remission on antidepressants should continue taking them for..
15 months to 3 years
Pts with chronic MDD or with concurrent dysthymia who achieve remission on antidepressants should continue taking them for..
15 months to 28 months
How long can it take for pts to see improvement on antidepressants?
2-6 wks
How often should you FU with pts on antidepressants?
after 1st month and then every 4-6 wks until stable
individualize based on pt
What can we do to improve pts adherence to medications?
understand the pts model of the illness
identify social/financial barriers
address pts concerns about meds
discuss pts understanding about tx and ability to follow through
How long should you trial a new medication?
8-12 wks
if tolerated increase dose every 2-4 weeks until remission achieved, max dose
