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Clinical Disciplines (Melicia) > Depression > Flashcards

Depression Flashcards

1
Q

What is disruptive dysregulation mood disorder?

A

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)

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2
Q

What is the age range for the first time dx of disruptive mood dysregulation disorder?

A

btwn age 1-18

onset before age 10

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3
Q

What other psychiatric disorders can disruptive mood dysregulation disorder co-exist with?

A

ADHD

major depressive disorder

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4
Q

disruptive mood dysregulation disorder course/prognosis?

A

chronic

high risk of progressing into major depressive disorder, dysthymic disorder and anxiety disorders

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5
Q

How do we treat disruptive mood dysregulation disorder?

A

treat sxs

If resembles depression/anxiety: SSRIs and stimulants

If resembles bipolar disorder: antipsychotic and mood stabilizer

+cognitive-behavioral therapy

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6
Q

Describe depressive disorder

A

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

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7
Q

Who is more likely to have a major depressive disorder?

A

women (2:1)

more often in ppl w/o close interpersonal relationships or are divorced/separated

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8
Q

What is the learned helplessness theory?

A

connects depression to experiencing uncontrollable events

those with depression may have internal causal explantations which produce self esteem loss after adverse external event

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9
Q

Who is generally effected by major depressive disorder?

A

76% americans >12 yrs

Female > male

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10
Q

What do pts with MDD usually present with?

A

some other complaint

don’t usually present with depression

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11
Q

How do you dx MDD?

A

based on hx and PE

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12
Q

Why do you need to perform a full medical evaluation on pts with MDD?

A

to r/o infection, medication effect, endocrine disorder, tumor, neurologic disorder

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13
Q

What might you see on PE for a pt with MDD?

A

decline in grooming/hygiene, weight can change, flat affect, psychomotor agitation

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14
Q

What screen tools can you use for MDD?

A

2-question test

Patient health questionnaire-9

Beck depression inventory

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15
Q

Work up for MDD?

A

lab study to r/o organic causes, neuroimaging

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16
Q

How can we treat MDD?

A

meds

psychotherapy

cognitive behavioral therapy

electroconvulsive therapy

bright light therapy

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17
Q

What medications can be used to treat MDD?

A

SSRIs, SNRIs, atypical antidepressants, SDAMs, tricyclic antidepressants, MOAIs, St. John’s Work

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18
Q

SSRI

A

Selective Serotonin Reuptake Inhibitor

Ex. Citalopram (Celexa), Escitalopram (Lexapro), Fluoxetin

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19
Q

SNRI

A

Serotonin/norepinephrine Reuptake Inhibitors

Ex. Venlafaxine, Desvenlafaxine, Duloxetine

20
Q

Atypical antidepressants

A

Bupropion, Mirtazapine, Trazodone

21
Q

SDAM

A

Serotin-Dopamine Activity Modulators

Ex. Brexpiprazole, Aripiprazole

22
Q

Tricyclic Antidepressants (TCAs)

A

Ex. Amitriptyline, Clomipramine, Desipramine

23
Q

MAOIs

A

Monoamine Oxidase Inhibitors

Ex. Isocarboxazid, Phenelzine, Selegiline

24
Q

St. John’s Wort

A

Hypericum perforatum

herbal remedy OTC

may act as SSRI

mild - mod depression sxs

25
Q

What is electroconvulsive therapy?

A

highly effective, rapid antidepressant response, used in pts who fail drug therapies

26
Q

What is bright light therapy?

A

treats seasonal affective disorder

30-90 mins within 1 hr of awakening

often combined with conventional medical therapy

can precipitate manic or hypomanic episode

27
Q

What is the most significant risk factor for suicide?

A

past suicide attempt

28
Q

When should you hospitalize pts with MDD?

A

SI/HI, severe depression, gross thought disorganization, inability to care for self, failing medical status

29
Q

Dysthymia aka…

A

Persistent depressive disorder

30
Q

What is dysthymia?

A

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”

31
Q

Characteristics of dysthymia

A

ongoing for at least 2 yrs

insidious onset (childhood/adolescence)

persistent

fam hx

32
Q

If a pt has met the criteria for both MDD and dysthymia, which dx should they receive?

A

MDD

33
Q

Dysthymia epidemiology

A

5-6% of gen pop

coexists with other psychiatric illness

no gender difference

34
Q

How do we treat dysthymia?

A

pharmacotherapy and psychotherapy

35
Q

What is Premenstrual Dysphoric Disorder (PMDD)

A

mood lability, irritability, dysphoria and anxiety sxs occurring repeatedly during time before onset of menstrual period

36
Q

Treatment of PMDD?

A

support/education about disorder

treat sxs

SSRIs and benzodiazepines

37
Q

What is substance/medication-Induced Depressive Disorder

A

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

38
Q

What are some depression co-morbidities?

A

heart disease, breast CA, immunological disease, chronic pain, multiple psychical disorders

39
Q

Pts with one lifetime episode of MDD who achieve remission on antidepressants should continue taking them for…

A

another 6-12 months

40
Q

Pts with 2 or more lifetime episode of MDD who achieve remission on antidepressants should continue taking them for..

A

15 months to 3 years

41
Q

Pts with chronic MDD or with concurrent dysthymia who achieve remission on antidepressants should continue taking them for..

A

15 months to 28 months

42
Q

How long can it take for pts to see improvement on antidepressants?

A

2-6 wks

43
Q

How often should you FU with pts on antidepressants?

A

after 1st month and then every 4-6 wks until stable

individualize based on pt

44
Q

What can we do to improve pts adherence to medications?

A

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

45
Q

How long should you trial a new medication?

A

8-12 wks

if tolerated increase dose every 2-4 weeks until remission achieved, max dose

Clinical Disciplines (Melicia) (9 decks)

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