depression Flashcards

1
Q

Half of all lifetime mental disorders begin by age ____.

A

14

twice as common in girls

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2
Q

Difficult to distinguish between _________ and _________ adolescent growth and development.

A

depression and “normal”

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3
Q

What is the leading cause of suicidal behavior and suicide?

A

Depression

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4
Q
psychosocial dysfunction manifested by: 
Severe sadness
Withdrawn behavior
Boredom
Low self-esteem
Feeling helpless and hopeless
Sense that there is no meaning in life
A

Definition of major depression

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5
Q

Criteria for major depressive disorder by DSM-V includes
_____or more of the following symptoms must be present during same ________ period; at least one of the symptoms is depressed mood or loss of interest or pleasure:
Depressed or irritable mood
Diminished interest or pleasure in activities
Weight change or appetite disturbance
Insomnia or hypersomnia
Psychomotor agitation or retardation
Fatigue or loss of energy
Feelings of worthlessness or guilt
Disturbed concentration or indecisiveness
Recurrent thoughts of death, suicidal ideation, or suicide attempt

A

five or more symptoms

during same 2 week period of time

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6
Q

What is the DSM-5 Criteria for Persistent Depressive Disorder (Dysthymia)?

A

An overwhelming, chronic state of depression
A depressed mood most days for at least two years; baseline irritable or depressed
Must not have gone for more than two months without two or more of the following symptoms:
Poor appetite or overeating
Insomnia or hypersomnia
Low energy
Low self-esteem
Difficulty making decisions
Feelings of hopelessness

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7
Q

Is family history a significant risk factor?

A

YES

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8
Q

What are clinical manifestations of depression in infants and young children?

A

Unable to verbalize feelings
Can present with:
Pattern of depressed affect, lack of pleasure; should be noted across settings, activities, and relationships
Failure to thrive
Developmental delays such as speech and motor
Repetitive self-soothing behaviors such as rocking
Poor attachment behaviors
Loss of developmental skills

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9
Q

What are clinical manifestations of depression in Toddlers and Preschoolers?

A
Unable to verbalize feelings
Can present with: 
Lack of energy
Eagerness to please, tendency to cling
Separation problems that are persistent and intense
Sadness, irritability, lack of pleasure
Poor appetite and weight loss
Sleep issues
Loss of developmental milestones or regression of behavior
Increased physical complaints
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10
Q

What are clinical manifestations of depression in school aged children?

A
Able to verbalize feelings, but not always willing to
Can present with: 
Irritability, anger, hostility
Hyperactivity, reckless behavior
Difficulty handling feelings
Frequent absences, school phobia
Feelings of anger, upset, sadness
Loss of interest and pleasure in usual activities
Describing themselves in negative terms
Feeling guilty about behaviors
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11
Q

What are clinical manifestations of depression in adolescents?

A
Stressed about separation from family, college decisions, school pressures, behavior choices
Cognitive development allows for more mature feelings of despair, blame, guilt, self-hate; capable of abstract thinking and recognizing feelings (Piaget)
Can present with: 
Decreased interest or pleasure
Withdrawal
Hopelessness
Changes in weight or appetite
Changes in sleep patterns
Substance abuse or self-medication
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12
Q

What is the most important part of diagnosing depression in children and adolescents?

A

History and Assessment

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13
Q

What standardized screening tools can be used in assessing children or adults for depression?

A

Child Behavior Checklist, 4–18 years
Children’s Depression Rating Scale, 6–12 years
Beck Depression Inventory: adolescents and adults
PHQ-9 (PHQ-2)
HEADSS: adolescents screening tool

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14
Q

What is the strongest predictor for suicide?

A

Suicide ideation or attempts: strongest predictor is a previous attempt

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15
Q

What are some differentials for depression?

A
Anemia
Chronic fatigue
Eating disorder
Endocrine disorder
Hypothyroidism
Chronic infection
Substance abuse: alcohol, marijuana, cocaine
Medications: some antihypertensives, clonidine, phenobarbital
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16
Q

What is the black box warning on SSRI medications?

A

Increased risk for suicide and suicidal ideation in individuals under the age of 25 taking SSRIs
***However the benefits outweigh the risks.

17
Q

What is the best treatment for depression?

A

Cognitive behavioral therapy (psychotherapy)

Medication

18
Q

Which medication is considered first line in the treatment of depression?

A

SSRIs

19
Q

If no benefit after ________, consider another medication

A

4 weeks

20
Q

If mild response, consider continuing for ________ to optimize response

A

10 weeks

21
Q

what is the duration of treatment for children/adolescents?

A

up to a year.

22
Q

How long should a child be symptom-free before decreasing dose?

A

for 3 months

23
Q

How long are children treated for depression?

A

Usually 6–9 months, up to 12 months, until child demonstrates a normal mood level
Taper antidepressant slowly
**Depression should be treated for a minimum of SIX months.

24
Q

Which anti-depressants should not be used for childhood/adolescent depression.

A

Tricyclic antidepressants

25
Q

What is the only FDA-approved medication for depression in children/adolescents.

A

Prozac

26
Q

What are some common comorbidities seen in patients with depression?

A

panic attacks
bulimia or anorexia
OCD
frequent mood swings

27
Q

Which medical illnesses can mimic depression?

A
hypothyroidism
dementia
low blood sugar 
vitamin D deficiency
caffeine withdrawal
28
Q

T/F: Every patient should be tried off an antidepressant at 12 months

A

TRUE

29
Q

What is a herbal medication that individuals use for treatment of depression?

A

St. John’s wort

30
Q

Can St. John’s Wort decrease estrogen in birth control and hormone therapy?

A

YES

31
Q

Can you combine St. John’s Wort with other anti-depressants?

A

NO