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Behavioral Health > Depression > Flashcards

Depression Flashcards

1
Q

lifetime incidence of major depressive disorder in women vs. men

A

women: 20%
men: 12%

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2
Q

demographics of depression in non-Hispanic black patients and white patients

A

Non-Hispanic blacks are 40% less likely than non-hispanic whites to have MDD during their lifetime

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3
Q

Describe what is known of the pathophysiology of depression using the terms heterogeneous disorder, neurotransmitter availability and receptor regulation

A

Depression is a clinically and etiologically heterogeneous disorder that involves a complex interaction b/w neurotransmitter availability and receptor regulation/sensitivity in the brain

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4
Q

biogenic amine hypothesis

A

hypothesis states the depression is caused by a deficiency of monoamines, particularly norepinephrine and serotonin, in the brain. Those NTs are thought to be key in control of mood and emotional behavior

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5
Q

Permissive Hypothesis

A

states that control of emotional behavior results from a balance b/w NE and serotonin in the brain. This theory postulates that serotonin regulates brain levels of NE.

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6
Q

State the purported roles of serotonin and norepinephrine in the pathophysiology of depression

A
  • If serotonin can’t control NE and NE falls to abnormally low levels, the patient becomes depressed
  • If the level of serotonin falls and the level of NE becomes abnormally high the patient becomes manic
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7
Q

Identify the neurobiological hypotheses for major depressive disorders

A
  • Genetic vulnerability
  • Altered HPA axis activity
  • Deficiency of monoamines
  • Dysfunction of specific brain regions
  • Neurotoxic and neurotrophic processes
  • Reduced GABAergic activity
  • Dysregulation of glutamate system
  • Impaired circadian rhythms
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8
Q

DSM-5 diagnostic criteria for a major depressive disorder

A

•At least 5 of the following sx must have been present during the same 2 week period and represent a change from previous functioning
•At least one of the sx is either:
oDepressed mood
oLoss of pleasure or interest
•Possible other sx:
oDepressed mood
oDiminished interest or pleasure
oSignificant weight loss or gain
oInsomnia or hypersomnia
oPsychomotor agitation or retardation
oFatigue or loss of energy
oFeelings of worthlessness or inappropriate guilt
oDiminished ability to think or concentrate or indecisiveness
oRecurrent thoughts of death, suicidal ideation w/o a specific plan, suicide attempt, or specific plan for suicide
•These sx must cause clinically significant distress or impairment in social, occupational, or other important areas of functioning
•Sx aren’t d/t the direct physiologic effects of a substance or another medical condition
•The sx aren’t accounted for by bereavement; Not better explained by schizoaffective disorder, schizophrenia, schizophreniform, delusional, or other psychotic disorder; Has never been a manic or hypomanic episode

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9
Q

affect and dysphoria in grief

A
  • Affect: emptiness and loss
  • Dysphoria: likely to decrease intensity over days to weeks and occurs in waves (the pangs of grief). The waves tend to be associated w/ thoughts or reminders of the deceased. The pain of grief may be accompanied by positive emotions and humor.
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10
Q

affect and dysphoria in MDE

A
  • Affect: persistent depressed mood and the inability to anticipate happiness or pleasure
  • Dysphoria: pervasive unhappiness and misery
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11
Q

thought content in grief

A

generally features a preoccupation w/ thoughts and memories of the deceased

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12
Q

thought content in MDE

A

self-critical or pessimistic ruminations

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13
Q

self worth and self derogatory ideation in grief

A
  • Self worth: self-esteem is generally preserved
  • Self-derogatory ideation: if present in grief, it typically involves perceived failing towards the deceased (not visiting or saying I love you enough)
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14
Q

self worth and self derogatory ideation in MDE

A
  • Self-worth: feelings of worthlessness and self loathing

- Self-derogatory ideation: pretty much all of the time

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15
Q

thoughts about death in grief

A

generally focused on the deceased and possibly about “joining” the deceased

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16
Q

thoughts about death in MDE

A

thoughts are focused on ending one’s own life b/c of feeling worthless, undeserving of life, or unable to cope with pain of depression

17
Q

Identify features of the atypical presentation of depression in children and adolescents

A
  • May not initially present w/ a complaint of low mood or other typical sx
  • The presenting complaints may be somatic such as fatigue, HA, abdominal pain, and weight change
  • The patient may complain more of irritability or anger (more in children and adolescents)
18
Q

features associated with lower recovery rates in those with major depressive disorder

A
  • Longer duration of the current episode
  • Psychotic features
  • Prominent anxiety
  • Personality disorders
  • Sx severity
19
Q

state the factors increasing the risk for recurrence of a major depressive episode

A
  • Those w/ a preceding severe episode
  • Younger individuals
  • Those who have experienced multiple
  • Those w/ even mild sx during remission
20
Q

State symptoms of a major depressive episode seen more commonly in younger patients

A
  • Hypersomnia
  • Hyperphagia
  • Anger
  • Irritability
21
Q

State symptoms of a major depressive episode seen more commonly in older patients

A
  • Melancholic sx
  • Psychomotor disturbances
  • Suicide attempts lessen
22
Q

what disorders commonly present with depression?

A

anxiety disorders

23
Q

DSM-5 diagnostic criteria for persistent depressive disorder (dysthymia)

A

•Depressed mood for at least 2 years
•Presence while depressed of 2 or more of the following:
oPoor appetite or overeating
oInsomnia or hypersomnia
oLow energy or fatigue
oLow self-esteem
oPoor concentration or difficulty making decisions
oFeelings of hopelessness
•Never w/o the sx of depressed mood or the 2 or more additional sx for more than 2 months at a time
•Never had a manic or hypomanic episode
•Sx not explained by another psychiatric disorder
•Sx not attributable to a substance or other medical condition
•The sx cause clinically significant distress or impairment in social, occupational, or other important areas of functioning
•Following sx of MDD are NOT present in PDD:
oMarkedly diminished interest or pleasure in all or almost all activities
oSignificant weight loss or weight gain
oPsychomotor agitation or retardation
oRecurrent thoughts of death, recurrent suicidal ideation w/o a plan, a suicide attempt or a specific plan for committing suicide

24
Q

DSM-5 diagnostic criteria for premenstrual dysphoric disorder

A

•In the majority of menstrual cycles in the preceding year, at least 5 sx must be present in the final week before the onset of menses, start to improve w/i a few days after the onset of menses, and become minimal or absent in the week post-menses
•One of the following sx must be present:
o Marked affective lability
o Marked irritability or anger or increased interpersonal conflicts
o Marked depressed mood, feelings of hopelessness, or self-deprecating thoughts
o Marked anxiety, tension, and/or feelings of being keyed up or on edge
•One or more of the following sx must additionally be present, to reach a total of 5 sx when combined w/ the sx listed above:
o Decreased interest in usual activities
o Subjective difficulty in concentration
o Lethargy, easy fatigability, or marked lack of energy
o Marked change in appetite; overeating; or specific food cravings
o Hypersomnia or insomnia
o A sense of being overwhelmed or out of control
o Physical sx such as breast tenderness or swelling, joint of muscle pain, a sensation of “bloating” or weight gain

25
Q

State the usual findings in a psychiatric assessment of a patient with depression in appearance

A
  • Normal or

- Decline in grooming and hygiene

26
Q

State the usual findings in a psychiatric assessment of a patient with depression in affect

A
  • Psychomotor retardation and flat affect

- Psychomotor agitation or restlessness

27
Q

State the usual findings in a psychiatric assessment of a patient with depression in mood

A
  • Sadness
  • Heaviness
  • Numbness
  • Irritability
  • Mood swings
  • Overwhelmed
28
Q

State the usual findings in a psychiatric assessment of a patient with depression in thought process

A

Thinking is negative

29
Q

State the usual findings in a psychiatric assessment of a patient with depression in thought content

A
  • Feeling inadequate
  • Hopeless
  • Helpless
  • Worthless
  • Delusions sometimes but not often
30
Q

State the usual findings in a psychiatric assessment of a patient with depression in speech

A
  • Normal
  • Slow
  • Monotonic
  • Lacking spontaneity and content
31
Q

Identify the meaning of each letter in the acronym SIG E CAPS useful when questioning patients to determine if they are experiencing a major depressive episode

A
  • Sleep
  • Interest
  • Guilt
  • Energy
  • Concentration
  • Appetite
  • Psychomotor function
  • Suicide
32
Q

List four questionnaires that patients may complete to assist in determining if they are suffering from depression

A
  • Back depression inventory – most widely used
  • Zung depression scale
  • Patient health outcomes – 9 (PHQ-9)
  • Mood disorder questionnaire
33
Q

State the role of electroconvulsant therapy in the management of major depressive disorder

A
  • Used for pts w/ major depression unresponsive to antidepressant therapy and psychotherapy
  • Sometimes used when pts pose a severe threat to themselves or others
34
Q

State the effectiveness of psychotherapy relative to drug therapy in the management of depression

A
  • Has been shown to be at least as effective as medication in treatment of mild to moderate depression
  • May be used in combo w/ antidepressant drug therapy
35
Q

State the percent of patients discontinuing drug therapy for depression after 3 months

A

40-50%

36
Q

barriers to effective treatment of depression

A
  • Adherence
  • Finances and insurance
  • Patient-provider communication
37
Q

List potential reasons for treatment failures in patients with depression

A
  • Limited time in primary care practices to arrange for mental health referrals
  • Patients unwillingness to see a mental health professional
  • Regional lack of availability of mental health professionals
  • Physicians concerns about stigmatizing patients sending them to a shrink
  • Patients concerns about such stigmatization

Behavioral Health (11 decks)

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