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Emma H&N II > Depression > Flashcards

Depression Flashcards

1
Q

major depressive disorder (MDD) criteria

A

A) must have at least 5 of SIGECAPS during a 2 week period.
-at least 1 has to be depressed mood OR anhedonia
B) cause social/occupational impairment
C) not due to a substance or other medical condition

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2
Q

SIG E CAPS

A 
Sleep
Interest (anhedonia)
Guilt
Energy
Concentration
Appetite
Psychomotor agitation
Suicidality

Must have 5. 1 must be depressed mood or anhedonia

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3
Q

anhedonia

A
  • inability to experience pleasure
  • hallmark of MDD
  • no sex drive
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4
Q

terminal insomnia

A

-early morning awakenings

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5
Q

sleep latency

A

takes longer to actually fall asleep

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6
Q

things to screen for if suspect MDD

A
  • endocrinopathies (Cushings, Addisons, diabetes, hypoglycemia, thyroid issues)
  • stroke patients
  • substance induced mood disorders
  • pancreatic cancer
  • carcinoid syndrome
  • Parkinsons
  • collagen vascular diseases
  • viral illness (mono)
  • heart disease
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7
Q

MDD: peak age of onset

A

in the 20s

-can occur at any age

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8
Q

MDD: lifetime prevalence

A

10-15% (worldwide)

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9
Q

factors contributing to MDD

A
  • decreased levels of serotonin in brain
  • high cortisol levels
  • genetics
  • psychosocial events
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10
Q

MDD vs bereavement

A
  • same clinical presentation of SIGECAPS
  • MDD has PERSISTENT symptoms, while bereavement symptoms wax and wane
  • MDD can last more than a year, bereavement is usually less
  • MDD more common feelings of guilt
  • MDD tx includes support and meds, while bereavement is just support (no meds)
  • MDD has suicidality, bereavement does not
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11
Q

leaden paralysis

A

-heavy feelings in arms/legs

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12
Q

non pharmacologic treatments for MDD

A

PSYCHOTHERAPY

  • CBT
  • supportive therapy
  • interpersonal psychotherapy
  • psychodynamic psychotherapy
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13
Q

pharmacologic treatment of MDD

A
  • SSRIs
  • SNRIs
  • TCAs
  • MAOIs
  • misc antidepressants
  • second generation antipsychotics
  • electroconvulsive therapy
  • transcranial magnetic stimulation (TMS)
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14
Q

SSRIs

A
  • first line Tx for MDD
  • take 4-6 WEEKS to achieve max efficacy
  • most common side effect: GI disturbances
  • most reported side effect: sexual dysfunction
  • other side fx: headaches, rebound anxiety, weight gain, vivid dreams
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15
Q

SNRIs

A
  • 2nd line agents after ineffective Tx with SSRIs
  • increased NE causes HYPERTENSION
  • also used for neuropathic pain
  • takes 4-6 weeks to reach max clinical efficacy
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16
Q

TCAs

A
  • original MDD Tx
  • overdose: lethal cardiac arrythmias
  • cause sedation, weight gain, QT prolongation, orthostatic hypertension, anticholinergic fx
  • now used for neuropathic pain, migraines, enuresis, OCD
17
Q

MAOIs

A
  • rarely used for MDD (old)
  • risk of hypertensive crisis
  • don’t take with tyramine
  • risk of serotonin syndrome, orthostatic hypotension
18
Q

ECT

A
  • controlled seizures to restart the brain
  • given if pt cannot tolerate pharmacologic Tx
  • can cause anterograde and retrograde amnesia (transient, resolves)
19
Q

Transcranial Magnetic Stimulation (TMS)

A
  • new

- FDA approved for MDD

20
Q

dysthymia

A

Persistent Depressive Disorder
A) depressed mood for most days for at least 2 YEARS
B) 2+ of:
-poor appetite/overeating
-insomnia/hypersomnia
-low energy
-low self esteem
-poor concentration
-feelings of HOPELESSNESS*
C) not been without symptoms for more than 2 months
D) not due to side fx of a substance/condition
E) social/occupational impairment or distress

*distinguishing feature

21
Q

treatment of dysthymia

A
  • same as MDD

- SSRIs not used as often

22
Q

manic-depressive illness (MDI)

A

OUTDATED (pre-1980, both bipolar and MDD were under this single diagnosis.)

MDI meant the present of recurrent manic OR depressive episodes.

It is NOT the same thing as bipolar illness, which means the presence of manic AND depressive episodes. In other words, MDI means bipolar disorder PLUS MDD, not just bipolar disorder.

23
Q

episode of depression

vs.

chronic depression

A

episode of depression –> 2 wks of depressive sx (SIGECAPS)

chronic depression –> persistent sx that have not remitted for over 6 mo.

24
Q

Which sx distinguishes dysthymia from MDD?

A

dysthymia includes feelings of HOPELESSNESS

25
Q

disruptive mood dysregulation disorder

A
  • out of proportion temper outbursts, inconsistent w/ developmental level
  • outbursts 3+/ week
  • mood between outbursts –> persistently irritable
  • sx for 12mo.
  • sx in 2/3 settings and severe in at least 1
  • dx between 6-18 y/o
  • age of onset before 10 y/o

Emma H&N II (49 decks)

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