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Psychiatry Terms > Depression > Flashcards

Depression Flashcards

subtypes

1
Q

Melancholic subtype responds classically to?

A

TCAs. Depression is worse in the early morning, hi risk of suicide.

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2
Q

Atypical features (4)

A

Hypersomnia, increased appetite or weight gain, leaden paralysis, sensitivity to interpersonal rejection.

Bipolar depressive episodes often look atypical.

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3
Q

Atypical subtype responds classically to?

A

MAOI’s.

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4
Q

Bereavement vs MDD

A

AVH can happen in bereavement, but are transient. Sustained in MDD. Bereavement is self-limited to 2 months, depression is sustained.

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5
Q

Which core depression symptom is not considered when diagnosing persistent depressive disorder?

A

suicidal ideation

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6
Q

Early onset persistent depressive disorder is highly comorbid with

A

Cluster B and C personality disorders.

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7
Q

Pathogenesis of PMDD

A

Fluctuations in estrogen and progesterone levels leads to serotonin deficiency.

Tx: SSRI, SNRI, calcium, mag, b6

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8
Q

Depression Theories

A

Low P11, GABA a receptors (brexanolone), glutamate , increased cortisol.

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9
Q

Dexamethasone Suppression Test in Depression

A

It normally suppresses endogenous glucocorticoids, but 50% of depressed people with melancholia will have non-supression. 80% in MDD with psychotic features.

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10
Q

Inflammatory markers in depression

A

Interleukins, Interferon gamma, TNF , CRP

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11
Q

Sleep:

  • REM latency
  • REM density
A

Reduced REM latency, increased REM density.

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12
Q

How long to treat after remission?

A

6-12 months at full dose (continuation) , then decide if maintenance treatment is indicated.

Very strongly recommended to continue maintenance if 3 episodes have happened. Use SAME DOSE as was used in acute and continuation treamtent.

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13
Q

Which TCA increases serotonin neurotransmission to the greatest extent?

A

Clomipramine

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14
Q

Most noradrenergic TCA?

A

Desipramine

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15
Q

Absolute contraindications to ECT?

A

None.

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16
Q

Pseudocholinesterase deficiency in ECT

A

Results in abnormally slow metabolism of exogenous choline ester drugs (succinylcholine)

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17
Q

Deaths with ECT

A

range is 1/10,000 to 1/50,000 based off texas data. Death could happen within 30 days of the ect, and was usually due to cardiac related complications.

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18
Q

Vagal Nerve Stimulation targets which vagal nerve?

A

Left, but the effects are bilateral

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19
Q

SSRI’s main birth defect

A

Persistent Pulmonary Hypertension in the newborn (PPHN) with any SSRI exposure after 20 weeks of pregnancy. 5 fold increase up to rate of 3/1000.

No increased risk of miscarriage.

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20
Q

SSRI rare birth defect

A

Neonatal Abstinence Syndrome. 30% of newborns get it who exposed to SSRI. 13% of those are sever and go to the ICU (1/313 babies) . Dehydration, temperature dysregulation, and seizures.

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21
Q

CAM alternative treatments for depression

A

1) St. Johns wort
2) Omega 3 fatty acids
3) SAM-E
4) Yoga

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22
Q

Nutritional Supplements for Depression

A

Folate, b12, homocysteine

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23
Q

Suicide biomarkers

A

1) Low 5-HIAA in lumbar csf associated with suicidal behavior
2) Tryptophan hydroxylase (TPH) genoypte L allele have increased risk of suicide.

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24
Q

Highest likelihood within the population to commit suicide

A

Eating disorders

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25
Q

Top 3 ways of committing suicide

A

1) Guns (51%)
2) Hanging (24%)
3) Poisoning/Overdose ( 16%)

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26
Q

When do SSRIs become protective against suicide?

A

In the elderly

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27
Q

Anticonvulsants and suicide risk

A

Increases risk slightly. 1 additional case of thought/behaviors per 530 patients

28
Q

Subthreshold Depression (minor depression)

A

Can be quite somatic. Linked to higher rates of disability.

29
Q

Ketamine MOA?

A

N-methyl-d-aspartate receptor antagonist

30
Q

Best predictor of post-operative depression for bariatric surgery?

A

Post-operative weight gain leads to increased depression (more than premorbid depression)

31
Q

Depression’s Pseudodementia

A

affective and vegetative changes associated with depression. The cognitive changes are usually brief, variable, and not associated with disorientation.

32
Q

Molecule dealing with the MOA of PMDD?

A

Dutasteride

33
Q

Risk factor for peripartum depression

A
  • More common in primiparous women
34
Q

Methyldopa

A

The correct response is methyldopa as there is significant evidence that they can induce or worsen depression through their impact on the central nervous depression. This occurrence is secondary to biogenic amine depletion and in turn variation in neurotransmitter levels and is known as medication-induced depressive disorder.

35
Q

SSRIS or MAOI’s have what effect on sleep?

A

Decrease the amount of REM sleep

36
Q

PMDD and additional sx

A

They crave sweet and salty food. However, there is no absolute weight gain seen.

37
Q

Between 2006 to 2017, the highest suicide rate was among adults aged?

A

between 45 and 54 years of age.

38
Q

Fetal heart rate and ECT in pregnant woman

A

If gestational age of the fetus is over 10 weeks, noninvasive monitoring of fetal heart rate should be done before and after each ECT treatment

39
Q

Why does the HAM-D get criticized?

A

The HAM-D has been criticized for giving too much weight to physical or neurovegetative symptoms, which may not be indicative of major depressive disorder in elderly or medically ill patients.

40
Q

Following ECT, what med combo has been proven to be the most effective for maintenance?

A

An RCT conducted in 2001 and another conducted in 2007 showed that the combination of nortriptyline and lithium was superior to placebo and nortriptyline alone for the prevention of relapse of major depressive disorder after a course of ECT

41
Q

Vagal nerve stimulation ant anterior cingulotomy

A

VNS can be used if ECT fails and pt doesnt want to try any more meds. Ant. Cingulotomy is more invasive .

42
Q

What is the time period for adjustment disorder?

A

3 months

43
Q

MAOI’s ok with surgery?

A

Yes, safe to continue

44
Q

Which blood pressure meds aren’t associated with depression?

A

ace inhibitors

45
Q

What med can be given for cancer related fatigue and loss of appetite?

A

Low dose methylphenidate has been shown helpful to improve cancer-related fatigue and appetite.

46
Q

Whats the association with hyperemesis gravidarum and depression/anxiety?

A

Depression and anxiety do not seem to affect the recurrence risk of hyperemesis gravidarum in subsequent pregnancies

47
Q

Only combined oral contraceptive pill that is FDA-approved and effective for the treatment of premenstrual dysphoric disorder (PMDD)?

A

Drospirenone/ethinyl estradiol is the only combined oral contraceptive pill that is FDA-approved and effective for the treatment of premenstrual dysphoric disorder (PMDD).

48
Q

Treatment for TCA overdose?

A

IV sodium bicarbonate, lipid emulsion, and plasmapheresis

49
Q

Minimum required seizure duration to have effectiveness?

A

A seizure duration of 20 to 40 seconds is considered to be the minimum necessary for efficacy in ECT.

50
Q

Which pulmonary drug can cause depression?

A

systemic corticosteroids. While there have been reports of suicidality with montelukast and other antileukotrienes, there is insufficient evidence to prove causality;

51
Q

Whats the timeline on adjustment disorder?

A

To diagnose an adjustment disorder, symptoms must develop within 3 months after the onset of the stressor(s) and resolve within 6 months of the termination of the stressor, unless the stressor is chronic or has enduring consequences, in which case the symptoms may persist longer than 6 months

52
Q

Best TCA to give to the elderly

A

Nortriptyline

53
Q

Melancholic flavor of depression

A

The correct response is major depressive disorder with melancholic features which presents with loss of pleasure in activities or lack of happiness in response to happy stimuli and 3 of the following: profound despondency or moroseness, depression particularly worse in the morning, early morning awakening, marked psychomotor retardation, significant anorexia or weight loss and inappropriate guilt

54
Q

How long do the boards want an SSRI trial to be before increasing or changing?

A

6-12 weeks

55
Q

What is FDA approved in fibromyalgia?

A

SNRI’s , including milnacipran.

56
Q

In the brain, what is the dif between bipolar vs unipolar depression

A

There is a reduction in the number of connections between pregenual anterior cingulate cortex, amygdala and dorsomedial thalamus in patients with bipolar depression as compared to unipolar depression. There is an increased activation of amygdala in patients with bipolar depression as compared to unipolar depression. There is an increased activation of dorsolateral as well as ventrolateral prefrontal cortex in patients with bipolar depression as compared to unipolar depression. There is an increased activation of caudate nucleus and putamen in patients with bipolar depression as compared to unipolar depression. In patients with bipolar depression as compared to unipolar depression there is an increase in the cross sectional area of corpus callosum.

57
Q

If an unstable epilepsy pt is depressed, how can you treat them?

A

ECT which can help raise the seizure threshold over time.

58
Q

Peripartum onset depression must be within how many weeks of delivery?

A

4

59
Q

What is the built in mechanism for TCA’s to treat depression?

A

SNRI’s

60
Q

Short duration depressive episode

A

Other Specified Depressive Disorder-short duration depressive episode as it is diagnosed when there is depressed effect with at least 4 of the 8 other criteria persisting for more than 4 but less than 14 days.

61
Q

Recurrent Brief Depression

A

Recurrent brief depression is incorrect as it is diagnosed when depressed mood is present for 2-13 days every month, not coinciding with the menstrual cycle, for at least 12 consecutive months.

62
Q

How do you diagnose PMDD in the office? What other info do you need?

A

The diagnosis is confirmed by prospective reporting of 2 consecutive symptomatic menstrual cycles.

63
Q

Paradoxical feeling side effect of MAOS.

A

Orthostatic hypotension. They actually cause that more commonly than htn.

64
Q

Risk factor for PMDD?

A

Inactivity

65
Q

Melancholic criteria for depression

A

loss of pleasure in all or almost all activities or lack of mood reactivity to usually pleasurable stimuli, and 3 or more of distinct quality of depressed mood (that is, distinctly different than the grief or sadness of bereavement, for example), depressed mood regularly worse in the morning, early morning awakening, marked psychomotor retardation or agitation, significant anorexia or weight loss, and excessive or inappropriate guilt.

66
Q

When must RAD manifest by?

A

9 months to 5 years of age

67
Q

What do PMDD patients crave?

A

Salts and sweets

Psychiatry Terms (33 decks)

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