Depression, Bipolar, and other Mood D/o Flashcards
Median age of onset for Depression: Persistent depressive d/o: Bipolar I: Bipolar II:
Depression: 32 y/o
Persistent depressive d/o: 31 y/o
Bipolar I: teens to 20’s (mean = 18 y/o)
Bipolar II: mid 20’s
General mood disorders are usually episodic and demarcated by either _______ or______
Switching to opposite state (manic to depressive) or 2 months or more of partial/full remission after an episode
Major Depressive D/o (MDD) dx criteria needs ____ out of _____ sx over a _____ week period and one of those sx must be either ________ or ______
5/9 sx over a 2 week period
anhedonia or depressed mood (subjective or observed)
Can a dx of MDD be made if the pt has evidence of mania, hypomania or a mixed episode?
No
In elderly pts with MDD, they may present with what type of new sx?
Elderly will often manifest new somatic complaints
__(fraction)__ of severely depressed pts may have psychotic sx (i.e. voices)
1/5
What is a very common complaint in patients with MDD?
Insomnia
Name the insomnia type!
______ insomnia: difficulty falling asleep, tossing and turning
______ insomnia: early morning awakening, unable to return to sleep
______ insomnia: awakening in middle of the night, up for a few hrs, back to sleep
Initial
Terminal
Middle
Which type of insomnia is associated with severe depression?
Terminal insomnia
Do pts with MDD feel worse after waking/later in the day?
Do pts with MDD feel better after waking/later in the day?
Often a diurnal variation
pts feel their worst/hopeless upon wakening and gradually feel better throughout the day
What would the lab workup look like for a pt with MDD?
CBC, thyroid fxn, LFT, electrolytes, B12, folate, UA, urine drug screen
Additional screening: Neuro consult, CXR, EKG, CT
Does MDD begin suddenly or gradually?
Both!
___-___% all pts hospitalized for depression will successfully commit suicide
10-15%
Risk factors for committing suicide in pts with MDD?
Divorced, living alone, EtOH/substance abuse, >40 y/o, previous suicide attempt, expressing SI
Even w/o tx, most cases of MDD resolve spontaneously in ___ mo
6 mo
Tx for Light-moderate MDD –> …
Tx for Mod-severe MDD –> …
Tx for Depression w/ psychotic features –> …. gold standard?
Tx for Light-moderate MDD: Psychotherapy, meds depending on pt preference
Mod-severe: Meds w/ or w/o psychotherapy, electroconvulsive therapy (ECT)
Dep w/ psych features: Combo antidepressant + antipsychotic
gold standard→ ECT
What are 1st line pharmacotherapy options for tx of MDD?
SSRIs: fluoxetine, citalopram, escitalopram, sertraline, paroxetine
SNRIs: Venlafaxine, duloxetine
TCAs: amitriptyline, nortriptyline, imipramine, desipramine
Many pts with MDD who are receiving pharmacotherapy tx, will show improvement in __-__ wks, but continue first med choice for at least __-__ wks before increasing dose or changing to a different antidepressant
1-2 wks
4-8 wks
What is ECT? Is it approved for tx of MDD?
Electroconvulsive therapy; Yes
80-90% remission rate; 50-80% relapse rate (6 mos out
Side Effects: MSK, HA, memory impairment)
What are some “other” options for tx of MDD?
Light therapy if seasonal component, social therapy, vocational rehab, social skills training
Is Persistent Depressive D/o (Dysthymia) more common in men or women?
Female > Male (2-3:1)
What is the dx criteria for Persistent Depressive D/o (Dysthymia)?
Depressed mood for at least 2 yrs, more days than not
Never w/o the sx for >2 mo at one time
x2 of the x6 sx
No Major Depressive Episode (MDE) is present for the first 2 yrs
How do you tx Dysthymia?
Tx w/ psychotherapy and possibly antidepressants
What is a manic episode defined as?
Abnormal persistent elevated, expansive or irritable mood lasting at least 1 wk
Any duration of elevated mood if hospitalization is required
At least x3 of the listed sx (x4 if mood is irritable)
