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Behavioral Health > Depression: Dr. Kelso > Flashcards

Depression: Dr. Kelso Flashcards

1
Q

Factors in Depression Pathogenesis

A 
Genetics
Early life adversity
Social factors
Psychological factors
Secondary depression
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2
Q

Reasons for Secondary Depression

A

General medical disorders
Medications
Substance of abuse

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3
Q

Define Epigenetics

A

Changes in expression of genes caused by early life experiences or chronic stress

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4
Q

How does early life adversity potentially lead to depression?

A

Predisposes to major depression by altering sensitivity to stress and response to negative stimuli

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5
Q

Social factors that could play into depression

A

Isolation
Poor social relationships
Criticism from family members
Depression in social networks

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6
Q

Psychological factors that may lead to depression

A

Cognitive/Behavioral: negative/distorted patterns of thinking
Personality: neuroticism
Psychodynamic: early losses, interpersonal relationships

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7
Q

Symptoms of Neuroticism

A 
Anxiety
Moodiness
Envy
Frustration
Loneliness
Respond poorly to stressors
Interpret ordinary situations as threatening
Minor frustrations as hopelessly difficult
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8
Q

Medical Conditions that may Lead to Depression

A 
Sleep apnea
Hypothyroidism
Vitamin D deficiency
DM
Chronic pain
Stroke
HD: ischemic, HF, cardiomyopathy
Parkinson's 
MS
Epilepsy
Head injury
CA
COPD
Dementia
HIV/Neurosyphilis
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9
Q

Medications that may Lead to Depression

A 
Interferon
Corticosteroids
Benzodiazepines
Opioids
Varenicline (Chantix)
Beta-blockers
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10
Q

Drugs of Abuse that may Lead to Depression

A 
PCP (withdrawal)
Amphetamines (withdrawal)
Cocaine (withdrawal)
Marijuana (withdrawal)
Sedative-hypnotics (intoxication)
Alcohol (intoxication)
Opiates (intoxication)
Steroids (intoxication)
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11
Q

Neurobiology of Depression

A

Altered brain structure and function

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12
Q

Altered Brain Structure in Depression

A

Increased ventricular-brain ratio
Smaller frontal lobe volumes
Smaller hippocampal volumes
Number/density/size of neurons and glial cells are abnormal

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13
Q

Altered Brain Function in Depression

A

Abnormal functioning of monoamines, GABA, glutamate
HPA axis- excess excretion of glucocorticoids may lead to suppression of neurogenesis & hippocampal atrophy
Abnormal neuronal networks
Sleep/circadian rhythms
Inflammation

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14
Q

Categories of Symptoms of Major Depression

A

Psychologica
Neurovegetative
Psychomotor/physical

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15
Q

Psychological Symptoms of Major Depression

A 
Depressed mood
Numbness
Anhedonia: inability to experience joy
Decreased interest
Irritability/anxiety
Guilt/worthlessness
Suicidal ideation
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16
Q

Neurovegetative Symptoms of Major Depression

A

Appetite
Sleep
Energy
Concentration

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17
Q

Psychomotor/Physical Symptoms of Major Depression

A

Psychomotor: retardation, agitation
Physical: aches/pain, weakness/malaise, GI distress

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18
Q

Qualifying Symptoms for Major Depression

A

Occur in same two weeks
Most of the day, every day
Distress or impairment
R/O substances, general medical condition, bereavement

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19
Q

Subtypes of Depression

A 
Anxious
Atypical
Catatonic
Melancholic
Mixed Features
Peripartum
Psychotic
Seasonal
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20
Q

Subcategories of Depression

A

Bipolar

Secondary: medical illness, medications, drugs of abuse

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21
Q

Co-morbid Psychiatric Conditions with Depression

A

Anxiety: generalized, panic disorder, OCD, PTSD

Substance abuse

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22
Q

What does SIGECAPY stand for?

A 
S: sleep
I: interest
G: guilt/worthlessness
E: energy
C: concentration
A: appetite
P: psychomotor disturbance
S: suicidal ideation
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23
Q

Evaluation of Depression

A 
Chronology of symptoms
Symptoms in the same two weeks
Most of the day, every day
Distress or impairment
Prior Hx of depressive episodes
Impact on functioning
Alleviating/aggravating factors
Address co-morbidity
Mania/hypomania
Distinguish major depression from persistent depressive disorder
Suicide risk
General medical illness
Family Hx: depression, suicide, psychosis, bipolar
Social Hx: interpersonal, occupational, financial stressors
\+/- complete physical & euro exam
MMSE
Toxicological screen
Lab screen: CBC, TSH, LFT's, chem7, Ca, B12, Folate, HIV 
Brain imaging
\+/- EEG, LP
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24
Q

Types of Psychotic Features

A 
Delusions
Hallucinations
Disordered though
20% of patients
Higher suicide risk
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25
Q

Suicide Risk Factors: SAD PERSONS

A 
S: sex (male)
A: age
D: depression
P: previous suicide attempts
E: ETOH abuse
R: rational thinking loss
S: social supports lacking
O: organized plan
N: no spouse
S: sickness
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26
Q

When to hospitalize a patient with psychosis?

A

Plan
Intent
Plan

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27
Q

Possible Safety Treatment Plan Items

A

Crisis Numbers
ROI for family in chart
Commitment to adhere to meds, appts., contact office with concerns
Agree to remove lethal means

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28
Q

Alcohol CAGE Screening

A

C: cut down on drinking
A: annoyed by people criticizing your drinking
G: guilty about your drinking
E: eye opener

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29
Q

Other Scales to Screen for Depression

A

Beck depression inventory
Quick inventory of depressive symptomatology
Mood disorder questionnaire
Hamilton anxiety rating scale

30
Q

Mental Status Exam Observation

A 
Affect
Cognition
Psychomotor activity
Ruminative thought process
Speech
Psychosis
Suicidal thoughts
31
Q

Antidepressant Classes

A 
SSRI
SNRI
TCA
MAOI
Others: mirtazapine, buproprion, trazodone
Atypical Antipsychotics
32
Q

Examples of SSRI’s

A 
Fluvoxamine (Luvox)
Paroxetine (Paxil)
Sertraline (Zoloft)
Citalopram (Celexa)
Escitalopram (Lexapro)
FLuoxetine (Prozac)
33
Q

Antidepressant SE

A 
GI disturbance: nausea, diarrhea, appetite
Sexual dysfunction
Anxiety
Insomnia or sedation
Sweating
Dizziness
34
Q

Examples of SNRI’s

A

Venlafaxine (Effexor)

Duloxetine (Cymbalta)

35
Q

Examples of TCAs

A

Amitriptyline
Clomipramine
Doxepin
Imipramine

36
Q

TCA SE

A

Anticholinergic
Antihistamine
Orthostatic hypotension
Cardiac

37
Q

TCA Overdose

A

Lethal

38
Q

Examples of MAOI’s

A

Phenelzine (Nardil)

Tranylcypromine (Parnate)

39
Q

What are the Drug-Druge Interactions with MAOIs

A

Serotonin syndrome

HTN crisis

40
Q

What are the dietary restrictions for MAOIs?

A

Avoid tyramine containing foods

41
Q

SE of Trazodone

A

Sedation
Orthostasis
Priapism
Piloerection

42
Q

Buproprion Considerations

A 
Avoid seizure disorders
Avoid in bulimia
Enhances dopamine: anxiety, psychosis, dopaminergic agents
No sexual side effects
Smoking cessation
Co-morbid ADHD
Often used with SSRIs
Consider with sleepy, slowed down patients
Preg. Cat. B
43
Q

Mirtazapine Considerations

A

Sedation
Weight gain: good for chemo/elderly patients
Less sexual side effects
Good for patients with nausea

44
Q

Positive Predictors of Depression Remission

A

Caucasian
Female
Employed
Education

45
Q

Negative Predictors of Depression Remission

A 
Longer index episodes
Drug abuse
Anxiety disorders
Medical disorders
Lower functioning
46
Q

Positives of Remission in Depression

A

Return of normal functioning
Lower rates of relapse
Lower risk of suicide
Less ETOH & drug abuse

47
Q

Acute Treatment of Mild Depression

A

Psychotherapy alone

48
Q

Acute Treatment of Moderate-Severe Depression

A

Medication

+/- therapy

49
Q

Acute Treatment of Bipolar Disorder

A

Mood stabilizer

+/- antidepressant

50
Q

Acute Treatment of Psychotic Disorder

A

Antipsychotic

Antidepressant

51
Q

Continuation Phase of Depression Treatment

A

4-6 months following remission
High risk for relapse
Use full therapeutic dosage

52
Q

Maintenance Phase of Depression Treatment

A

Risk of recurrence: #/severity previous episodes, residual symptoms, co-morbid disorders
Patient preference
SE

53
Q

Education on Antidepressant Medication

A

Minimum 2-4 weeks to be effective
Take every day
Duration: at least 4-6 months
SE: time dependent

54
Q

General Principles of Depression Treatment

A 
Titrate to target dose
Monitor for SE
Monitor adherence
No improvement: consider switch
Limited response: consider increase or augmentation
SE: switch or augment
55
Q

Factors in Choosing an Antidepressant

A 
Personal history
Pharmacogenetics
Family history
Cost
Overdose/safety
SE/unique benefits
Drug-drug interactions
Co-morbid conditions
Depression subtypes
56
Q

Define Pharmacogenetics

A

Study of the role of genetic variation on drug response

57
Q

Cheap Antidepressants

A 
Citalopram
Paroxetine
Fluoxetine
Sertraline
Burprion SR, XL
Mirtazapine
58
Q

More Expensive Antidepressants

A

Escitalopram
Bupropion XL
Venlafaxine XR
Duloxetine

59
Q

TCA Overdose

A

Highly lethal

60
Q

Lithium Overdose

A

Lethal

61
Q

Process of Dealing with SE of Antidepressants

A

Wait
Lower dose, slow titration
Change dosing schedule
Augment

62
Q

Process for Dealing with Sexual SE

A

Drug holiday
Augment
Lower dose
Wait

63
Q

Which Benzodiazepines better than others for abuse potential?

A

Clonazepam

Lorazepam

64
Q

Discontinuation of Antidepressants

A 
Nausea
Headache
Irritability
Vivid dreams
Vertigo
Slower taper +/- benzodiazepine
65
Q

SSRI Drug Interactions

A

Fluoxetine
Paroxetine
Fluvoxamine
Least interactions: escitalopram

66
Q

Depression Subtypes

A

Psychotic depression

Bipolar depression

67
Q

Psychotic Depression

A

Higher remission with combination of antidepressant & antipsychotic

68
Q

Bipolar Depression

A

30-50% risk of cycling into mania on antidepressant without a mood stabilizer

69
Q

Types of Psychotherapy

A

CBT: understand distortions in thinking; learn new coping strategy
IPT: grief, role transition/role dispute
interpersonal deficits

70
Q

Augmentation Strategies

A 
Bibliotherapy: self help books
Relaxation techniques
Meditation
Exercise
Apps/support groups/ telepsychology

Behavioral Health (25 decks)

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