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Behavioral Health > Depressive Disorders 1 > Flashcards

Depressive Disorders 1 Flashcards

1
Q

What are the main risk factors of depression?

A

Family history
Female
Peaks in 20s

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2
Q

What is the pathophysiology of depression?

A

Alteration in neurotransmitters

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3
Q

What is a common secondary physiology of depression?

A

Endocrine

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4
Q

What patient demographic has higher rates of suicide?

A

Males

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5
Q

What health questionnaire is used for depression screening?

A

PHQ 2 -> PHQ 9

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6
Q

Diagnostic Criteria for MDD:

-At least ______, almost every day for at least 2 weeks

-1 symptom must be depressive mood or anhedonia

Symptoms:
Depressed mood
Fatigue
Weight change
Sleep disturbances
Interest (anhedonia)
Guilt or worthlessness
Energy changes
Concentration difficulties
Appetite changes
Psychomotor symptoms
Suicidal ideation

-The symptoms must cause significant distress or impairment (social or occupational)

-The symptoms are not due to substance abuse, bereavement or medical conditions

A

2 distinct episodes of 5 associated symptoms

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7
Q

Diagnostic Criteria for MDD:

-At least 2 distinct episodes of 5 associated symptoms, ______

-1 symptom must be depressive mood or anhedonia

Symptoms:
Depressed mood
Fatigue
Weight change
Sleep disturbances
Interest (anhedonia)
Guilt or worthlessness
Energy changes
Concentration difficulties
Appetite changes
Psychomotor symptoms
Suicidal ideation

-The symptoms must cause significant distress or impairment (social or occupational)

-The symptoms are not due to substance abuse, bereavement or medical conditions

A

almost every day for at least 2 weeks

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8
Q

Diagnostic Criteria for MDD:

-At least 2 distinct episodes of 5 associated symptoms, almost every day for at least 2 weeks

-1 symptom must be ________
Symptoms:
Depressed mood
Fatigue
Weight change
Sleep disturbances
Interest (anhedonia)
Guilt or worthlessness
Energy changes
Concentration difficulties
Appetite changes
Psychomotor symptoms
Suicidal ideation

-The symptoms must cause significant distress or impairment (social or occupational)

-The symptoms are not due to substance abuse, bereavement or medical conditions

A

depressive mood or anhedonia

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9
Q

Diagnostic Criteria for MDD:

-At least 2 distinct episodes of 5 associated symptoms, almost every day for at least 2 weeks

-1 symptom must be depressive mood or anhedonia

Symptoms:
_________________

-The symptoms must cause significant distress or impairment (social or occupational)

-The symptoms are not due to substance abuse, bereavement or medical conditions

A

Depressed mood
Fatigue
Weight change
Sleep disturbances
Interest (anhedonia)
Guilt or worthlessness
Energy changes
Concentration difficulties
Appetite changes
Psychomotor symptoms
Suicidal ideation

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10
Q

Diagnostic Criteria for MDD:

-At least 2 distinct episodes of 5 associated symptoms, almost every day for at least 2 weeks

-1 symptom must be depressive mood or anhedonia

Symptoms:
Depressed mood
Fatigue
Weight change
Sleep disturbances
Interest (anhedonia)
Guilt or worthlessness
Energy changes
Concentration difficulties
Appetite changes
Psychomotor symptoms
Suicidal ideation

-The symptoms must _________

-The symptoms are not due to substance abuse, bereavement or medical conditions

A

cause significant distress or impairment (social or occupational)

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11
Q

Diagnostic Criteria for MDD:

-At least 2 distinct episodes of 5 associated symptoms, almost every day for at least 2 weeks

-1 symptom must be depressive mood or anhedonia

Symptoms:
Depressed mood
Fatigue
Weight change
Sleep disturbances
Interest (anhedonia)
Guilt or worthlessness
Energy changes
Concentration difficulties
Appetite changes
Psychomotor symptoms
Suicidal ideation

-The symptoms must cause significant distress or impairment (social or occupational)

-The symptoms are not due to _________

A

substance abuse, bereavement or medical conditions

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12
Q

What is the first line medical management for MDD

A

SSRIs

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13
Q

How long should an SSRI be trialed in MDD?

A

4 weeks

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14
Q

If an SSRI is unsuccessful after 4 weeks in MDD, what should be done?

A

Try a second SSRI before going to second line

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15
Q

What is second line for MDD?

A

SNRI

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16
Q

What are later line options for MDD?

A

TCAs, Tetracyclics, MAOIs

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17
Q

What is first line non-medical intervention for MDD?

A

Pyschotherapy (CBT, interpersonal therapy and supportive therapy)

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18
Q

What therapy is available for patients with MDD who are unresponsive to medical therapy?

A

Electroconvulsive therapy

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19
Q

When is electroconvulsive therapy indicated for MDD?

A

-Nonresponsive to medical therapy
-Unable to tolerate medical therapy (pregnancy)
-Need for rapid symptom reduction

20
Q

What are the four subtypes of MDD?

A
  1. Seasonal Affective Disorder (Seasonal Pattern)
  2. Atypical Depression
  3. Melancholia
  4. Catatonic depression
21
Q

What characterizes SAD MDD?

A

Presence of symptoms at the same time annually, usually in winter

22
Q

What is treatment for SAD MDD? (3)

A

SSRIs
Light therapy
Bupropion

23
Q

What is the characteristic of atypical depression?

A

Mood reactivity (mood improves in response to positive events)

24
Q

What symptoms are typically characteristic of atypical depression? (5)

A

-Mood reactivity
-Significant weight gain
-Hypersomnia
-Heavy/leaden feelings in arms or legs
-Oversensitivity to personal rejection

25
Q

What is the management of atypical depression?

26
Q

What characterizes melancholia?

A
  1. Anhedonia
  2. Lack of mood reactivity
  3. Depression
  4. Severe weight loss
  5. Excessive guilt
  6. Psychomotor agitation/retardation
  7. Sleep disturbance
27
Q

What does sleep disturbance in melancholia present like?

A

-Increased REM and reduced sleep
-Possible early AM awakenings or worse mood in mornings

28
Q

What characterizes catatonic depression? (3)

A

Motor immobility
Stupor
Extreme withdrawal

29
Q

What is Persistent Depressive Order (PDD) same same as?

30
Q

What is the criteria for PDD?

-Chronic depressed mood for at least 2 years that lasts most of the day more days than not. Patient is never symptom free for > 2 months

-At least two of the following conditions must be present:
1. Insomnia or hypersomnia
2. Fatigue
3. Low self esteem
4. Under or overeating
5. Hopelessness
6. Poor concentration or indecisiveness

-May have depressive episodes or meet the criteria for MDD continuously

-Must never have manic or hypomanic episode

31
Q

What changes in the criteria for PDD in children/adolescents?

A

Depression for 1 year instead of 2

32
Q

-Chronic _______ that lasts most of the day more days than not. Patient is never symptom free for > 2 months

-At least two of the following conditions must be present:
1. Insomnia or hypersomnia
2. Fatigue
3. Low self esteem
4. Under or overeating
5. Hopelessness
6. Poor concentration or indecisiveness

-May have depressive episodes or meet the criteria for MDD continuously

-Must never have manic or hypomanic episode

A

depressed mood for at least 2 years

33
Q

-Chronic depressed mood for _________. Patient is never symptom free for > 2 months

-At least two of the following conditions must be present:
1. Insomnia or hypersomnia
2. Fatigue
3. Low self esteem
4. Under or overeating
5. Hopelessness
6. Poor concentration or indecisiveness

-May have depressive episodes or meet the criteria for MDD continuously

-Must never have manic or hypomanic episode

A

at least 2 years that lasts most of the day more days than not

34
Q

-Chronic depressed mood for at least 2 years that lasts most of the day more days than not. Patient is never ________

-At least two of the following conditions must be present:
1. Insomnia or hypersomnia
2. Fatigue
3. Low self esteem
4. Under or overeating
5. Hopelessness
6. Poor concentration or indecisiveness

-May have depressive episodes or meet the criteria for MDD continuously

-Must never have manic or hypomanic episode

A

symptom free for > 2 months

35
Q

-Chronic depressed mood for at least 2 years that lasts most of the day more days than not. Patient is never symptom free for > 2 months

-At least ____ of the following conditions must be present:
1. Insomnia or hypersomnia
2. Fatigue
3. Low self esteem
4. Under or overeating
5. Hopelessness
6. Poor concentration or indecisiveness

-May have depressive episodes or meet the criteria for MDD continuously

-Must never have manic or hypomanic episode

36
Q

-Chronic depressed mood for at least 2 years that lasts most of the day more days than not. Patient is never symptom free for > 2 months

-At least two of the following conditions must be present:
__________

-May have depressive episodes or meet the criteria for MDD continuously

-Must never have manic or hypomanic episode

A
  1. Insomnia or hypersomnia
  2. Fatigue
  3. Low self esteem
  4. Under or overeating
  5. Hopelessness
  6. Poor concentration or indecisiveness
37
Q

-Chronic depressed mood for at least 2 years that lasts most of the day more days than not. Patient is never symptom free for > 2 months

-At least two of the following conditions must be present:
1. Insomnia or hypersomnia
2. Fatigue
3. Low self esteem
4. Under or overeating
5. Hopelessness
6. Poor concentration or indecisiveness

-May have ______ or ________

-Must never have manic or hypomanic episode

A

depressive episodes or meet the criteria for MDD continuously

38
Q

-Chronic depressed mood for at least 2 years that lasts most of the day more days than not. Patient is never symptom free for > 2 months

-At least two of the following conditions must be present:
1. Insomnia or hypersomnia
2. Fatigue
3. Low self esteem
4. Under or overeating
5. Hopelessness
6. Poor concentration or indecisiveness

-May have depressive episodes or meet the criteria for MDD continuously

-Must never have ________

A

manic or hypomanic episode

39
Q

What is the treatment for PDD?

A

Combination treatment with psychotherapy and pharmacotherapy (SSRIs, SNRIs, TCAs and MAOIs) more efficacious than either alone

40
Q

What is cyclothymic disorder?

A

Similar to Bipolar II but less severe

41
Q

Approximately ____ of patients with cyclothymic disorder will eventually develop BPD

42
Q

Cyclothymic disorder may coexist with ____

43
Q

Cyclothymia:

-At least ____ of milder elevations and depressions in mood that do not meet the criteria for full hypomanic episodes or major depressive episodes

-Symptom free periods don’t last longer than 2 months at a time

-No major depressive, manic or mixed episodes

44
Q

Cyclothymia:

-At least 2 years of ______

-Symptom free periods don’t last longer than 2 months at a time

-No major depressive, manic or mixed episodes

A

milder elevations and depressions in mood that do not meet the criteria for full hypomanic episodes or major depressive episodes

45
Q

Cyclothymia:

-At least 2 years of milder elevations and depressions in mood that do not meet the criteria for full hypomanic episodes or major depressive episodes

-Symptom free periods don’t last longer than ____

-No major depressive, manic or mixed episodes

A

2 months at a time

46
Q

Cyclothymia:

-At least 2 years of milder elevations and depressions in mood that do not meet the criteria for full hypomanic episodes or major depressive episodes

-Symptom free periods don’t last longer than 2 months at a time

-No ________ or _____

A

major depressive, manic or mixed episodes

47
Q

Cyclothymia treatment

A

Similar to Bipolar I:
-Mood stabilizers (lithium, valproic acid)
-Second gen antipsychotics

Behavioral Health (19 decks)

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