Depressive Disorders 1 Flashcards by Erin Snyder

What are the main risk factors of depression?

Family history
Female
Peaks in 20s

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What is the pathophysiology of depression?

Alteration in neurotransmitters

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What is a common secondary physiology of depression?

Endocrine

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What patient demographic has higher rates of suicide?

Males

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What health questionnaire is used for depression screening?

PHQ 2 -> PHQ 9

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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

2 distinct episodes of 5 associated symptoms

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Diagnostic Criteria for MDD:

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

-1 symptom must be depressive mood or anhedonia

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

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

almost every day for at least 2 weeks

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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

depressive mood or anhedonia

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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

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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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

-The symptoms must _________

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

cause significant distress or impairment (social or occupational)

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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

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

-The symptoms are not due to _________

substance abuse, bereavement or medical conditions

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What is the first line medical management for MDD

SSRIs

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How long should an SSRI be trialed in MDD?

4 weeks

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

Try a second SSRI before going to second line

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What is second line for MDD?

SNRI

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What are later line options for MDD?

TCAs, Tetracyclics, MAOIs

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What is first line non-medical intervention for MDD?

Pyschotherapy (CBT, interpersonal therapy and supportive therapy)

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

Electroconvulsive therapy

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When is electroconvulsive therapy indicated for MDD?

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

What are the four subtypes of MDD?

Seasonal Affective Disorder (Seasonal Pattern)
Atypical Depression
Melancholia
Catatonic depression

What characterizes SAD MDD?

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

What is treatment for SAD MDD? (3)

SSRIs
Light therapy
Bupropion

What is the characteristic of atypical depression?

Mood reactivity (mood improves in response to positive events)

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

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

What is the management of atypical depression?

MAOIs

What characterizes melancholia?

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

What does sleep disturbance in melancholia present like?

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

What characterizes catatonic depression? (3)

Motor immobility Stupor Extreme withdrawal

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

Dysthymia

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

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

Depression for 1 year instead of 2

-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

depressed mood for at least 2 years

-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

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

-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

symptom free for > 2 months

-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

two

-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

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

-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

depressive episodes or meet the criteria for MDD continuously

-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

What is the treatment for PDD?

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

What is cyclothymic disorder?

Similar to Bipolar II but less severe

Approximately ____ of patients with cyclothymic disorder will eventually develop BPD

1/3

Cyclothymic disorder may coexist with ____

BPD

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

2 years

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

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

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

2 months at a time

major depressive, manic or mixed episodes

Cyclothymia treatment

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