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Psychiatry > Depressive Disorders > Flashcards

Depressive Disorders Flashcards

1
Q

Name 8 symptoms of depression

A

Need 5 or more in 2 weeks

SIGE CAPS

Sleep disturbances (Neuro vegetative)
Interest decrease - anhedonia (behavioural)
Guilt (cognitive)
Energy decrease (Neuro vegetative)
Concentration decrease (cognitive)
Appetite changes (Neuro vegetative)
Psychomotor agitation/retardation (behavioural)
Suicidal ideation (cognitive)

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2
Q

What is the incidence of suicide attempt in MDD?

A

15%

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3
Q

What are the anatomical regions affected by depression? (3)

A

Neoplasticity in:
• hippocampus (major role learning and memory)
• amygdala (emotional processes)
• frontal Cortex

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4
Q

What are the DSM criteria of MDD? (5)

A
  1. 5 or more symptoms (sige caps) during 2 weeks in 1 year. Change from previous functioning. At least one symptom depressed mood or anhedonia.
  2. Distress/impairment
  3. No amc/substances
  4. Not another psych condition
  5. No mania/hypomania.
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5
Q

Group the clinical features of mdd into 3 and give examples. (15)

A
  1. Neurovegetative: disturbed sleep, loss appetite, loss energy ( loss libido, pain)
  2. Cognitive: guilt, loss self esteem, impaired attention and concentration (hopelessness)
  3. Behavioural: psychomotor slowing or agitation, social withdrawal, self neglect
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6
Q

Give 5 differences between grief and MDD

A
  1. Grief has predominant feeling loss and emptiness, MDD persistent depressed mood and inability to anticipate happiness/pleasure
  2. Decreased intensity (days-weeks) and occur in waves , persistent
  3. Thoughts/memories of loss/ deceased and occurs in waves with reminders; not tied to specific thoughts
  4. Thoughts of death focused on deceased, suicidal thoughts/undeserving of life
  5. Preserved self esteem, self-loathing and feelings of worthlessness
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7
Q

How long must persistent depressive disorder (pdd) be in children and adults before can make diagnosis? (3)

A

Mood disturbance >2 years in adults, > 1 year children AND is never without symptoms for more than 2 months

2 or more sigecaps symptoms

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8
Q

What is the difference between MDD and PDD symptom-wise?

A

PDD has no suicidal thoughts, and no psychomotor changes! Functional.

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9
Q

How can a patient be psycho-educated about their condition? (8)

A
  1. Nature of condition
  2. Identification of symptoms and signs
  3. Treatment options
  4. Response to treatment and course of disorder
  5. Dosages, side effects etc
  6. Avoidance of alcohol and other substances
  7. Relapse prevention
  8. Support groups and family support.
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10
Q

Time period and specifications of pre-menstrual dysphoric disorder? (Pmdd) (5)

A
  • Majority of menstrual cycles
  • At least 5 pms symptoms in week before onset of menses
  • start to improve a few days after onset of menses
  • Become minimal/absent 1 week post menses
  • > 2 symptomatic cycles to make diagnosis
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11
Q

Name 3 pharmacological options (and examples ) for treatment of PMDD

A

• Serotonergic agonists: fluoxetine, sertraline, paroxetine, citalopram, (ssri) venlafaxine (snri), clomipramide (TAD)
• other psychotropics: alprazolam (benzo)
• Suppress ovulation: GNRH analogues, danazol (adrenergic hormones), transdermal estradiol patches, selected OCP
Also calcium, l-tryptophan, CBT

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12
Q

Name the treatment phases and time period in rx of mdd

A
  • Acute: 6-12 weeks. To achieve response and remission
  • continuation: 4-12 months. Remission consolidated to prevent relapses
  • maintenance: last 1 year or longer. Prevent depression recurrences.
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13
Q

Define disruptive mood dysregulation disorder (dmdd) and age group

A

*Paeds depressive disorder

Persistent irritability with frequent episodes of extreme behavioural dyscontrol.
After 6 and onset before 10.
Typically develop unipolar depressive or anxiety disorder.

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14
Q

Define pervasive or persistent depressive disorder (pdd) and time period

A

Chronic depressive condition with fewer symptoms than mdd with no suicidal ideation but lasts min 2 years in adults and 1 in children.
Replaces dysthymic disorder

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15
Q

Name 8 specifiers for mdd

A
  • with anxious distress
  • with mixed features
  • with atypical features (mood reactivity or 2 or more: significant weight gain/ appetite increase, hypersomnia, leaden paralysis, longstanding pattern of interpersonal rejection sensitivity)
  • with melancholic features
  • with mood congruent or incongruent psychotic features
  • with catatonia
  • with peripartum onset
  • with seasonal pattern
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16
Q

What is second line treatment for mdd in children if ssri fail?

A

Snri: venlafaxine

17
Q

Criteria A and B (core symptoms) of dmdd? (4)

A

Severe recurrent outbursts in response to common stressors:
• verbally/behaviourally eg verbal rages/physical aggression
• Grossly out of proportion in intersity/duration to situation/provocation.
• b. inconsistent with child’s developmental level

18
Q

Criteria C (frequency) of DMDD?

A

Disruptive mood dysregulation disorder

Temper outbursts occur, on average, 3 or more times per week

19
Q

Criteria D ( mood ) of DMDD?

A

Mood between temper outburst is persistently negative (irritable, angry ) most of day nearly every day

20
Q

Criteria E (time period) of DMDD?

A

Criteria a-c present for at least 12 months and hasn’t been symptom free for 3 months

21
Q

Criteria F (setting) of DMDD?

A

Criteria a and d present in at least 1 of 3 settings ie at home, school, with peers ; and are severe in at least 1 of these

22
Q

Criteria G and H (age) of DMDD?

A

Should not make diagnosis before 6 or after 18.

Age of onset criteria a- E before 10.

23
Q

Criteria I (mania) of DMDD?

A

No mania or hypomania set of symptoms met for more than 1 day

24
Q

Which 3 mental dis orders cannot coexist with dmdd?

A
  • Oppositional defiant disorder
  • intermittent explosive disorder
  • bipolar disorder
25
Q

Name 10 specifiers for MDD

A
  • With anxious distress
  • with mixed features (mania)
  • with rapid cycling
  • with melancholic features
  • with atypical features (mood reactivity when positive event, weight gain, hypersomnia)
  • with mood- congruent psychotic features
  • with mood- incongruent psychotic features (not depression themes )
  • with peripartum onset (pregnancy- 4 weeks pp)
  • with Catatonia
  • with seasonal pattern
26
Q

Which neurotransmitters play role in depression/anxiety

A

Serotonin
Noradrenaline

27
Q

Define premenstrual dysphoric disorder

A

In majority of menstrual cycles in last year, at least 5 symptoms (with at least 1 from criteria B and 1 from C ) present in final week before menses onset. Symptoms start to improve within few days after onset menses, become minimal/absent in week postmenses. Confirm by prospective daily ratings during at least 2 symptomatic cycles. If not, specify as provisional.

Criteria B : mood + affect
Criteria c : behaviour, cognition, physical symptoms

28
Q

Name 3 presentations that fall under other specified depressive disorder

A
  • Recurrent brief depression: depressed mood+ 4 other symptoms for 2-13 days at least once per month for 12 consecutive months, not related to menstruation
  • short duration depressive episode: 4-13 days
  • depressive episode with insufficient symptoms: depressed effect+ 1 other symptom for 2 weeks
29
Q

Severity specifiers for depressive disorders? (3)

A
  • Mild: 2 symptoms + distressing but manageable + minor impairment
  • moderate: 3 -5
  • severe: >5 + unmanageable + marked interference

Psychiatry (31 decks)

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