Depressive Disorders Flashcards
Major Depressive Disorder Diagnosis qualifiers
- 1 major depressive episode (MDE)
- Cannot have a history of mania or hypomania
Major Depressive Episode Diagnosis
9
Must have 5+ symptoms (1 being affective)
1. Depressed mood
2. Anhedonia
3. Change in appetite (weight)
4. Insomnia/Hypersomnia
45. Loss of Energy
6. Psychomotor changes
7. Feeling guilty/worthless
8. Decreased concentration
9. Thoughts of death/suicidal ideation
MDD with melancholic features
7
- Severe anhedonia
- Lack of mood reactivity
- Profound despair
- Depression worse in the morning
- Early-morning awakening
- SIgnificant weight loss
- Excessive guilt
MDD with atypical features
4
- Mood reactivity (mood brightens in response to potential/actual +ve events
- Significant weight gain
- Hypersomnia
- Leaden paralysis
MDD with psychotic features
Delusions or hallucinations
Can be mood congruent or mood incongruent
MDD with Catatonia (abnormal movements)
5
Characterized by psychomotor symptoms
1. Mutism
2. Immobility
3. Waxy flexibility
4. Stereotypes
5. Odd posturing
MDD with Peri-Partum Onset
Time of onset
Occurs during pregnancy or within 4 wks post delivery
MDD with Seasonal Pattern (SAD)
Consistent temporal relationship between time of year and mood episode
Common findings in Depression
Theory-genetic or not?
- Genetic predisposition
- Chronic increase activity of the hypothalamus pituitary axis (HPA)-elevated cortisol, chronic activation of immune system
- Decreased monoamine transmission
- Decreased prefrontal cortex activity
Treatment of MDD
5 categories
- CBT
- Antidepressant drugs (1. SSRI/SNRI, 2. TCA/MAOI)
- ECT-fastest acting
- VNS
- rTMS
What has a black box warning for treatment of MDD?
Antidepressant drugs-increased risk of suicide in people aged less than 25
Other treatments are Esketamine and phototherapy
Persisent Depressive Disorder(PDD)
Timeline
Depression for 2 years
Three subcategories of PDD
PDD with persistent MDE
PDD with pure dysthmic syndrome
PDD with intermittent MDEs (cycle between MDE and dysthymia)
PDD Treatment (dysthymic subtype)
CBT and/or antidepressant meds
PDD Treatment (MDE subtypes)
- CBT and/ or antidepressant meds
- More invasive techniques such as ECT
What are the parameters for diagnosis of Premenstrual Dysphoric Disorder (PMDD)
SYMPTOMS MUST
- Present in the week before menses onset
- Improve a few days after menses
- Minimize in the week post-menses
- Symptoms must cause clinically significant distress or functional imparement
PMDD treatment
SSRI’s
Dirsuptive Mood Dysregulation Disorder (DMDD)
Timeline
- Child must be at least 6 yrs old
- Symptoms begin before age 10
- NOT DIAGNOSED after age 18
Mnemonic for MDE
SIG-E-CAPS
- Sleep change
- Interest loss
- Guilt
- Energy problem
- Concentration poor
- Appetite change
- Psychomotor changes
- Suicidal ideation
DMDD Core Features
- Severe temper outbursts 3 x week
- Sad/irritable/angry mood almost every day
- Reaction is disproportionate to situation
- Symptoms are present in multiple settings
