Depressive disorders Flashcards by Tyece Henry

signs of depression

Mood changes
Sadness, despair, and pessimism
Loss of interest
Possible changes in appetite, sleep patterns, or cognition

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a leading cause of disability in US

depression

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percentage of US adults with at least one depressive episode (diagnosed)

8.4% (21 million)

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U.S. adults aged 18 or older had at least one major depressive episode with severe impairment in the past year

6% (14.8 million)

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“severe impairment” could look like:

loss of function
no ADLs
cannot go to work/school

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most prevalent regions with diagnosed clinical depression

africa
middle east

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epidemiology (patterns) of depression

more prevalent in women than men, especially after 65
it is doubled

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most prevalent demographics in US

-18-25
-white females
-2 or more ethnicities

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Inverse relationship between___ and report of depressive symptoms

social class

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No consistent relationship between __and affective (mood) disorder

race

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Increased risk in ___ people

single and divorced (support)

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possible biological theories of depressive disorders

Heritability: 40-50%
Deficiency of norepinephrine, serotonin, dopamine
Excessive cholinergic transmission

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Diagnosis points for MDD (clinical)

Depressed mood
Loss of interest or pleasure in usual activities
Symptoms present for at least 2 weeks
Impaired social and occupational functioning
No history of manic behavior (bipolar)
Not attributed to use of substances or another medical condition

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opposite end of spectrum than depression
-bipolar disorder

mania

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screening tools for depressive disorders

PHQ-2
PHQ-9

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major depressive order signs lasting at least two weeks

Depressed mood
and/or
Markedly diminished interest or pleasure in all, or almost all, activities

Also: impairment in functioning

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major depressive disorder symptoms

5 of the following are diagnostic of depression

Depressed mood or irritability
Decreased interest of pleasure in activities
Significant weight change (5%) or appetite changes
Change in sleep (insomnia or hypersomnia)
Change in activity (decreased)
Fatigue or loss of energy
Guilt or worthlessness
Concentration
Suicidality

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assessment of MDD (SIGECAPS)

Sleep disorder
Interest deficit (anhedonia)
Guilt
Energy deficit
Concentration deficit
Appetite disorder, weight change
Psychomotor retardation or agitation
Suicidality

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dysthymia (persistent depressive disorder)

Sad or “down in the dumps”
No evidence of psychotic symptoms
Chronically depressed mood for:
Most of the day
Most days
At least 2 years

premenstrual dysphoric disorder

Depressed mood
Anxiety
Mood swings
Decreased interest in activities
Symptoms begin week before menses
Improve within few days after onset of menses
Minimal or absent week after menses

consequences of MDD

Depression can be deadly
Risk for suicide
Emotional, cognitive, behavioral, and physical consequences
Metabolic changes in the prefrontal cortex and limbic system (emotions)
Structural changes in hippocampus (memory) and prefrontal cortex (decision making)
Diminished neurotrophic support

function involved with limbic system

emotions

function involved with hippocampus

memory

function involved with prefrontal cortex

decision making

signs of childhood depression in children <3 yo

feeding problems tantrums lack of playfulness and emotional expressiveness

signs of childhood depression in children 3-5 yo

accident prone phobias excessive self-reproach

signs of childhood depression in children 6-8 yo

physical complaints aggressive behavior clinging behavior

signs of childhood depression in children 9-12 yo

morbid thoughts excessive worrying

signs of adolescent depression

Anger, aggressiveness Running away Delinquency Social withdrawal Sexual acting out Substance abuse Restlessness, apathy

most prevalent age for adolescents to have clinical depression

16-17

how to differenciate between depression vs expected adolescent behavior

Visible manifestation of behavioral change for several weeks

Most common precipitant to adolescent suicide

Perception of abandonment by parents or peer

treatment options for adolescent depression

Supportive psychosocial intervention Antidepressant medication

questions to ask teens and children with MDD

3 wishes (things to change) Going to an island and can only take one person, who would it be? (support person) If you had 1 million dollars Where do you see yourself in five years? (hopefulness) Draw a picture

significant percentage of suicides among what demographic

elderly (85 and older) especially caucasian males depression often mistake for neurocognitive disorder

treatment for depression in older adults

Antidepressants Electroconvulsive therapy (ECT) Psychosocial therapy

Few weeks to several months Hormonal changes, tryptophan metabolism, cell alterations

postpartum depression

treatment for postpartum depression

antidepressants and psychosocial therapies

symptoms of postpartum depression

Fatigue, Irritability Loss of appetite Sleep disturbances, loss of libido Concern about inability to care for infant

outcomes of success in treatment of depression

Experienced no physical harm to self Discusses feelings with staff and family members Expresses hopefulness Sets realistic goals for self Able to identify aspects of self-control over life situation Expresses personal satisfaction and support from spiritual practices

evaluation questions to ask yourself for evaluation of depression

Has self-harm to the client been avoided? Have suicidal ideations subsided? Does the client know where to seek assistance outside of the hospital when suicidal thoughts occur? Has the client discussed the recent loss with the staff and family members? Is the client able to verbalize positive aspects about self, past accomplishments, and future prospects? Can the client identify areas of life situation over which he or she has control?

treatments for depression

Individual psychotherapy Group therapy Family therapy Cognitive therapy Electroconvulsive therapy Transcranial magnetic stimulation (lowrisk) Vagal nerve stimulation and deep brain stimulation Light therapy

psychopharmacology meds

Tricyclic antidepressants (TCAs) Selective serotonin reuptake inhibitors (SSRIs) Monoamine oxidase inhibitors (MAOIs) Serotonin-norepinephrine reuptake inhibitors (SNRIs)

client/family education for antidepressants

-Continue to take medication for 4 weeks -Do not discontinue medication abruptly -Report sore throat, fever, malaise, yellow skin, bleeding, bruising, persistent vomiting or headaches, rapid heart rate, seizures, stiff neck and chest pain to physician -All antidepressants: FDA black-box warning for increased risk of suicidality in children and adolescents

client goals and interventions for self-care deficit in depression

-increase ADLs -good nutrition -involvement in usual activities

client goals and interventions for powerlessness

-determining what she does and does not have control over