Depressive Disorders

Question 1

Normal depression

Answer 1

Transient sx are healthy response to loss or pain

Question 2

Pathological depression

Answer 2

Occurs when adaptation fails to occur or is ineffective

Question 3

Persistent Depressive disorder

Answer 3

Feelings of Low level depression
1. most of the day for majority of the day for 2 years
- Plus at least 2 of the following
1. poor appetite or overeating
2. insomnia/hypersomnia
3. low energy or fatigue
4. low self esteem
5. poor concentration
6. feelings of hopelessness

• No SI

Question 4

Premenstural Dysphoric Disorder (PMDD)

Answer 4

• At least 5 symptoms appear in the last oh, week prior to menses, start to improve at menses onset.

-Marked inability or anger or increased conflict
-Marked depressed mood, feeling of hopelessness
or self -deprecation.
- marked anxiety tension feeling of being keyed up or on edge.
- Decreased interest in usual activities.
- Difficulty concentrating.
- Lethargy easily fatigues
- Mark lack of energy.
- Mark change in appetite.
- Hypersomnia or insomnia.
- Breast tenderness, aching, bloating, and weight gain.

Question 5

Major Depressive Disorder (MDD)

Answer 5

Symptoms cause significant Distress in employment , social or other area in life

** 5 or > must be present for 2 WEEKS, with a change from previous function.

1. DEPRESSED MOOD MOST OF THE DAY NERALY EVERY DAY
2. ANHEDONIA= UNABLE TO EXPERIENCE PLEASURE
3. Weight/ appetite lose/gain .
4. Insomnia/hypersomnia.
5. Psycho motor agitation or retardation.
6. Energy/fatigue, feel worthless, inappropriate guilt. 7. Trouble thinking, concentrating indecisiveness.
7. Recurrent thoughts of death suicide, thoughts and plans.

Question 6

Monoamine Oxidase Inhibitors (MAOI)

Answer 6

• First drug specifically for depression
• Dietary restrictions: AVOID
  
  1. aged cheese
  2. raisins, fava beans, flat italian beans
  3. red wines
  4. smoked or processed meats/ caviar
  5. soy sauce / products/ fermented food
• Will increase BP= HYPERTENSIVE CRISIS
  
  • HA, N/V, Tachycardia, Fever, diaphoresis, epistaxis, chest pain, SOB, vision changes

TX: activated charcoal, IV vasodilators, Nipride

• Cant take with other antidepressants
  
  • Must stop taking MAOI for 14 days before starting another another antidepressant ( Vice versa )

Question 7

MAOI’s and Tricyclics: CAUTION

Answer 7

Caution w/ suicidal patients:
* VERY FATAL IN OVERDOSING: CARDIAC ARRHYTHMIAS

Question 8

Discontinuation Syndrome

Answer 8

When you stop a antidepressant

SX: dizzy, insomnia, nervous, irritable, agitation

Question 9

Serotonin Syndrome

Answer 9

Rare: Occurs most often when more than one drug is used that increases serotonin levels or when high doses are used

THE TRIAD OF SS
1. Altered mental status: agitation, confusion, decreased GCS

2. Autonomic hyperactivity: fever, tachycardia, hyper or hypotension, dry mucous membranes
3. Neuromuscular Abnormality: Tremor, hyperreflexia, myoclonus, shivering

Tx: stop taking med

Question 10

What is ECT

Answer 10

-Induce a seizure
-pt is under anesthesia
-Seizure should last 25 seconds -1 minute

Question 11

ECT: Indications for use

Answer 11

1. severe depression
2. psychotic symptoms with depression
3. mania
4. schizophrenia
5. anxiety disorder

Question 12

ECT: Contraindications

Answer 12

Increased intracranial pressure