Depressive Disorders 2 Flashcards
What is PMS?
A cluster of physical, behavioral and mood changes with cyclical occurrence during the luteal phase of the menstrual cycle
What is PMDD?
Severe PMS with functional impairment where anger, irritability and internal tension are prominent
What are the three categories of symptoms in PMDD?
- Physical
- Emotional
- Behavioral
What are the physical sxs of PMDD?
-Abdominal bloating
-Fatigue
-Breast swelling/pain
-Weight gain
-HA
What are the emotional findings of PMDD?
-Irritability
-Tension
-Depression/Anxiety
-Hostility
-Libido changes
-Agression
What are the behavioral findings of PMDD?
-Food cravings
-Poor concentration
-Noise sensitivity
-Loss of motor senses
What qualifies a diagnosis of PMDD?
Symptoms occurring 1-2 weeks before menses (luteal phase), relieved within 2-3 days of the onset of menses
PLUS
at least 7 symptom-free days during the follicular phase
What should be done for PMDD diagnosis?
Patient diary of symptoms for at least two cycles
What is first line management of PMDD?
Lifestyle: stress reduction, exercise
-Reduction of caffeine, alcohol, cigarettes and Na
What OTC is useful for PMDD?
NSAIDs, Vitamin B6 and E
What is first line pharm for PMDD?
SSRIS for emotional symptoms with dysfunction
What pharm option is good for PMDD if pts do not want to take SSRIs?
OCPs
What pharm is used for PMDD refractory to SSRIs and OCPs?
GnRH agonist therapy with estrogen-progestin addback
What is the single strongest predictive factor of suicide?
Previous attempt
Having an ______ is a major suicide risk
organized plan
Suicide risk: access
Firearms in the home
Suicide risk: gender
Females attempt more, men are more successful
Suicide risk: age
Increased age, highest risk in US is elderly white males
Suicide risk: race
Whites > blacks
Suicide risk: disorders
Underlying psychiatric disorders are majority of cases
Suicide risk: substances
Increased risk with substance use
Suicide risk: marital status
Alone:
Never married > widowed > separated or divorced > married without children > married with children
Suicide risk: misc
-Family history
-Hx of impulsivity
-Chronic illness
Among highly skilled workers, _____ are at an increased risk of suicide
Physicians
