Depressive Disorders

Question 0

Disruptive mood dyregulation disorder - sx?

Answer 0

recurrent, severe temper outbursts
shouting, screaming, disregard for feelings of others
reckless aggression to people/animals/property
OVERLAID ON IRRITABLE/UPSET/ANGRY MOOD NEARLY EVERYDAY

Question 1

Disruptive mood dysregulation disorder- population?

Answer 1

6-10yo

*6yo: any younger, they do not have the skills to control

Question 2

Disruptive mood dyregulation disorder - hx?

Answer 2

pyschosocial elements (abused from home, not enough attn)

Question 3

Disruptive mood dyregulation disorder - tx?

Answer 3

no validated tx
tx the sx:
-aggression: stimulants
-irritablity: SSRIs
behavioral management strategies

Question 4

Major depressive disorder?

Answer 4

DISORDERED AFFECT (attitude, feelings, expressive)

Question 5

Major depressive disorder - dx?

Answer 5

2wks of 5 sx:

• depressed mood/anhedonia (cannot find pleasure): REQ**
• wt loss/gain*
• psychomotor agitation/retardation*
• fatigue/loss of energy
• sense of worthlessness/excessive guilt*
• trouble concentrating
• thoughts of death/suicidal ideation*

Question 6

What is anhedonia?

Answer 6

cannot find pleasure

Question 7

What is hypersomnia?

Answer 7

TOO sleepy

Question 8

What is psychomotor retardation?

Answer 8

do not act d/t feelings

Question 9

“Not able to take out dishes from the wash”

Answer 9

pyschomotor retardation

Question 10

“This activity isn’t fun anymore”

Answer 10

anhedonia

Question 11

Worthlessness vs excessive guilt?

Answer 11

Worthhlessness: no one cares
Excessive guilt: guilty for something you can’t do anything about
Delusional guilt: guilty for something you didn’t do

Question 12

MDD - prognosis?

Answer 12

single or recurrent episodes
episodes last 5-6 mo: 20% become chronic, lasting 2 yrs
energy may improve before mood: start to do more things but MOOD is not (remember sommers: they get more energy… but commit suicide)

Question 13

MDD - RF?

Answer 13

adverse childhood experiences
stressful life event (giving birth, career change)
genetic tendency (first degree relatives)
neuroticism

Question 14

Neurotism?

Answer 14

baseline of irritability, moodiness, negativity on life

anxiety

Question 15

MDD - tx?

Answer 15

antidepressants
-SSRI, SNRI, TCA, MAOI
-- based on hx and family hx
TITRATE!!
monitor 102 wks 
psychotherapy, ECT, hospitalization if suicidal

Question 16

MDD - tx: no response?

Answer 16

try another- same or different class

Question 17

Persistent depressive disorder/dysthymia?

Answer 17

NEVER gets better, but never gets to baseline OVERTIME

chronic low grade depression cxing SIGNIFICANT DISTRESS/IMPARIMENT

Question 18

PDD - dx?

Answer 18

2 yrs (1yr in children and adolescents)
NEVER asymptomatic for more than 2 mo at a time

Question 19

PDD - sx?

Answer 19

sullen
low energy
low drive
preoccupied w/ GUILT AND FAILURE
ruminate (dark thoughts)

Question 20

PDD - PE?

Answer 20

dysthymic sx

*MAY HAVE DOUBLE DEPRESSION: a major depressive disorder

Question 21

PDD - tx?

Answer 21

antidepressants + anxiolytic

psychotherapy w/ or w/out meds

Question 22

Flow for depression?

Answer 22

make dx –> select and initiate tx –> asses response in 6 wks
clearly better: cont tx for wks –> complete remission: meds for 4-9 mo
somewhat better: cont tx and adjust dosage
not better: augement or change tx
*somewhat better + not better: monitor tx 1-2 wks) –> consult psychiatrist/change tx

Question 23

Premenstrual Depressive Disorder PMDD?

Answer 23

different from PMS
NOT culturally bound (WORLD WIDE disorder)
1.8-5.8% - just as high as HTN
many just “manage” sx and do not seek tx

Question 24

PMDD - sx?

Answer 24

cxing significant distress/interference in social., occupational, physical and other environments

Question 25

PMDD - dx?

Answer 25

• sx have to show 1 wk before
• start to improve within a few days after onset of menses
• minimal or absent in a week POST menses
  1) affective lability (expression of internal emotion physically; unpredictable and random expression)
  2) irritability/anger/interpersonal conflicts
  3) depression/hopelessness/self-deprecating thoughts
  4) anxiety, tension, keyed up or on edge
  AND
  -decreased interest in usual activities
  difficulty in concentration
  lethargy, easy fatigability, marked lack of energy
  -marked change in appetite, overeating, specific food cravings
  -hyperinsomnia/insomnia
  -sense of being overwhelmed or out of control
  -physical: breast tenderness/swelling, joint/muscle pain, “bloating”, wt gain

Question 26

PMDD - tx?

Answer 26

lifestyle modifications
SSRi for the week before the onset of menses or on a regular basis
adjunctive CBT can be helpful

Question 27

Depression characteristics - general?

Answer 27

fatigue/low energy
sleep change (hypersomnia/insomnia)
change in eating
depressed mood
low self-esteem
low concentration

Question 28

MDD vs PDD?

Answer 28

MDD: 
5x for 2wks
*wt change
*anhedonia and/or depression
*worthlessness/excessive guilt
*suicidal ideation 
PDD:
2sx for 2yrs

Question 29

“My situation/life will never get better”

Answer 29

hopelessness

Question 30

“I am not important”

Answer 30

worthlessness

Question 31

What is pt does not meet criteria for MDD or PDD?

Answer 31

-unspecified depressive disorder

Question 32

If pt has depressive sx d/t drugs/meds?

Answer 32

other specified depressive disorder