Depressive Disorders Flashcards
Disruptive mood dyregulation disorder - sx?
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
Disruptive mood dysregulation disorder- population?
6-10yo
*6yo: any younger, they do not have the skills to control
Disruptive mood dyregulation disorder - hx?
pyschosocial elements (abused from home, not enough attn)
Disruptive mood dyregulation disorder - tx?
no validated tx tx the sx: -aggression: stimulants -irritablity: SSRIs behavioral management strategies
Major depressive disorder?
DISORDERED AFFECT (attitude, feelings, expressive)
Major depressive disorder - dx?
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*
What is anhedonia?
cannot find pleasure
What is hypersomnia?
TOO sleepy
What is psychomotor retardation?
do not act d/t feelings
“Not able to take out dishes from the wash”
pyschomotor retardation
“This activity isn’t fun anymore”
anhedonia
Worthlessness vs excessive guilt?
Worthhlessness: no one cares
Excessive guilt: guilty for something you can’t do anything about
Delusional guilt: guilty for something you didn’t do
MDD - prognosis?
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)
MDD - RF?
adverse childhood experiences
stressful life event (giving birth, career change)
genetic tendency (first degree relatives)
neuroticism
Neurotism?
baseline of irritability, moodiness, negativity on life
anxiety
MDD - tx?
antidepressants -SSRI, SNRI, TCA, MAOI -- based on hx and family hx TITRATE!! monitor 102 wks psychotherapy, ECT, hospitalization if suicidal
MDD - tx: no response?
try another- same or different class
Persistent depressive disorder/dysthymia?
NEVER gets better, but never gets to baseline OVERTIME
chronic low grade depression cxing SIGNIFICANT DISTRESS/IMPARIMENT
PDD - dx?
2 yrs (1yr in children and adolescents) NEVER asymptomatic for more than 2 mo at a time
PDD - sx?
sullen low energy low drive preoccupied w/ GUILT AND FAILURE ruminate (dark thoughts)
PDD - PE?
dysthymic sx
*MAY HAVE DOUBLE DEPRESSION: a major depressive disorder
PDD - tx?
antidepressants + anxiolytic
psychotherapy w/ or w/out meds
Flow for depression?
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
Premenstrual Depressive Disorder PMDD?
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
PMDD - sx?
cxing significant distress/interference in social., occupational, physical and other environments
PMDD - dx?
- 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
PMDD - tx?
lifestyle modifications
SSRi for the week before the onset of menses or on a regular basis
adjunctive CBT can be helpful
Depression characteristics - general?
fatigue/low energy sleep change (hypersomnia/insomnia) change in eating depressed mood low self-esteem low concentration
MDD vs PDD?
MDD: 5x for 2wks *wt change *anhedonia and/or depression *worthlessness/excessive guilt *suicidal ideation PDD: 2sx for 2yrs
“My situation/life will never get better”
hopelessness
“I am not important”
worthlessness
What is pt does not meet criteria for MDD or PDD?
-unspecified depressive disorder
If pt has depressive sx d/t drugs/meds?
other specified depressive disorder
