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Case Files Psychiatry > Depressive Disorders > Flashcards

Depressive Disorders Flashcards

1
Q

What must be evident in the patients medical history to make a diganosis of “due to another medical condition”?

A

Causal relationship

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2
Q

Besides medical condtions, what other causes must be considered?

A

Substance induced depressive disorders

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3
Q

What medical conditions cause ONLY depression?

A 
Parkinson
Hypothyroid
Hyperparathyroid
Hypoparathyroid
Cushing
Addison
SLE
RA
Folate def.
HIV
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4
Q

What medical conditions casue ONLY mania?

A

Wilson

Temporal lobe epilepsy

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5
Q

Which medical conditions cause either depression or mania?

A 
Huntington
CVA
Cerebral tumor
Cerebral trauma
Encephalitis
MS
Hyperthyroid
Uremia
B12 def.
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6
Q

What can clue the clinician into metabolic changes that might be causing depression?

A

Weight gain without a change increased appetite

- Atypical depression will have increased appetite

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7
Q

What is the appropraite step if a patient presents with substance/medication induced depression?

A
  1. Stopping the substance is usually enough
    - May take several weeks
  2. Use of an antidepressant may be needed
  3. Substance abuse treatment
  4. Admit is SI, HI, or psychosis is present
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8
Q

What critera must be met to make a dx of S/M induced depression?

A
  1. Developed during use, intoxication, or withdrawal
    - May occur up to 1 month after use has stopped
  2. Subtance is known to cause depression
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9
Q

What disorders overide S/M induced depression?

A

Any depressive disorder not caused by a substance/medication

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10
Q

What symptoms, if present, disqualifies S/M induced depression?

A

Delirum

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11
Q

What are the signs and symptoms of cocaine withdrawal?

A

Fatigue
Low energy
Hypersomnia
Increased appetite

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12
Q

What kind of most is most likely to be present during cocaine use or intoxication?

A

Mania

- Depression occurs most often during withdrawal

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13
Q

What nonpsychiatric medications can cause mood distrubance?

A
  1. Antihypertensive agents
    - Beta blockers
  2. Interferon
  3. Cytotoxic agents
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14
Q

What other conditions should be ruled out if someone present with S/M induced depression?

A
  1. Primary mood disorder
    - MDD
  2. Depressive disorder due to another medical condition
  3. Bipolar disorder
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15
Q

When treating someone with co-occurring depression and cocaine use, what medication may be superior to an SSRI?

A

TCAs

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16
Q

How many attempts do patients usually need at substance abuse treatment before being successful?

A

10

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17
Q

What physical exam findings indicated the use of opioids?

A

Miosis
Slurred speech
Drowsiness

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18
Q

What physical exam findings indicate a patient has been using phencyclidine?

A

Nystagmus
Hypertension
Muscle rigidity

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19
Q

What physical exam findings indicates a patient has been using cannabis?

A

Conjucntival injection
Increased appetite
Dry mouth

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20
Q

What physical exam findings indicates a patient is going through opiod withdrawal?

A

Mydriasis
Gooseflesh
Rhinorrhea
Muscle aches

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21
Q

What are some substances that can induce depression?

A

Cocaine
Alcohol
Methamphetamine
Spray paint

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22
Q

What is the appropriate treatment plan for a patient who has MDD with severe features and mood-congruent psychosis?

A
  1. Offer psychiatric admission
  2. Start with an SSRI
  3. Add an atypical antipsychotic
  4. Discharge when stable
  5. Weekly follow-ups for 4 weeks after discharge
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23
Q

What symptoms would tip a diagnosis toward MDD vs Adjustment disorder?

A
  1. Vegetative symptoms
  2. Suicidal ideation
  3. Auditory hallucinations
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24
Q

How do children and adolescents with MDD typically describe their mood?

A

Angry or mad

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25
Q

What things need to be considered inorder to “commit” somone to the unit for depression?

A
  1. Are they an imminent danger to themself or others?

2. Can they take care of themselves?

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26
Q

How many symptoms are need to meet criteria for MDD?

A

5

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27
Q

How long do the symptoms need to be present to meet critera for MDD?

A

2 week period

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28
Q

One of which two symptoms must be present to meet criterai for MDD?

A

Depressed mood or Anhedonia

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29
Q

What other areas are impacted by MDD (SiG E CAPS)?

A

Si- SI
G- Guild or worthlessness
E- Energy- Decreased
C- Concentration - Impaired
A- Appetite/Weight - Increased or decreased
P- Psychomotor - Retardation or agitation
S- Sleep - Increased or decreased

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30
Q

What other conditions supersede MDD?

A
  1. Bipolar disorder
  2. Due to medical illness or substance
  3. Not normal bereavement
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31
Q

What are “mood-congruent delusion or hallucinations” for a patient with MDD?

A

Pertaining to being:

  • Defective or deficient
  • Diseased
  • Guilty and deserving of punishment
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32
Q

What is the key aspect of psychosis?

A

Ability to assess reality is impaired

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33
Q

What are the three catagorial symptoms present during depression?

A
  1. Vegetative
  2. Cognitive
  3. Emotional
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34
Q

What are vegetative symptoms?

A

Anything related to body function

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35
Q

What cognitive symptoms?

A
  1. Poor concentration
  2. Low self-esteem
    3.
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36
Q

What are emotional symptoms?

A

Crying speels

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37
Q

What are predictors of MDD in childhood and adulthood?

A
  1. Genetics
  2. Loss of a parent before the age of 11
  3. Adverse early life experiences
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38
Q

How do children usually present with MDD?

A
  1. Anger or irritability
  2. Anhedoina
  3. Decreased energy
  4. Poor grades
  5. Staying up late
  6. Social isolation
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39
Q

Why are patients often diagnosed with a depressive disorder before bipolar disorder?

A

The patient often goes through several depressive episodes before mania occurs
- Important to review clinical and family history of BP disorder

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40
Q

How long must a patient abstain from a substance before a diagnosis of S/M induced or MDD can be confirmed?

A

Several weeks

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41
Q

What are some indications that bereavement may be becoming MDD?

A
  1. Guilt
  2. Patient feels they caused the death
  3. SI
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42
Q

What is a common symptom of bereavemnt in children?

A

Hallucinatory phenomena

- Usually reassuring and comforting

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43
Q

What type of hallucinations are usually more common with MDD?

A

Hostile accusatory hallucinations

44
Q

At what point should an atypical antispychotic be tapered off?

A

3 months

45
Q

At what point should an antidepressant be tapered off?

A

6 to 12 months

- Taper over 2 to 3 months

46
Q

What type of therapy is most effective for MDD?

A

CBT

- Interpersonal therapy

47
Q

At what time point does bereavement need to be evaluated as MDD?

A

Bereavemnt can present with all the same symptoms of MDD (excpet psychosis or SI/HI). If symptoms are still there after 4 months, MDD may be considered an appropriate dx.

48
Q

According to the AACAP, what is the appropiate pharmacotherapy for a patient with MDD and psychosis?

A

SSRI and atypical neuroleptic

- Taper to effect, max dose, or side effects become an issue

49
Q

What SSRIs are available for MDD?

A 
Sertaline
Citalopram
Fluoxetine
Fluvoxamine
Paroxetine
50
Q

What SNRIs are available for treating MDD?

A

Venlafaxine
Desvenlafaxine
Duloxetine
Levomilnacipran

51
Q

What other treatments for MDD are available?

A

Bupropion

Mirtazapine

52
Q

What are the most common side effect of SSRIs?

A 
GI upset
Sleep disturbances
Tremor
Dizziness
Increase prespiration
Sexual dysfunction
53
Q

What treatment for MDD is not associated with sexual dysfunction?

A

Bupropion

54
Q

What side effect of TCAs can be leathal?

A

Cardiac arrhythmias

55
Q

What is the time requirement to meet critera for MDD?

A

2 weeks

56
Q

How many symptoms need to be present to meed MDD?

A

5+

57
Q

What other conditions supersede MDD?

A 
Bipolar disorder
S/M induced
Medical condition 
Schizophrenia
Schizoaffective
Delusional disorder
Other psychotic disorder
Bereavement
58
Q

What critera qualify bereavement as MDD?

A

Symtpoms last longer then 2 months
Marked functional impairment
SI
Psychotic symptoms

59
Q

What other conditions can SSRIs be used to treat?

A

Eating disorders
Panic attack disorder
OCD
Borderline personality

60
Q

What other condtions can be treated with an SNRI?

A

GAD

61
Q

What is the MOA of bupropion?

A

Blocks uptake of NE and DA

62
Q

What conditions can be treated with bupropion?

A

Anxiety associated depression

Smoking

63
Q

What is the MOA of mirtazapine?

A

TCA
Acts on noradrenergic and serotonergic mechanisms
Does not block uptake

64
Q

What other conditions can be treated with mirtazapine?

A

Anxiety

Insomnia

65
Q

How many people in the US will suffer from depression at some point in their life?

A

1 in 7

66
Q

What are some warning signs of suicide?

A

Patient becomes quite and less agitated after a previous expression of SI
Making a will
Giving away personel property

67
Q

What are risk factors for suicide?

A 
Older age
Alcohol or drugs dependence
Prior suicide attempts
Male gender
Family history
68
Q

What needs to be monitored in MDD patients being treated with an antidepressant?

A

Worsening depressed mood and suicidality

  • First couple of months
  • Whenever there is a dosage change
69
Q

What are the key symptoms of the “baby blues”?

A

Sadness
Strong feelings of dependency
Frequent crying spells
Dysphoria

70
Q

How long do the “baby blues” typically last?

A

Days to 1-week

71
Q

Can antidepressants get into the breast milk?

A

yes

72
Q

What is the lifetime recurrence rate for MDD?

A

85%

73
Q

What is the 1-year recurrence rate for MDD?

A

40%

74
Q

What conditions increase the risk of MDD recurrance?

A

Residual symptoms between episodes
Comorbid psychiatric disorders
Chronic medical conditions

75
Q

What not medical options are avaliable for the treatment of MDD?

A

ECT

Transcranial magnetic stimulation

76
Q

Which two antidepressants are most commonly associated with sexual dysfunction?

A

SSRIs

Venlafaxine

77
Q

What are the major side effects of TCAs?

A

Anticholinergic effects
Orthostasis
Cardiac effects

78
Q

Why are MAOIs not used very often?

A

DDI

Dietary restrictions

79
Q

What is the best indication for what medication will work in a patient with recurrent MDD?

A

Whatever medication put them in remission before

80
Q

At what point does sexual dysfunction become an issue for patients taking SSRIs?

A

Weeks to months after being on the medication

81
Q

What is the best medical therapy for persistent depressive disorder?

A 
SSRI
SNRI
Bupropion
Mirtazapine
TCA
MAOIs
82
Q

What is the time critera for persistent depressive disorder?

A

Depressed mood on most of the day, for most of the days
At least 2 years
1 year in children and adolescents
No longer then 2 months symptoms free

83
Q

How many symptoms need to be present to meet critera for PDD?

A

2+

84
Q

What are the symtpoms for PDD?

A

CHASES

Concentration
Hopelessness
Appetite
Self-esteem
Energy
Sleep
85
Q

What conditions superscede PDD?

A

Bipolar
Cyclothymia
Any psychosis
Substances or Medical condition

86
Q

Which medical conditions often coexist with PDD?

A

MDD
Anxiety- Especailly panic disorder
Substance abuse
Borderline personality disorder

87
Q

What are important differences between PDD and MDD?

A 
PDD
- Earlier onset (Teenage to early adulthood)
- More chronic course
- Less intense and longer lasting
MDD
- Later onset
- Episodic
- More severe
88
Q

What is the concept of “double depression”?

A

When PDD has an episode of MDD

- Poor prognosis

89
Q

What non-medical therapy is available for PDD?

A

CBT
Insight-oriented therapy
Interpersonal therapy

90
Q

What are key signs of serotonin syndrome?

A

Headache
Rapid heartbeat
Fever
Chills

91
Q

What medications can be used to manage PMDD?

A

SSRI are 1st line

92
Q

What is the timeline requirement to meet critera for PMDD?

A 
Majority of menstrual cycles
1 year
Start the week before
Improve within days after onset
Minimal to absent postmenses
93
Q

What two areas are assessed to determine critera for PMDD?

A

Mood

Associated symptoms

94
Q

How many symptoms are required to meet critera for PMDD?

A

5+

95
Q

What are the mood symptoms of PMDD?

A
  1. Depression, hopelessness, and self-deprication
  2. Affective instability, mood swings, and rejection sensitvity
  3. Increased irritablity, anger, or interpersonel conflicts
  4. Significant anxiety and tension
96
Q

What are the associated symptoms of PMDD?

A
  1. Anhedonia
  2. Concnetration
  3. Sleep disturbance
  4. Energy
  5. Overwhelmed
  6. Appetite or specific craving
  7. Weight gain, bloating, muscle/joint pain, breast tenderness, or swelling
97
Q

What conditions supercede PMDD?

A

Substance or medication

Medication condition

98
Q

What is affective lability?

A

Rapid change in affect (ie mood swings)

99
Q

PMDD is a significant risk factor for what condition?

A

Postpartum depression

100
Q

What conditions can manifest similar to PMDD?

A

Thyroid dysfunction
Fibromyalgia
IBS

101
Q

What type of therapy is often prescibed for symptoms of PMDD, that can actually make it worse?

A

Exogenous hormones

102
Q

What is the difference between PMS and PMDD?

A

PMS has fewer symptoms and is usually without mood changes

103
Q

Which symptoms are most severe with PMDD?

A

Mood swings and irritability

104
Q

When can SSRIs be taken to treat PMDD?

A

Continuously or only during the luteal phase

105
Q

What is the only TCA that has shown any effectiveness in treating PMDD?

A

clomipramine

106
Q

What type of therapy is useful for PMDD?

A

CBT

Case Files Psychiatry (10 decks)

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