Depressive Disorders Flashcards
mania
abnormally and persistently elevated, expansive, or irritable mood lasting at least 1 week (or less if hospitalization required)
hypomania
abnormally and persistently elevated, expansive, or irritable mood lasting at least 4 days
euthymia
normal range of mood
dysthymia
chronically depressed mood that occurs most of the day more days than not for at least 2 years
major depression
at least 2 weeks with depressed mood or loss of interest/pleasure in nearly all activities
diagnostic criteria for major depressive episode
at least 5 of these during 2 weeks: SIGECAPS Sleep (inc or dec) Interest (loss of) Guilt (or negative thoughts) Energy loss Concentration problems Appetite (inc or dec) Psychomotor activity (retardation or agitation) Suicidal thoughts/ intent/ plan/ action
diagnostic criteria for major depressive disorder
2+ major depressive episodes separated by at least 2 months that aren’t better accounted for by other disorders
no hypo/mania
no alcohol, drugs, or medical condition
functional impairment
medical mimics of depressive symptoms
endocrinopathies (hypo or hyperthyroid, Cushing’s)
pancreatic cancer
chronic viral infection (HIV, HCV, CMV, EBV)
stroke (esp left side)
neuro dz (PD, MS)
substance-induced vs. primary mood disorder
substance-induced will resolve after 1 month of sobriety from substance
grief vs. major depressive episode
grief: gets better in 8 weeks, can have positive emotions, maintains self-esteem
MDE: persistent and pervasive unhappiness, self-loathing
prevalence of MDD, mean duration of MDEs, family history effect
F: 20%, M: 10%
MDE: avg 16 wks, longest episode avg 24 wks
FH: 2-4x higher if 1st degree family member diagnosed
MDD presentation in adolescents and elderly
kids more likely to be irritable than dysphoric
elderly deny mood changes but acknowledge anhedonia
risk factors for major depression
neuroticism, adverse childhood experiences (esp multiple of different types), family history
prognostic factors in MDD
increased likelihood of refractory course: comorbid illness, substance use, anxiety, borderline personality, DM, obesity, CVD
relapse rates of MDD
after 1 episode: 50%
2: 70%
3+: 80-90% - consider bipolar
“switch to bipolarity” in MDD patients
20-30% pts will experience manic episode later in life
drug-induced mania, hx postpartum depression (1st MDE), early onset MDD, sx hypomania, atypical features like psychomotor retardation, hypersomnia/ phagia - esp. bipolar 1
rates of suicide in MDD, alcohol dependence, SZ
MDD - 6%
EtOH - 7%
SZ - 4%
risk factors for suicide
male >65, white or native American, prior attempt, psych d/o, chronic med condition, fam hx, chronic pain, substance abuse
recent extreme loss, exacerbation of psych/med disorder, impulsivity, access to firearms, high lethality plan
factors increasing lethality of suicide attempt
lethality of means, access to means, extent/details of plan, attempt where unlikely to be discovered
protective factors against suicide
marriage, religious affiliation, children in household, positive social support
neurobiology of depression
? genetics, diet, environment –> dec 5HT and/or NE = inc receptors and inc transmission –> depression, anxiety, sleep disturbances, other physical signs
increased transmission of glucocorticoids/ bad stuff and less good stuff/BDNF
theories of depression: psychoanalytic
d/t real or imagined loss of love object
theories of depression: cognitive
perception of events –> negative view of self or world/others or future
theories of depression: behavioral
lack of positive reinforcement d/t stopping enjoyable activities or doing unenjoyable ones
theories of depression: learned helplessness
behavior doesn’t affect feelings
theories of depression: attachment
don’t attach to security figure in development –> fear of exploring/ going out
persistent depressive disorder (dysthymia): dx features
chronically depressed mood for most of day on most days for 2 years (1 year irritability in kids)
during: at least 2 of: dec/inc appetite, in/hypersomnia, low energy, low self-esteem, poor concentration or difficulty making decisions
feelings of hopelessness
impairment in social/ work/ school function
*no euthymia >2 months
*dx only if first 2 years have no MDEs
double depression
dysthymia for 2+ years, then MDD on top of that
course of dysthymia/ persistent depressive disorder
early and insidious onset, chronic
much less likely to resolve depressive sx vs MDE
inc risk of MDD (w/i 5 y), and MDE revert to dys- not euthymia
risk factors for dysthymia
parental loss or separation
genetic: inc % 1st deg relatives with depressive d/os
comorbidity risk in dysthymia
higher risk than MDD for:
anxiety d/o, substance use d/o
early onset: inc risk for cluster B and C personality d/o
PMDD diagnostic criteria
for majority of menstrual cycles
1+ of: depressed mood, hopelessness, self-deprecation; anxiety or tension; affective lability; anger or irritability
1+ of: dec interest in activities; feeling of difficulty concentrating; lethargy
to total 5: change in appetite or cravings; hyper or insomnia; sense of being overwhelmed or out of control; physical sx (breast tenderness, jj/mm pain, “bloating”, wt gain)
risk and prognostic factors for PMDD
hx interpersonal trauma
use of oral contraceptives lowers sx
first line tx for depressive disorders
SSRI, SNRI, bupropion, TCAs, MAOIs, etc.
neurotransmitters and sx of depression
5HT: obsessions, compulsions, mood, anxiety
NE: alertness, energy, mood, anxiety
DA: attention, pleasure, reward, motivation, mood
CBT
cognitive behavioral therapy identifies negative thoughts that affect mood
IPT
interpersonal therapy addresses relationship difficulties
psychoanalysis
oriented insight reserved for higher functioning adults
family therapy
for difficulties at home
ECT
eletroconvulsive therapy for refractory cases or psychotic episodes
very effective with minimal side effects like temporary memory impairments
rTMS
repetitive transcranial magnetic stimulation
non-invasive, targets neuronal circuitry implicated in neuropsych disorders
not as effective as ECT
consequences of failing to achieve remission of depressive symptoms
increased risk short-term relapse
increased risk long-term chronic course
poor social functioning
