Depressive Disorders Flashcards by J N

mania

abnormally and persistently elevated, expansive, or irritable mood lasting at least 1 week (or less if hospitalization required)

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hypomania

abnormally and persistently elevated, expansive, or irritable mood lasting at least 4 days

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euthymia

normal range of mood

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dysthymia

chronically depressed mood that occurs most of the day more days than not for at least 2 years

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major depression

at least 2 weeks with depressed mood or loss of interest/pleasure in nearly all activities

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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

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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

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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)

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substance-induced vs. primary mood disorder

substance-induced will resolve after 1 month of sobriety from substance

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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

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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

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MDD presentation in adolescents and elderly

kids more likely to be irritable than dysphoric

elderly deny mood changes but acknowledge anhedonia

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risk factors for major depression

neuroticism, adverse childhood experiences (esp multiple of different types), family history

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prognostic factors in MDD

increased likelihood of refractory course: comorbid illness, substance use, anxiety, borderline personality, DM, obesity, CVD

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relapse rates of MDD

after 1 episode: 50%
2: 70%
3+: 80-90% - consider bipolar

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“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

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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