Depressive Disorders Flashcards
major depression disorder accounts for ____ of lifetime psychiatric disorders:
17%
one of the big issues with depression is:
either inadequately treated (27 percent were treated adequatly within first 3 months) or not treated (34% got no treatment after being diagnosed with major depression).
why does it matter that so many patients are either not or are inadequately treated?
if the patients are not adequately treated, they will die; morbidity goes up in everything from MI recovery, breast cancer, stroke, etc
diagnosing major depressive disorder:
sigecaps
the worksheet that clinics give out to patients to help diagnose depression is called:
phq9
patient
health
quaotient 9
major depressive episode can either be:
no “oranically caused” (i.e. thyroid problem, or other medications, etc); If someone is greiving over the recent loss of a loved one, that is not necessarily a depression disorder
compare grief vs depression:
grief is less than 2 months, it fluctuates, it is preserved, minor functioning, specific guilt (or no real gult, but there is definite guilt in depression) and passive or no suicidal thoughts
TEST: “I miss my loved one and I want to commit suicide so that I can be there with them…”
depression not grief, once suicide is implicated
24 yr old comes to ed with chief complaint of “my stomach is rotting out from the inside.” States that 6 months of crying on a daily basis, decreased concentration, energy and interest in her usual hobbies. Lost 25 lbs during that time and connot get to sleep, and when she does wakes up early in the morning.
major depression: over 2 weeks of symptoms, anhedonia, crying, anergia, decreased concentration, 25 lb weight loss, and insomnia (early morning waking).
25 yr old with chief complaint of depressed mood for 1 month. Mother died 1 month ago, and since then has felt sad and been very tearful. Difficulty concentration, lost 3lbs, not sleeping soundly through the night:
uncomplicated bereavement (symptoms such as major depression, sadness, weepiness, insomnia, reduced appetitie, weight loss. Considered normal if less than 2 months. For this to be major depression, it would have to accompany marked functinal impairment, morbid preoccupations with unrealistic guilt or worthlessness, suicidal ideation, marked psychomotor retardaion, and psychotic symptoms in addition to the original symptoms described above).
45 yr old states “ever since my husband died suddenly of a hear attack 9 weeks ago, I can’t sleep.” Since then the patient has a very depressed mood, been crying, lost interest in activities, is fatigued, and has insomnia. Why is this major depression instead of bereavement?
the patient exhibits a marked functional impairment: guilt about things other than actions taken or not taken by the survivor at the time of loved one’s death, thoughts of death other than the survivor feeling he/she would be better off dead without the loved one, a morbid preoccupation with worthlessness, maked psychomotor retardation, marked and prolonged function impariment, and hallucinations other than the survivor believeing he can hear the voice of the loved one
39 yr old married woman presents with 1 month of a gradually worsening depressed mood, with increased sleep, low energy, and difficulty concentrating, but no appetite or weight changes. Her medical history is significant for multiple sclerosis, but she is currently not taking medication. Her mental status exam is notable for psychomotor slowing and a depressed and blunted affect. Physical exam demonstrates several different sensory and motor deficits.
major depressive disorder du to another medical condition
52 yr old executive presents with the new onset of depression, early-morning awakening, decreased energy, distractibility, anhedonia, poor appetite, and weight loss for the past 3 months. His symptoms began shortly after he suffered a MI, and although he experienced significant sequelae, he felst less motivated and fulfilled in his life and work, believing that he is now “vulnerable.” As a result, he does not push himself as he used to and his work output is beginning to decline. He feels “empty” but denies suicidal ideation
major depression disorder
14 yr old presents with 15 months of being irritable and depressed almost constantly. The boy has difficulty concentrating, and has lost 5 lbs during that time without trying. He states that he feels as if he has always been depressed, and he feels hopeless about ever feeling better. He denies suicidal ideation or hallucinations. He is sleeping well and doing well in school, though his teachers have noticed that he does not seem to be able to concentrate as well as he had previously.
dythymic disorder (for adults it is 2 years)
_____ presents as a kind of low grade depression
dysthymia (depression most of the day, more days than not, for 2 years)
dysthymia presents with:
appetite, sleep, self-esteem, concentration decline for up to 2 years