Depressive Disorders Flashcards
Depressive disorders (8)
- Disruptive Mood Dysregulation Disorder
- MDD
- Persistent Depressive Disorder
- Premenstrual Dysmorphic
- Substance/Med induced
- Depressive due to another condition
- Other specified
- Unspecified
Risk factors of depression
Female
Family history of MDD
Stressful life events (loss of job, marital discord, major health problems, loss of relationship)
Adverse childhood events (abuse, poor parental relationships, divorce, substance abuse in home)
Certain personality traits (neuroticism - tendency to develop emotional upset)
Definition of MDD
DSM 5
Depressed mood (irritable in children) and/or loss of interest/pleasure accompanied by AT LEAST 4 other depressive symptoms lasting 2+ weeks
Depressive symptoms
SIG-E-CAPS
S: Sleep - insomnia/hypersonic
I: interest - reduced interest/pleasure
G: guilt - excessive guilt/worthlessness
E: energy - reduced energy/fatigue
C: concentration - diminished concentration/indecision
A: appetite - loss of/increase appetite/weight
P: psychomotor agitation
S: suicide - thoughts of suicide/attempt/thinking of death
Severity of MDD categorized by
Mild/Moderate/Severe
of symptoms and degree of impairment
Subtypes of MDD
Anxious, mixed, melancholic, atypical, psychotic, catatonic, peri-partum, seasonal
Anxious depression
Very common, worse prognosis (slower to respond)
Keyed up/tense, restless, can’t concentrate, thinking something awful might happen, fear of losing control
Mixed depression
S/s of mania but doesn’t meet criteria (3 or more present nearly every day during episode)
Elated mood, grandiose, talkative, FOI, increased energy, high risk activities, decreased need for sleep
Psychotic depression
Symptoms of depression with delusions and/or hallucinations
Content of psychosis typically mood congruent (consistent with depressive themes of guilt, deserving punishment) but can be mood-incongruent
Particularly responsive to antidepressant PLUS antipsychotic or ECT
Peri-partum depression
Symptoms occur during pregnancy or in 4 weeks following delivery
Post part Ulm mood episodes with psychosis (depression or manic)
Risk factors = prior postpartum episode, hx of depression, hx of bipolar, +FH of bipolar
Also screen for delusions/hallucinations of harm to child
Persistent depressive D/o
Less symptoms, but constant
Depressed mood more days than not for AT LEAST 2 years PLUS 2 of:
-poor appetite/overeating, insomnia/hypersomnia, low energy/fatigue, low self esteem, poor concentration, hopelessness
Patient must have never been without symptoms for more than 2 months
Other specified depressive D/o
Short duration depressive episodes (4-13 days)
OR
Depressive episodes with insufficient symptoms
Unspecified depressive d/o
Depression is present, causes impairment
Doesn’t meet full criteria but you don’t want to specify reasons why and includes situation where there is insufficient information to make more specified diagnosis
“I think that they have something going on” – esp. in ER
Substance/medication induced depressive disorder
Depressed mood (anhedonia)
Evidence from history/PE or labs of both symptoms developed soon after (intox/withdrawal) or involved substance/med is capable of producing the symptoms (side effects)
Neuro circuit of emotion
Limbic system and PFC
In depression: PFC is impaired and the limbic system is overactive
