Depressive Disorders Flashcards
Depression Basic Facts
- twice as common in females than males
- depression increases risk for CAD, DM, and worsening prognosis
- 3/4 experience recurrent depression
- Risk of recurrent depression is higher if the index episode occurs at an earlier age and if there is a FH of depression
- longer depression goes untreated, the worse the prognosis
- 2/3 of completed suicides occurred in depressed pts.
Risk Factor For Depression
1) Female gender
2) +Family history of MDD
3) Stressful life events
4) Adverse childhood events:
5) Certain personality traits (neuroticism)
MDD diagnostic criteria
- Depressed mood AND/OR loss of interest/pleasure (anhedonia) accompanied by other depressive symptom.
- if pt. has BOTH depressed mood and anhedonia they only need 3 additional depressive s/s to be diagnosed
- if pt. has ONLY 1 of depressed mood or anhedonia they need 4 additional depressive s/s to be diagnosed
Additional Depressive Symptoms
- Insomnia or hypersomnia
- Significant weight loss or weight gain (eg, 5 percent within a month) or decrease or increase in appetite nearly every day
- Psychomotor retardation or agitation nearly every day that is observable by others
- Fatigue or low energy
- Decreased ability to concentrate, think, or make decisions
- Thoughts of worthlessness or excessive or inappropriate guilt
- Recurrent thoughts of death or suicidal ideation, or a suicide attempt
SIGECAPS mnemonic for diagnosing MDD
S: insomnia/hypersomnia I: reduced interest/pleasure G: excessive guilt/worthlessness E: reduced energy/fatigue C: diminished concentration/indecision A: loss of/increase appetite/weight P: psychomotor agitation/retardation S: thoughts of suicide/attempt/thinking of death
Subtypes of depression
Anxious, mixed, melancholic, atypical, psychotic, catatonic, peri-partum, seasonal
Severity of Depression is based on:
of symps and degree of impairment
Subtype of depression characterized by:
- very common, worse prognosis, slower to respond to tx
- Keyed up/tense, restless, can’t concentrate because of worry, fear something awful might happen, fear loss of control
Anxious depression
Subtype of Depression characterized by:
-s/s of mania but does not meet criteria: 3 or more present nearly every day during the episode of MDD:
-Elated mood, grandiose, talkative, FOI (flight of ideas),
-Increased energy, high risk activities, decreased need for sleep
(this is a mix between depression and bipolar disorder)
Mixed Depression
Subtype of Depression characterized by:
- 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 (vs either alone) or ECT.
Psychotic depression
Subtype of depression characterized by:
- if symptoms occurred during pregnancy or in the 4 wks following delivery
- Post partum mood episodes with psychosis(depression or Manic): 1:500-1:1000.
Peri-partum depression
Persistant Depressive d/o
Depressed mood more days than not for ≥ 2yrs, Plus ≥2 of:
~Poor appetite/overeating ~Insomnia/hypersomnia ~Low energy/fatigue ~Low self esteem ~Poor concentration or indecision ~Hopelessness *during the 2 yr period the patient has never been without the symptoms for more than 2 months.
Other Specified Depressive d/o
1) short duration depressive episodes (4-13 days)
2) depressive episode with insufficient amount of symptoms
Unspecified Depressive d/o
Depression is present, causes impairment, doesn’t meet full criteria but you don’t want to specify the reasons why and includes situation in which there is insufficient information to make a more specified diagnosis.
-Often diagnosed in ED
Substance Induced Depressive d/o
-Depressed mood or anhedonia
- There is evidence from history/PE or labs of both:
1) symptoms developed during or soon after substance intox/withdrawal
2) the involved substance/medication is capable of producing the symptoms noted.
