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Psych 1 > Depressive disorders > Flashcards

Depressive disorders Flashcards

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1
Q

Depressed mood OR loss of interest/pleasure PLUS four associated symptoms for at least 2 weeks

Decreased interest
Weight or appetite changes 
Insomnia or hypersomnia 
Psychomotor agitation or retardation
Fatigue or loss of energy
Feeling worthless or guilty
Decreased ability to concentrate
SI or other thoughts of death
A

Major depressive disorder

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2
Q

Major depressive disorder should have depressed mood OR loss of interest/pleasure for two weeks… plus 4 other sxs from this list… which is?

A 
Decreased interest
Weight or appetite changes 
Insomnia or hypersomnia 
Psychomotor agitation or retardation
Fatigue or loss of energy
Feeling worthless or guilty
Decreased ability to concentrate
SI or other thoughts of death
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3
Q

Easy way to remember major depressive disorder?

A 
Depressed mood or loss of interest PLUS 4 of these 
S- Sleep
I- Interest
G- Guilty
E- Energy
C- Concentration 
A- Appetite 
P- Psychomotor
S- SI/HI
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4
Q

Essential feature is at least 2 weeks of a depressed mood “sad” “hopeless” “down in the dumps” “discouraged” etc…

Sxs need to be present most of the day for nearly everyday

Fatigue or insomnia is a common presenting complaint

A

MDD

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5
Q

Psychomotor sxs are less common but if present, indicate a greater overall severity

Appetite changes can be an increase or decrease

Sleep changes can be insomnia or hypersomnia

Psychomotor changes must be severe enough to be noticed, not just subjective reports

A

MDD

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6
Q

Associated with high mortality

Suicidal thoughts range from:

Passive thoughts of death
Others being better off if they were dead
Contemplating suicide
Plans to commit suicide

A

MDD

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7
Q

Biggest risk factor for suicide attempt?

A

history of suicide attempts

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8
Q

Male sex, living alone, being single, prominent feelings of hopelessness

Presence of Borderline Personality DO markedly increases risk

A

suicide risks in MDD

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9
Q

MDD who is actively suicidal?

A

Probably shoudn’t prescribe antidepressants…. Pt shouldn’t leave observation

(point is… consider the black box warning for antidepressants and their likelihood of increasing suicide risk)

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10
Q

MDD non-pharm tx?

A

Cognitive behavioral therapy = Key to a good plan for depressed patients! All patients should have some form of this

Electroconvulsive therapy:
Indicated when medications can’t be used and/or extreme suicidality
Risks include memory disturbances and headache
Causes a generalized seizure
Works best when used for severe depression

Phototherapy

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11
Q

Major Depressive Disorder pharmacological tx?

A

SSRI
Typically well tolerated
Starting dose is typically therapeutic
Lower lethality in overdose

Adjunctive bupropion

Trial new medication

(Sertraline should be used for patients with acute MI or unstable angina)

[Also consider SNRIs]

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12
Q

In MDD patient who experience sexual dysfxn, consider?

A

trial of oral PDE5 inhibitors (sildenafil)

Adjunctive bupropion

Trial of new med

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13
Q

Antidepressant

Associated w/ less sexual dysfxn than other ADs

BUT CI in patients at risk for seizures, hx of anorexia/bulimia, or use in withdrawal from ETOH/BZDs

A

bupropion (NDRI)

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14
Q

Most activating SSRIs?

A

fluoxetine

Sertraline

(avoid in patients having trouble sleeping… dose in the morning)

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15
Q

Most sedating SSRIs?

A

paroxetine

fluvoxamine

(dose in evening)

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16
Q

SNRI?

A

Duloxetine

Venlafaxine

17
Q

Aside from SSRIs/SNRIs, what are other pharmacologic options for MDD?

A

TCA (but use with caution/avoid in pts w/ cardiac condition… they can produce life threatening arrhythmias and delirium, coma, seizures, psychosis)

A “3rd line” option would be MAOIs

18
Q

For a pt w/ MDD, what do you do if the response to an initial medication is poor?

(remember, response to a SSRI/SNRI can take 3-8 weeks…)

A

Reassess diagnosis

Trial a second medication is appropriate

Allow time for a medication “wash-out” if switching drug classes (consult pharmacist…)

Adjunct if needed (e.g., lithium, busipirone, thyroid hormone)

19
Q

When considering adjunctive therapy (w/ lithium, buspirone, thyroid hormone) in a MDD pt who’s unresponsive to initial, what’s a consideration?

A

strongly consider getting sub-specialty help or transfer patient’s care to sub-specialist

20
Q

For MDD pts, when should you consider full dosage indefinitely?

A

Consider need for full dosage indefinitely if

First episode before 20 or after 50,

over 40 w/ 2 episodes

one episode after 50, 3 episodes over a lifetime

21
Q

Depressed mood, most of the day, more days than not, for at least 2 years PLUS 2 things

Sleep
Concentration
Hopelessness 
Appetite
Low self-esteem
Energy

2 consecutive years without at least a 2 month remission

A

Persistent Depressive Disorder

22
Q

Persistent Depressive Disorder in children/adolescents… what’s the stipulation for them?

A

Children/adolescents mood can be irritable, and only for 1 year

23
Q

Essential feature is depressive mood for at least 2 years

These symptoms are frequently considered part of their daily life and limit them from seeking help

A

Persistent Depressive Disorder

24
Q

Difference between PDD and MDD?

A

MDD needs to have those 5 things!

PDD doesn’t quite have 5 of those thing (depressed + 2 other things NOTE THAT LOSS OF INTEREST ISN”T ON PDD)

PDD is a “long-term, less-severe version” of MDD

25
Q

Note that patients can have MDD for longer than two years… so if a patient fits the MDD for longer than two years.. they’ve got MDD

A

not PDD…

26
Q

How would you treat PDD?

A

Same as MDD

27
Q

Mild depressive d/o (PDD, MDD)… tx plan?

So barely meets criteria, mostly self-controlled, NOT adversely affecting life….

A

Refer for behavioral health/non-medication mgmt

F/u as needed… add meds IF needed (start w/ daily meds and f/u and adjust as necessary)

28
Q

Moderate depressive d/o tx plan…

So, more than meets criteria, mostly self-controlled, may/may not be adversely affecting life…

A

Refer for behavioral therapy (duh)

Consider starting daily med at this point (SSRIs, SNRIs)

Consider work restriction suggestions

Follow up as needed/scheduled and adjust prn

29
Q

DOC for MDD patients w/ acute MI or unstable angina?

A

sertraline

30
Q

Severe depressive d/o tx plan…

More than meets criteria, severe sxs, uncontrolled, adversely affected life…

A

Refer for therapy ALWAYS

Actively work with sub-specialist if possible

Consider starting daily medication at this point (SSRIs/SNRIs)

Consider work restriction suggestions

Psych 1 (9 decks)

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