endocrine related depression

Question 1

Depression is ___ times more common in diabetics than in the general population

Answer 1

2–3

Question 2

Increased type 2 diabetes in patients with_____

Answer 2

bipolar disorder.

Question 3

Weight gain is associated with obstructive sleep apnea which also worsens_____

Answer 3

insulin resistance

Question 4

CALCIUM:
• Symptoms in _____ directly reflect serum calcium. It is common for a person with mild-to-moderate hypercalcemia (10–14 mg/dL) to experience_____ , apathy, irritability, lack of initiative, and lack of spontaneity.
• Severe hypercalcemia (>14 mg/dL) can result in delirium, psychosis, catatonia, or lethargy, and may progress to coma.
• In mild hypocalcemia, patients have anxiety, paresthesias, irritability, and emo/onal lability.
• Mania, psychosis, tetany, and seizures are common in severe hypocalcemia.

Answer 4

hyperparathyroidism

depression

Question 5

• The brain is sensitive to thyroid hormone.
• The thyroid is important for both the maturation of the central nervous system and the maintenance of homeostasis.
• Receptors are located within networks throughout the brain. High concentraDons of T3 receptors are found in the ______ and the ______.
• These receptors, in turn, are able to influence neural activity. The effects of thyroid dysregulation on brain function are variable at different stages of life.
• Interactions of the thyroid and neurotransmitter systems,
primarily __, __, and ___which help regulate mood and
behavior.

Answer 5

amygdala and hippocampus

NE, 5HT and DA

Question 6

A significant proportion of individuals have asymptomatic chronic autoimmune thyroiditis, and ___ of women (10% of women over age 55 years, 20% >60) and ____ of men have subclinical hypothyroidism.

Answer 6

8%, 3%

Question 7

____of clinically hypothyroid paDents have symptoms of depression.

Answer 7

~40%

Question 8

subclinical hypothyroidism is present in up to ___ of women aged over 60 years.

Answer 8

20%

Question 9

Subclinical hypothyroidism is a risk factor for

Answer 9

1. depression,
2. treatment resistant depression,
3. and is often found in rapid cycling bipolar disorder.

Question 10

• Treatment-resistant depression responds to thyroid hormone supplementaDon without lab evidence of thyroid malfuncDon.

Pregnancy: 5-8% of all pregnancies are followed by postpartum thyroidiDs which may result in permanent hypothyroidism

Approximately___ of thyrotoxic patients have an anxiety disorder
Between 31% and 69% have a depressive disorder.

Answer 10

60%

Question 11

• Hypo- and hyperthyroidism can present with psychiatric symptoms, depression, fatigue, anxiety.
• In primary mood disorders, thyroid hormones appear to be capable of modulating the phenotypic expression of illness.
• Most patients with primary mood disorders don’t have overt thyroid disease but relative abnormalities including subclinical hypothyroidism, are associated with a worse outcome.
• Thyroid replacement may improve outcomes especially in treatment resistance and rapid cycling bipolar disorder.
• Take home: always check patient thyroid status, especially if they have psychiatric symptoms. Consider “subclinical” hypothyroidism, especially in women.

Answer 11

!!