First Aid - Depression

Question 0

MSE?

Answer 0

#Appearance (alertness, gender, grooming, dress)
#Behavior (cooperative or hostile, eye contact)
#Psychomotor
#Speech (rate, rhythm, volume, fluency, amount)
#Mood
#Affect (anxious, fearful, flat, blunted, expensive)
#Thought process (fluency, echolalia, delusions, clanging, perseveration)
#Thought content (suicidal ideation, homicidal ideation, hallucinations, delusions, paranoia, concessions, ideas of reference)
#Cognition (MMSE)
#Insight
#Judgment
#Impulsiveness

Question 1

Diagnoses?

Answer 1

SEA MAPS

Substance abuse
Eating disorders
Adjustment disorder
Mood disorders
Anxiety disorder (GAD, panic, OCD, PTSD)
Psychotic disorders (schizophrenia, schizoaffective)
Suicidal ideation

Question 2

Major depression – male to female ratio? Average age of onset? Untreated, episodes last for how long? Recurrence rate after one episode?

Answer 2

2:1, 20s;

Over four months; greater than 50%

Question 3

Differential for major depressive disorder?

Answer 3

#Bipolar
#Schizoaffective
#Substance induced mood disorder and
#Disorder due to a general medical condition
#Adjustment disorder with depressed mood
#Dementia/delirium

Question 4

Organic causes of depression?

Answer 4

#Hypothyroidism
#Multiple sclerosis
#HIV
#Parkinson's
#Addison's/Cushing's
#Anemias
#Mononucleosis
#Malignancy

Question 5

Pharmacologic causes of depression?

Answer 5

#OCP
#Steroids
#Beta blockers
#Medication withdrawal

Question 6

Diagnostic criteria for depression?

Answer 6

#Depressed mood for anhedonia
#In addition, 4/9 SIGECAPS
#Symptoms for two weeks

Question 7

Treatment for major depression?

Answer 7

#Pharmacotherapy (STAR*D trial supported being treatment with SSRI and maximizing deuce over several weeks before switching meds)
#Psychotherapy (psychodynamic and supportive therapy most common)

Question 8

Major depression recurrence rates?

Answer 8

50% after one episode
70% after two episodes
90% after three episodes

Question 9

Serotonin syndrome hallmarks?

Answer 9

#Fever
#myoclonus
#mental status changes

Question 10

SSRIs with fewer drug-drug interactions?

Answer 10

Citalopram, escitalopram

Question 11

Side effects of SSRIs?

Answer 11

#Sexual side effects
#Insomnia
#Headache
#tremor, Akathisia 
#G.I.
#Changes in appetite

Question 12

Adverse effect of Bupropion?

Answer 12

#Lowers seizure threshold
#Activating

Question 13

TCAs – Mechanism? Side effects? Toxicities?

Answer 13

Block reuptake of norepinephrine and serotonin

#anticholinergic Effects
#Sedation
#orthostatic hypotension (alpha blocker)
#Arrhythmias (widened QRS, prolonged QT/PR)

Convulsions, coma, cardiotoxicity

Question 14

Before starting TCA, must get?

Answer 14

EKG

Question 15

TCA – names?

Answer 15

#Anitriptyine, nortriptyline
#Imipramine, clomipramine, desipramine
#Doxepin

Question 16

MAOIs - names?

Answer 16

#Selegine
#phenlzine
#isocaboxazid
#tranylcypromine

Question 17

Use MAOIs to treat?

Answer 17

#Atypical depression
#Anxiety
#Hypochondriasis

Question 18

Side effects of MAOIs?

Answer 18

#Orthostatic hypertension
#Hypertensive crisis
#weight gain
#Insomnia

Question 19

Do not give MAOIs to patients taking?

Answer 19

#Beta agonist
#SSRI
#Meperidine

Question 20

Second line antidepressants used after SSRIs?

Key points of each?

Answer 20

#Venlafaxine (activating; can increase diastolic blood pressure)
#Duloxetine (use in diabetics with peripheral nerve pain; avoid in renal failure)

Question 21

Nefazodone – Mechanism of action? Side effects?

Answer 21

inhibits serotonin reuptake by mechanism different than SSRIs

Postural hypotension and sedation

Question 22

Pre-ECT evaluation?

Answer 22

#EKG
#BMP, CBC
#LFTs, TFTs
#UA
#CXR, spinal series, head CT

Question 23

Relative Contraindications to ECT?

Answer 23

#Reason MI
#Recent stroke
#Intracranial mass