HYHO: Depression and Anxiety

Question 1

Depression is MC in what countries and what gender?

Answer 1

• Developed countries
• Females

Question 2

Depression is associated with which medical conditions?

Answer 2

1. TBI: head injury in btween 11-15YO is a strong predictor of getting depression
2. Heart dz or hx stroke
3. DB/obesity
4. COPD
5. Arthritis or chronic pain
6. Cancer

Question 3

Head injury/TBI in between ages _____ is a strong predictor of getting depression

Answer 3

11 - 15

Question 4

Diagnosis of Depressive Episode

Answer 4

[Depressed mood for most of the day/q day or anhedonia] + [at least 5 of the following] for 2 weeks:

SIG E CAPS

1. Sleep disturbances (insomnia or hypersomnia)
2. Interest: loss of interest
3. Guilt/feelings of worthlessness
4. Energy loss and fatigue
5. Concentration/thinking problems
6. Appetite/weight changes (most often WL)
7. Psychomotor retardation/agitation
8. Suicidal ideation

Question 5

Diagnosis of Major Depressive Disorder

Answer 5

1 or more major depressive episodes WITHOUT a hx manic/hypomanic or mixed

Question 6

What is the Geriatric Depression Scale?

Answer 6

1. Are you satisfied with your life?
2. Do you often get bored?
3. Do you often feel helpless?
4. Do you prefer to stay at home rather than going out and doing new things?
5. Do you feel pretty worthless the way you are now?

• 2/5 = suggests diagnosis of depression

Question 7

Majority of cases of GAD (Generalized Anxiety Disorder) have a comorbidity with ___________.

Answer 7

Major Depression and other anxiety disorder

Question 8

What disorders tend to co-occur with GAD? (in order)

Answer 8

1. Specific phobia
2. Social phobia
3. Panic disorder

Question 9

GAD is associated with increased rates of what?

Answer 9

• 1. Substance abuse
• 2. PTSD
• 3. OCD

Question 10

Diagnosis of GAD

Answer 10

Excessive anxiety and worry about daily life that is hard to control most days/ most of the day for ≥6 months with ≥3 of the following sx in adults (≥1 in kids):

FIRM-DS

• 1. Fatigue
• 2. Irratibility
• 3. Restlessness
• 4. Muscle tension
• 5. Difficulty concentrating
• 6. Sleep disturbance

Question 11

Treatment for GAD

Answer 11

1st line = CBT, SSRI (paroxetine or paxil) , SNRI

Question 12

________ = best way to diagnose depression/anxiety

Answer 12

Patients history

Question 13

For depression and GAD, only do lab work/imaging in what patients?

Answer 13

Whom the history and/or PE suggests another etiology.

Question 14

A patient with a family history of ______ is at increased risk of suicide.

Answer 14

Bipolar Disorder

Question 15

What patients must be asked about suicidal ideation and behavior.

Asking about suicidal ideation does not increase risk of suicide.

Answer 15

All depressed patients

Question 16

Any positive or equivocal response when asking about suicide should prompt docs to do what?

Answer 16

Ask about

1. Specific nature of the ideation, intent, plans and available means (firearms) and actions
2. RF: past hx of attempts, comorbid illnesses, FHx of suicidal behavior
3. Develop a safety plan for further eval and treatment that depends on risk (can range from F/U - outpatient clinic -ER psych eval)

Question 17

DDx for depression

Answer 17

• 1. Sadness
• 2. Burnout
• 3. Adjustment disorder with depressed mood
• 4. Bipolar disorder
• 5. Borderline personality disorder
• 6. Delirium
• 7. Schizo and schizoaffective

Question 18

What is often under dx in patients with depression?

Answer 18

Bipolar

Question 19

RF for suicide

Answer 19

(SAD PERSONS)

• 1. Sex: Male
• 2. Age: young adults or elderly
• 3. Depression
• 4. Prior attempts
• 5. Ethanol or drugs
• 6. Rational thinking loss (psychosis)
• 7. Sickness (mental illness)
• 8. Organized plan
• 9. No spouse (lack of social support)
• 10. Stated intent

Question 20

What is delirium?

Answer 20

Reversible LOC and ATN that is acute (waxes and wanes)

Question 21

What is the difference between unipolar psychotic depression and schizo/schizoaffective disorder?

Answer 21

• Major depression: delusions and hallucinations only occur during episodes
• Schizo/schizoaffective: psychotic sx occur with and w/o major depression

Question 22

Treatment of Unipolar Major depression

Answer 22

• 1st line: CBT and SSRI
• If treatment resistant: ECT

Question 23

What are reasons for psych referral?

Answer 23

1. If dx of depression/comorbidities is uncertain
2. Depression endangers pts life
3. Severe, psychotic, catatonic depression
4. Depression that occurs w/ bipolar + schizoaffective disorder + schizophrenia (if pt has auditory/visual hallucinations)

Question 24

Younger or older: who responds better to CBT?

Answer 24

Younger

Question 25

in the 5 model approach for depression, what is the biomechanical approach?

Answer 25

• Look for any SD, esp cranial.
• Chronic pain can contribute to depression.
• Patients may have GI issues bc 5HT receptors are in GI system.

Question 26

What should you consider in patients with GAD + severe depression?

Answer 26

May be too symptomatic to fully engage and participate in CBT and treatment with a serotonergic reuptake inhibitor (SRI) with or without CBT may be preferable.