HYHO! Depression and Anxiety Flashcards
Which gender is more likely to be depressed?
Women
What 7 medical conditions is depression associated with?
TBI (esp between 11 and 15 yrs) Heart disease or stroke hx Diabetes COPD Arthritis/on going pain Cancer Obesity
Diagnosis of unipolar depression
1 or more major depressive episodes w no hx of mania/hypomania. 5 or more of these sx for >2 wks.
–> Depressed mood
–> Loss of interest/ pleasure
Insomnia or hypersomnia nearly every day
Significant weight loss/weight gain
Psychomotor retardation or agitation nearly every day that is observed by others
Fatigue/low energy nearly every day
Decreased ability to concentrate or make decisions
Thoughts of worthlessness, excessive or inappropriate guilt
Suicidal ideation or attempt
List the five items of the geriatric depression scale and how to interpret it
- Are you basically satisfied with your life?
- Do you often get bored?
- Do you often feel helpless?
- Do you prefer to stay at home rather than going out and trying new things?
- Do you feel pretty worthless the way you are now?
2 out of 5 suggests depression (or just no to q 1)
What can a dx of GAD make you more susceptible to?
Substance abuse
PTSD
OCD
What is the DSM-5 diagnostic criteria for GAD? there’s a lot i’m sorry
Excessive anxiety and worry more often than not in 6 months
Finds it difficult to control the worry
Anxiety and worry are associated w three or more of the following (or one in children)
1. restless or on edge
2. Easily fatigued.
3. Difficulty concentrating/mind going blank
4. Irritability
5. Muscle Tension
6. Sleep disturbance
Have distress in social, occupational, etc situations
Not attributable to substance or condition
Not better explained by other mental disorder
What is something to check for in Fhx for depression or GAD?
Family history - could increase risk for certain disorders or suicide. If hx of bipolar, they are increased risk of suicide AND increase risk of bipolar depression if presenting w depressive episode
What should you do if a patient states they are feeling suicidal?
- Ask about specific nature of ideation, intent, plans, and available means
- Assess the patient risk factors for suicide, like prior hc of attempt, family hx, etc
- Develop safety plan for further evaluation and tx reliant on level of risk
* *also ask about homicidal ideation or behavior
What two diseases could present w depressive symptoms?
Hypothyroidism or anemia
What are some things that should be in your ddx for depression?
Sadness
Burnout
Adjustment disorder with depressed mood
Bipolar disorder - ask about mania/hypomania
Borderline personality disorder - moods fluctuate in single day
Complicated grief
Partner abuse
Delirium - decreased alertness and consciousness
Partner abuse
Schizophrenia and schizoaffective disorder - psychotic episodes in the absence of depression
What should you use to pick the anti-depressant your patient needs?
Look at factors life safety, side effects, co-morbid illnesses, concurrent meds and drug to drug interactions, patient preference, and cost
What psychotherapies should be considered for major depression?
CBT or interpersonal psychotherapies.
When should you consider a psychiatric referral in depressed patients?
- diagnosis of depression/comorbidities is uncertain
- Depression endangers life of patient or others
- severe, psychotic, and catatonic depression
- Depression that occurs in context of bipolar disorder, schizoaffective disorder, or schizophrenia
When in GAD would you want to consider giving an SRI w no CBT?
If it concurs with depression and the patient wouldn’t be able to fully engage and participate in CBT
Biomechanical approach
Evaluate and correct SDs - chronic pain is a contributor to moods
Check for GI complaints and offer visceral techniques
