Major depressive disorder

Question 1

DSM-5 Criteria

Answer 1

At least one MDE (SIG E CAPS 2 weeks) with NO hx of manic or hypomanic episodes

Question 2

lifetime prevalence?
onset age peak?
female vs male onset?
Most common disorders among those who commit suicide?

Answer 2

12%
20s
1.5-2 times higher in females during reproductive years
MDD and bipolar 1

Question 3

Sleep disturbances in MDD?
disorder mimics MDD?

Answer 3

Multiple awakenings, initial and terminal insomnia (most common), increased REM and shifted to early in the night and reduced stage 3 and 4 sleep.
OSA

Question 4

what scale measures severity of MDD and which is a screening tool?

Answer 4

Hamilton depression rating scale
PHQ-9

Question 5

Etiology

Answer 5

low serotonin, abnormal thyroid axis, high cortisol, multiple childhood adverse events (esp. losing a parent before 11)

Question 6

if left untreated?
risk of another MDE?
risk of suicide?

Answer 6

self limiting, lasting 6-12 mo.
50-60% for 2 years after the last MDE
15%

Question 7

who should be hospitalized?

Answer 7

if theyre at risk for suicide, homicide, or cannot care for themselves (cant eat or drink, catatonic, etc)

Question 8

MDD with atypical features?

Answer 8

hypersomnia, mood reactivity, leaden paralysis, hypersensitive to interpersonal rejection

Question 9

MDD with catatonia? Tx?

Answer 9

catalepsy (immobility), abnormal and uncomfortable posture, mutism, negativism (not following instructions), staring, echolalia, purposeless motor activity.
responsive to ECT and lorazepam

Question 10

MDD with psychotic features?

Answer 10

MDD with delusions or hallucinations common in 24-53% of hospitalized elder patients

Question 11

MDD with anxious distress?

Answer 11

feeling tense, restless, difficulty concentrating, fears of something bad happening, feeling of losing control

Question 12

MDD seasonal? Tx?

Answer 12

irritability, carb cravings, hypersomnia. treated with 10,000 lux white light for 30 minutes early mornings