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Disciplines Exam 2 SHEA > Major Depressive Disorder > Flashcards

Major Depressive Disorder Flashcards

1
Q

What 4 moods does Depressive Disorder include?

A
  • Mild depression
  • moderate depression
  • severe depression
  • severe depression with psychosis
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2
Q

What 3 moods does Cyclothemia include?

A
  • Elation
  • normal mood
  • dysthymia
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3
Q

What 6 moods does recurrent depressive disorder include?

A
  • normal mood
  • dysthymia
  • mild depression
  • moderate depression
  • severe depression
  • severe depression with psychosis
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4
Q

What moods does Bipolar affective disorder include?

A

All of them

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5
Q

Disturbance of emotions that are severe or prolonged enough to cause impairment of functioning - magnification of normal rxn

A

Mood disorders

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6
Q
  • Period of extreme sadness and helplessness
  • sadness
  • feelings of worthlessness
  • withdrawal from others
  • changes in sleep/appetite
A

Depression

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7
Q
  • Period of abnormally high emotion and activity
  • intense elation or irritability
  • hyperactivity
  • talkativeness
  • distractibility
A

Mania

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8
Q

The diagnostic criteria for Major depressive disorder is sad mood or loss of pleasure for ___ weeks w/ at least ___ other sxs.

A
  • 2 weeks
  • 4
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9
Q

The diagnostic criteria for dysthymic disorder is mood is down and other sxs are present for at least _______.

A

50% of the time for at least 2 years

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10
Q

What are the 3 main causes of mood disorders?

A
  • Biological vulnerability
  • psychological vulnerability
  • stressful life event
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11
Q

What 3 things can a stressful life event cause?

A
  • stress hormone effect neurotransmitters
  • sense of hopelessness and negative thought process
  • problems in interpersonal relationships and lack of social support
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12
Q

What is the most common mood disorder?

A

major depressive disorder

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13
Q

When in life does MDD occur?

A

may occur at any age but likelihood increases after puberty

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14
Q

MDD is prevalent in which sex most and when?

A

Women between time of menstruation and menopause

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15
Q
  • Occurrence of at least a single major depressive episode, (although most patients will experience recurrent episodes.)
A

MDD

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16
Q

What makes women more prone to MDD than men?

(6 things)

A

***Hormones***

  • girls 2x as likely to experience sexual abuse
  • women have more chronic stressors
  • more likely to worry about body image
  • react more intensely to interpersonal loss
  • women spend more time ruminating; (men tend to distract)
    • ruminating intensifies and prolongs sad moods
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17
Q

MDD risk factors (lots of em)

A
  • alcohol dependence
  • comorbid chronic medical conditions
  • female sex
  • personal or fam hx of depression
  • recent childbirth
  • recent stressful evetns
  • parental loss
  • trauma during childhood or adulthood
  • low parental warmth
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18
Q

Rate of depression is higher in which type of twin?

A

Higher in Identical (50%) than Fraternal is 20%

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19
Q

Is the brain more or less active during major depression?

A

Less active, due to diminished neurotransmitter levels

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20
Q

Stable vs Temporary explanations of MDD

A
  • Stable: bad situation will last for a long time
  • Temporary: This is hard to take but I will get through this
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21
Q

Global vs. Specific MDD

A
  • Global: My explanation applies to many areas of my life. (Ex: w/o my partner, I cant seem to do anything right).
  • Specific: I miss my partner but thankfully i have family and other friends.
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22
Q

Internal vs External MDD

A
  • Internal: our break up was all my fault
  • External: it takes 2 to make a relationship work and it wasn’t meant to be
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23
Q
  • Subjected to events with little or no control –>
  • fails to succeed –>
  • feels overwhelmed/powerless –>
  • develop sense of helplessness –>
  • give up and stop trying to improve the situation –>
  • cycle repeats –>
  • learned behavior develops –>
A

Learned Helplessness (MDD)

*women are more likely to be abused and twice as likely to feel overwhelmed*

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24
Q

Who should be screened for MDD according to USPSTF?

A
  • All adults that you can provide adequate resources for diagnosis, treatment and follow up are available
    • including pregnant/postpartum women
    • older adults
  • Patients w/ identified risk factors
  • Patient w/ unexplained somatic sxs, chronic pain, anxiety, substance misuse, or non-responsive to effective tx
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25
Q

MDD 1st step for depression screening

A
  • Over the past 2 weeks, have you felt down, depressed, or hopeless?
  • Over the past 2 weeks, have you felt little interest or pleasure in doing things? (anhedonia)

If pt answers yes to either question, this is a + screen and you need to move onto step 2 questions

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26
Q

MDD 2nd step for depression screening

A
  • dig deeper and engage in conversation about mood and changes in behavior
  • Have pt fill out PHQ9
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27
Q

Criteria for MDD on PHQ9

A
  • Checked 1 or 2 at level of ‘nearly every day’ AND
  • 5 items from 3 to 9 checked at level of ‘for more than half’ or ‘nearly every day’
  • SI always counted if + response regardless of severity
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28
Q

PHQ-9 Score

  • None/Minimal
  • What is tx?
A
  • 0-4
  • no tx
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29
Q

PHQ-9 Score

  • Mild
  • Tx?
A
  • 5-9
  • “watchful waiting”
  • Reevaluate at FU appt
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30
Q

PHQ-9 Score

  • Moderate
  • Tx?
A
  • 10-14
  • Consider referral for psychotherapy / initiation of psychopharm therapy
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31
Q

PHQ9 Score

  • Moderately Severe
  • Tx?
A
  • 15-19
  • Initiate psychopharm therapy
  • Refer for pschotherapy
32
Q

PHQ9 Score

  • Severe
  • Tx?
A
  • 20-27
  • Initiate psychopharm therapy
  • If severe impairment/tx resistant, then “expedite” referral for psychotherapy
33
Q

DSM dx of MDD requires:

  • __ or more of the following sxs and has been present for the same __ week period and represents a change from previous functioning.
  • At least ___ of the sxs is either which 2 things?
A
  • 5 or more
  • 2 week period
  • At least 1 of the sxs is either Depressed mood or Loss of interest or pleasure (anhedonia)
34
Q

SIGECAPS

A

Used for MDD

  • sleep pattern changes (cognitive)
  • interest/activity changes (cognitive)
  • guilt / increased worry
  • energy changes (somatic)
  • concentration changes (cognitive)
  • appetite changes (somatic)
  • psychomotor disturbances (somatic)
  • suicidal ideation (cognitive)
35
Q
  • anxious distress
  • mixed features: mania/hypomania sxs
  • melancholic features: loss of pleasure
  • atypical -
  • mood congruent: delusions/hallucinations
  • mood incongruent: delusions/hallucinations
  • catatonia
  • peripartum onset: during or within ___ wks of delivery
  • -seasonal pattern
A

“MDD Specifiers”

  • 4 weeks
36
Q

How do you determine the severity of MDD?

(3 things)

A
  • Clinical Interview
  • Validated depression screening tool (PHQ-9)
  • Assessment of severity guides the tx
37
Q

What 4 symptoms do MDD and PDD have in common?

A
  • depressed mood (irritable mood)
  • Insomnia/hypersomnia
  • Fatigue
  • Poor concentration or difficulty making decisions
38
Q
  • citalopram
  • escitalopram
  • fluoxetine
  • paroxetine
  • sertraline
A

SSRI

(Depressive Disorder Tx)

39
Q

Reasons to choose which drug?

  • ease of dosing and low toxicity
  • good for children, adolescents and late onset depression
  • less adverse effects

Common adverse effects:

  • GI upset
  • Sexual dysfunction
  • Changes in energy (fatigue or restlessness)
A

SSRI

40
Q

What are 3 common adverse effects of SSRIs?

A
  • GI upset
  • Sexual dysfunction
  • fatigue/restlessness
41
Q
  • venlafaxine
  • desvenlafaxine
  • duloxetine
A

SNRIs

42
Q

Which drugs are 1st line for those with significant fatigue and/or pain syndromes?

A

SNRIs

43
Q

When would you rx an SNRI?

A

if a patient is not responding to an SSRI

44
Q

SNRI adverse effects

A

noradrenergic side effects: HTN

45
Q
  • Bupropion
  • Mitazapine
  • nefazodone
  • trazadone
A

Atypical Antidepressants

46
Q

What 3 advantage does Bupropion have over other SSRIs?

A
  • Causes less sexual dysfunction
  • Less GI distress
  • Is weight neutral
47
Q

Mitrazapine is associated with a high risk of _________

A

weight gain

48
Q

If a pt came in complaining about sexual side effects/erectile dysfunction due to their SSRI/SNRI, how would you treat? (2 things)

A
  • pretreatment counseling
  • sildenafil for ED
49
Q

If a pt came in complaining about undesired weight gain due to their SSRI/SNRI, how would you treat?

A

switch to bupropion

50
Q

If a pt came in complaining about agitation due to their SSRI/SNRI, how would you treat?

A

switch to another SSRI/SNRI; consider mania

51
Q

If a pt came in complaining about insomnia due to their SSRI/SNRI, how would you treat?

A
  • Add:
    • mirtazapine
    • trazodone
    • or sedative-hypnotic
52
Q

If a pt came in complaining about anxiety due to their SSRI/SNRI, how would you treat?

A
  • Short course of benzodiazepines during initiation
53
Q

What do we have to watch out for in the elderly when rx SSRI/SNRI?

A

Hyponatremia, because it may promote osteoporosis

(Sodium levels too low)

54
Q

How long should you treat a patient with MDD?

A

atleast 6-9 mo with close follow up

55
Q

When should you f/up with pts after they start pharmacotherapy for MDD?

A

1-2 weeks

56
Q

If pt response to meds is inadequate, when should you modify treatment?

(MDD)

A

At 6 weeks

57
Q

Possible increased suicide risk in ________, _____, _______ who start pharmacotherapy

A
  • children
  • adolescents
  • young adults
58
Q

Why is there a high rate of nonadherance in the early months of pharm tx for MDD?

A
  • misperception regarding how long it would take to feel better -> (2-6 weeks)
  • med side effects
  • didn’t understand the need to continue the meds
59
Q

What should you do if pt has partial response to the meds?

A
  • 1st: maximize dose of initial agent
  • 2nd: switch to another medication or add 2nd drug if needed
60
Q

If the partial response continues despite maximizing dose, switching meds, or adding a drug, what should you do?

A
  • add psychotherapy
  • change antidepressants
  • augment with bupropion, mirtazapine, non-traditional agent
61
Q

How long should you maintain meds for pts who experience their first episode of depression?

A
  • treatment may take 1 to several months until remission
  • continue for another 6-12 mos
62
Q

How long should you maintain meds for pts who experience multiple episodes of depression?

A

15 months - 3 yrs

63
Q

How long should you maintain meds for pts older than 70 who respond to an SSRI?

A

2 yrs to prevent recurrence

64
Q

What to do if relapse occurs after cessation of meds for MDD?

A
  • use AD that previously led to remission
    • initiate long term maintenance therapy
65
Q

Lifetime therapy may be required for patients who have experienced greater than or equal to ___ episodes

A

3

66
Q

5 Risk factors for first recurrence and more than one recurrence of depressive episode

A
  • fam hx of bipolar recurrence
  • < 1 yr
  • onset in adolescence
  • severe depression
  • suicided attempt
67
Q

Identifies and modifies dysfunctional or inaccurate thoughts and behaviors

A

CBT

68
Q
  • Targets conflicts and role transitions
  • pt needs capacity for psychological insight
A

IPT (interpersonal therapy)

69
Q

Practical approaches to coping with everyday problems

A

PST

70
Q
  • treatment of mild depression only -
  • serious adverse effects are uncommon -
  • DO NOT USE WITH SSRIs: bc/ may lead to serotonin excess syndrome -
  • may reduce concentrations of certain mends (digoxin, theophylline, simvastatin and warfarin.)
  • at high dose, may harm sperm cells, reduce fertility.
A

St. John’s Wort

71
Q

5 reasons to consult with behavioral health provider

A
  • diagnostic uncertainty
  • severe symptoms
  • heightened suicide risk
  • need for hospitalization
  • Treatment-resistant depression
72
Q

Alternatives for Treatment resistant depression

A

electroconvulsive therapy transcranial magnetic stimulation

73
Q

When to consider hospitalization (8)

A
  • Significant SI or intent w/o safeguards
  • Intent to hurt others is expressed
  • unable to care for self
  • close observation needed
  • detoxification or substance abuse treatment
  • electroconvulsive therapy initiated
  • dysfunctional family systems worsen depression or interfere with treatment
  • patients life is in jeopardy
74
Q

Severity of MDD

  • May not require tx
  • Responds equally to meds or psychotherapy
  • Benefits more from meds alone or combined w/ psychotherapy
A
  • Mild
  • Mild to Moderate
  • Severe
75
Q

Which drugs have a low toxicity in overdose?

A

Atypical Antidepressants

Disciplines Exam 2 SHEA (11 decks)

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