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Summary Notes Royal College > Major Depressive Disorder > Flashcards

Major Depressive Disorder Flashcards

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1
Q

Superior efficacy antidepressants? CANMAT level 1

A

Escitalopram
Mirtazapine
Sertraline
Venlafaxine

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2
Q

What are level 2 antidepressants ?

A

Agomelatine

Citalopram

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3
Q

What are level 1 evidence psychological treatments?

A

CBT

mCBT

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4
Q

What are level 2 - psychological?

A

Behavioral activation
iPT
cAsp

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5
Q

First line augmenting agents for MDD after non response ?

A
  1. Aripiprazole - Level 1
  2. Quetiapine- Level 1
  3. Risperidone- Level 1
Second line:
Bupropion
Lithium
Mirtazapine
Olanzapine
T3
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6
Q

First line switching - non response ?

A

Escitalopram
Sertraline
Venlafaxine

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7
Q

Persistent Depressive Disorder Criterion

A 
CHAS LEE
C- poor concentration
H - hopelessness
A - Poor appetite or overeating
S - Insomnia or hypersomnia
LE - low self esteem
E - Low energy/fatigue
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8
Q

What are early onset PDD patients at risk for developing ?

A

Bipolar - 5% progress to bipolar 1, 15% to bipolar II

MDD - 20% get MDD

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9
Q

Brief PD postpartum/peripartum specifier?

A

occurs during or four weeks after pregnancy

psychotic symptoms at least one day but less than 1 month

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10
Q

Once a woman has had a postpartum episode with psychotic features, the risk of recurrence with each subsequent delivery is ?

A

30-50%

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11
Q

What are the three subtypes of brief psychotic disorder?

A

1) Presence of a stressor
2) Absence of a stressor
3) Postpartum onset

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12
Q

Baby blues

A

30-75 % women that give birth
3-5 days after delivery
duration: days to weeks

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13
Q

Postpartum depression

A

10-15% women who give birth

within 3-6 months

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14
Q

Features suggestive of atypical depression

A

a.ka hysteroid dysphoria
younger, more severe psychomotor slowing
more frequent comorbid panic disorder, substance abuse, and somatization
may preference to MAOi or SSRI
social phobia + avoidant personality disorder = more at risk*

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15
Q

Atypical features

A

A. Mood reactivity
B. 2 of the following:
Weight gain
Hypersomnia
Leaden paralysis (heavy feelings in arms or legs)
Longstanding pattern of interpersonal rejection sensitivity

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16
Q

What is a postnatal postpartum depression scale?

A

Edinburg

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17
Q

Etiology of postpartum depression?

A

rapid decrease in progesterone or estrogen after childbirth

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18
Q

Risk factors for Chronic or Recurrent Episodes of Depression ?

A

1-early age of onset, 2-greater # of episodes, 3-severity of index episode, 4-psych
comorbidity (+dysthymia), 5-stressful life events, 6-family psych hx, 7-lack of social
supports, 8-disruption of sleep wake cycle, 9-high neuroticism, 10-negative cognitions.

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19
Q

Clinical features of bipolar disorder?

A

early age of onset
psychotic depression before age 25
postpartum depression , especially with psychotic features
rapid onset and offset of depressive episodes of short duration (< 3 months)
Seasonality
family history of bipolar disorder
repeated loss of efficacy of antidepressants
depressive mixed state

20
Q

Complications of SSRI in pregnancy ?

A

third trimester :
- respiratory distress, cyanosis
- seizures
- increased risk for persistent pulmonary hypertension of newborn
1/1000
most common is poor neonatal adaptation syndrome

21
Q

Maternal depression and link with boys?

A

more aggressive - antisocial

22
Q

Risk of relapse after 1 episode of MDD?

A

50%

23
Q

Risk of relapse after 2 episodes of MDE ?

A

70%

24
Q

Risk of relapse after 3 episodes of MDE ?

A

90%

25
Q

MDD and neuroimaging finding?

A

amygdala hyperactivity

26
Q

Memory loss in dementia

A

severe for recent vs remote events

in pseudodementia - equal for remote and recent

27
Q

Features of pseudodementia?

A

Abrupt onset
Emphasis on disability
Fluctuating cognitive loss

28
Q

Bipolar - Therapy guidelines:

A

Depression:
Level 2/2nd line: CBT, Family focused
Third line/level 2: Interpesonal and Social rhythm

Maintenance:
First line: psychoeducation (level I)
Second line: CBT/FFT (level 2)
Third line: IPSRT/Peer support (level 2)

29
Q

Sleep disturbances in depression

A

decreased sleep efficiency
shortened REM latency; higher REM density
decreased slow wave sleep (stage III and IV)
increase in nocturnal awakenings
reduction in total sleep time
increased REM sleep
increased core body temperature

30
Q

What do antidepressants do to REM?

A

suppress

31
Q

A major depressive episode in prepubertal child is likely to manifest by:

A

somatic complaints
psychomotor agitation
mood congruent hallucinations

32
Q

PMDD

A

DSM 5 Premenstrual Dysphoric Disorder criteria include 5+ of the following (present during the week before
menses, improve within days of menses onset, and become minimal/absent in the week post-menses):
• 1. Marked affective lability
• 2. Marked irritability/anger/increased interpersonal conflicts
• 3. Marked depressed mood/feelings of hopelessness/self-deprecating thoughts
• 4. Marked anxiety/tension

33
Q

What does PMDD not have vs MDD ?

A

no guilt
no psychomotor changes
no suicidality

34
Q

Good prognostic indicators for MDD tx response?

A

mild episodes, absence of psychotic symptoms
short hospital stay
advance age of onset

35
Q

Poor prognosis - MDD factors?

A

-coexisting dysthymic disorder, -abuse of
alcohol and other substances, -anxiety
disorder symptoms, and a history of more
than one previous depressive episode
• -early age of onset (typically worse prognosis)
• Men are more likely than women to
experience a chronically impaired course.

36
Q

When to use methylphendiate in augmentation - MDD ?

A

depression

with psychomotor retardation

37
Q

Cotard syndrome?

A 
nihilistic and hypochondriacal delusions that are most often found in
psychotic depression (correct answer; Cotard’s syndrome is a nihilistic delusion in
which a person believes that their possessions, friends, or parts of their own body
do not exist or are about to not exist)
38
Q

Poor prognosis in MDD tx

A

coexistence of dysthymic disorder
alcohol and substance use disorders
anxiety symptom disorders

39
Q

Possible mechanisms for SSRI-associated sexual dysfunction

A

1) nonspecific neurological effects eg. sedation
2) brain systems
3) peripheral sexual organs and tissues
4) direct or indirect effects on hormones
5) SSRI mediated inhibition of NO

40
Q

Risk factors for suicide

A 
past attempts
male
family hx of mental health disorder
personality disorder
hopelessness
substance abuse
anxiety
41
Q

Associated features of Vascular depression

A 
less responsive to pharmacotherapy
Limited depressive ideation
e.g. guilt
•Cognitive impairment including executive
dysfunction
•Psychomotor retardation
•Poor insight
•Absence of family or personal history of mood
disorder
42
Q

What does collobaration not do?

A

improve clinical outcomes - NO
does not result in skill transfer or enduring changes to PCP
- it does = increase medication adherence
Colocation is impt*

43
Q

Risk factors for self harm

A

previous self harm
previous psychiatric treatment
employment status
marital status

44
Q

Catatonic excitement

A

Catatonic delerium

45
Q

Impulse control disorders - DSM 5

A 
ODD
Conduct Disorder
Intermittent explosive disorder
Kleptomania
Pyromania
46
Q

Major depressive disorder, mixed features

A

Lurasidone

Ziprasodone

Summary Notes Royal College (16 decks)

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