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Psychosocial Care -Schreibman > Management of Depressive Mood Disorders > Flashcards

Management of Depressive Mood Disorders Flashcards

1
Q

What is the DSM diagnostic criteria for diagnosing Major Depression

A

Pt must have 5/9 of the symptoms for at least 2 weeks, and one of them MUST be either: depressed mood or loss of interest or pleasure in doing things (and 4 others)

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2
Q

What are the 9 symptoms included in the major depression criteria

A
  1. Depressed mood
  2. Loss of interest or pleasure
  3. Significant change in weight or appetite
  4. Insomnia or hypersomnia
  5. Psychomotor agitation or retardation
  6. Fatigue or loss of energy
  7. Feelings of worthlessness or guilt
  8. Impaired concentration or ability to make decisions
  9. Thoughts of suicide or self harm
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3
Q

What patient population is most likely to experience symptoms of thoughts of suicide or self harm

A

Elderly are highest risk

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4
Q

What are the atypical symptoms of seasonal depression

A

A pt will experience increased appetite and increased sleep

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5
Q

What is the criteria for minor depression

A

Pt must have 2-4 of the 9 symptoms of major depression and it MUST include on of the following: depressed mood or loss of pleasure or interest

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6
Q

What does SIGECAPS stand for

A 
Sleep disturbance
Interest
Guilt
Energy change
Concentration
Appetite
Psychomotor retardation or agitation
Suicidal
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7
Q

What is considered a score of severe depression on the PHQ-9

A

Score > or = to 20

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8
Q

What is considered a score of moderate/severe depression with the PHQ-9

A

15-19

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9
Q

What is considered a score of moderate depression with the PHQ-9

A

10-14

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10
Q

What is considered a score of minor depression with the PHQ-9

A

5-9

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11
Q

What is considered a normal PHQ-9 score

A

0-4

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12
Q

What are vegetative symptoms of depression

A

Vegetative symptoms of depression are physiological or are related to body function such as sleep/appetite/energy/sexual interest

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13
Q

What are the emotional symptoms of depression

A

Crying spells

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14
Q

What are the cognitive symptoms of depression

A

poor concentration

low self esteem

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15
Q

What are the treatment-resistant/depressive sub-types

A 
atypical depression
double depression
psychotic depression
severe and melancholic depression
co-morbidity- psychiatric or medical
psychosocial stressors
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16
Q

How many patients with 1st depression have a 2nd depression

A

about half

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17
Q

How much does a second episode of depression increase the risk of getting a third

A

70-80%

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18
Q

How much does third depression increase the risk for a fourth

A

80-89%

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19
Q

What happens to depressive episodes with age

A

The get longer and more frequent

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20
Q

What is melancholic depression

A

Major depression with an emphasis on lack of pleasure or lack of reactivity to pleasure with three or more:

  • depressed mood worst in the morning
  • early morning awakening
  • psychomotor agitation or retardation
  • significant weight loss
  • inappropriate guilt
21
Q

What medications do melancholic depressive pts respond to best

A

TCA or Norepi reuptake inhibitors

22
Q

What are the s/s associated with melancholic depression

A 
Depressed mood worst in the morning
Early morning awakening
Psychomotor agitation or retardation
Sig. WL
Inappropriate guilt
23
Q

What is required to have a dx of persistent depressive d/o

A
  • Depressed mood for most of the day, for more days than not, as indicated either by subjective account or observation of others, for at least to years and the presence of two or more of the classic depression sxs
  • During the 2 year period of the distrubance the person has never been without sx for more than 2 months at a time
  • No Major Depressive Episode has been present during the first 2 years
24
Q

What is the exception for dx persistent depressive disorder in pts that are <18 years old

A

The symptoms are only required to be persistent for 1 year, not two

25
Q

What factors need to be considered when selecting an antidepressant

A
  • Pts hx of response to an antidepressant/their preference
  • Hx of response in 1st degree relative
  • Cardiovascular and medical status of pt
  • Safety in OD if applicable
  • S/E
  • Drug interactions
  • Cost
  • does the pt have bipolar?
  • Does the pt need pain mgmt too?
  • Smoker?
  • Comorbities?
26
Q

What medication has an extremely long half life

A

Prozac/fluoxetine

27
Q

When prescribing an antidepressant to a pt with bipolar what should you always do

A

Make sure to prescribe with a mood stabilizer

28
Q

What is a good med to RX a smoker with depression

A

Wellbutrin

29
Q

What antidepressant should not be prescribed to someone who could get pregnant

30
Q

What antidepressants are also helpful for pain mgmt

31
Q

When should TCAs NOT be rxed

A 
If a pt has a hx of:
Ischemic heart disease
Fall risks
BPH
Suicidal ideations
32
Q

What are the uses of SSRIs

A 
MDD
Dysthmia (melancholic)
SAD
Panic d/o
GAD
PMDD
OCD
Substance Abuse
Eating Disorders
PTSD
Premature ejaculation
33
Q

What are common reasons pts d/c their antidepressants

A

Not being told about the s/e
sexual dysfunction
feeling better

34
Q

How can you prevent initial anxiety/jitteriness that is commonly associated with initiating tx with SSRIs

A

Gradual titration

35
Q

What are the important characteristics or s/e of SSRIs

A
  • low cardiovascular effects
  • absence of anticholinergic activity or weight gain (except paxil)
  • Low OD and SZ potential
  • Nausea
  • Insomnia
  • Sexual Dysfxn
  • HA
36
Q

What SSRI is rated D in pregnancy

A

paroxetine

37
Q

What SSRI is considered the least activating

A

paroxetine

38
Q

How do you prevent activation or insomnia associated with starting SSRIs

A

Start with tiny doses
Switch to other agents
Add Trazadone (for insomnia)
Temporarily add clonazepam, xanax, or ambien (last choice)

39
Q

What is a rare but serious s/e of trazodone

40
Q

What are some tx options for sexual dysfunction associated with SSRIs

A 
Yohimbine
Amantadine
Cyproheptadine
Buspirone
Buproprion
Dose-Reduction
Skipped Dose
41
Q

What are the s/s of serotonin syndrome

A 
Uncontrollable shivering
Incoordination
Restlessness in feet
Hyperreflexia
Frightened/diaphoretic/hyperarousal state
Agitation
Oculogyric Crisis
Diarrhea
Fever
42
Q

What med is never recommended to mix with an SSRI and why

A

Triptans (can lead to serotonin syndrome)

43
Q

What is FLUSH and what does it stand for

A

The sx associated with abruptly d/cing SSRIS

F-Flu-like symptoms
L-Light headedness/dizziness
U-Uneasiness
S-Sleep disturbance
H-HA
44
Q

___________ and ____________ decreased suicidal thoughts and behavior for adult and geriatric pts

A

Fluoxetine/venlafaxine

45
Q

Didn’t know if we needed to know slide 34 and I am confused

A

Ask about attenuation in class

46
Q

What will depression with psychotic fx increase the risk of

A

Suicide (by 66%)

Depressive symptoms

47
Q

What is an additive tx that pts with depression with psychotic features should receive

A

Antipsychotics

48
Q

What meds are typically less successful for depression with psychotic features

A

SSRIs- shouldnt be used as monotherapy

49
Q

Left off on slide 38/44

A

Need to ask what the focus should be on since the last few slides were skimmed over

Psychosocial Care -Schreibman (1 decks)

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