Mehl. Depressive disorders + NBME 10 155Q, 55Q, 138Q 03-21 (2) Flashcards
MDD. What are the SIGECAPS criteria for diagnosing depression?
At least 5 out of 9 must be present for at least a 2-week period.
MDD. What does the ‘S’ in SIGECAPS stand for?
Sleep disturbance (insomnia or hypersomnia).
MDD. What does the ‘I’ in SIGECAPS represent?
Interest loss.
MDD. What does the ‘G’ in SIGECAPS indicate?
Guilt or feelings of worthlessness.
MDD. What is represented by the ‘E’ in SIGECAPS?
Energy loss.
MDD. What does the ‘C’ in SIGECAPS stand for?
Concentration problems.
MDD. What does the ‘A’ in SIGECAPS refer to?
Appetite changes (usually causes weight loss, but sometimes weight gain).
MDD. What does the ‘P’ in SIGECAPS signify?
Psychomotor agitation (restlessness; slowed speech or movements).
MDD. What does the ‘S’ in SIGECAPS denote?
Suicidal ideation.
MDD. The symptoms must cause socio-occupational impairment and must not be attributed to a substance or another medication condition.
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MDD. As far as NBME Qs go, I can say that USMLE doesn’t actually give a fuck about fulfilling the 5/9 criteria. They’ll give you an elderly male who’s a bit quiet + teary- eyed + who’s had weight loss, and the answer is just depression. Students get confused because they don’t count 5/9, but as I said, USMLE doesn’t care.
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MDD. It’s to my observation that ………. is one of the most buzzy indicators in a psych vignette that MDD is likely the answer.????
WEIGHT LOSS
MDD. what regarding sleeping?
Terminal insomnia (patient wakes up too early in the morning) can be seen.
MDD. what about libido? erection?
Can cause decr. libido, but patient still has nocturnal erections (asked on NBME).
MDD. what medication can cause?
Can be caused by beta-blockers (propranolol); asked on NBME.
MDD. Tx?
SSRIs, CBT, and occasionally ECT.
Depression due to a medical condition. what is most important cause?
Hypothyroidism is important cause of low mood and apathy.
Depression due to a medical condition. USMLE likes what 2 conditions as causes of depression.??
post-MI and cancer
Depression due to a medical condition.
Q might give guy who’s had weight loss + teary-eyed post-MI; answer on an NBME form is just sertraline (an SSRI).
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Atypical depression. CP? budingi CP lyginant su tiesiog depresija
Hypersomnolence + hyperphagia in the setting of depression that is reactive / ameliorates when positive circumstances present themselves.
This latter aspect is called “mood reactivity,” where positive events of experiences can significantly improve mood; this distinguishes atypical depression from other forms of depression, where mood usually remains persistently low regardless of external circumstances.
Atypical depression. Tx?
Tx = CBT, SSRIs, or monoamine oxidase inhibitors (MAOIs
Atypical depression. Why MAOIs are not first line?
MAOIs are considered to be highly efficacious but are not usually used first-line because of serotonin syndrome risk (discussed later).
Pseudodementia. definition?
Not actual dementia.
This is depression that presents as cognitive decline, usually in elderly.
Pseudodementia. what abnormal test?
Patients with depression who have apathy will perform poorly on the MMSE.
Pseudodementia.
The Q might say the patient is unable to draw a clockface, but when prompted, is able to finish it quickly. They might also say patient remembers 0 out of 3 objects after 5 minutes.
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Pseudodementia.
Look for obvious signs of depression, such as short, quiet answers, and low mood.
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Depression due to a medical condition. IN PEDS. what cause?
Hypothyroidism is important cause of low mood and apathy.
There is 2CK Peds Q where they give Hashimoto in a 14-year-old.
Can occur after severe diagnoses, e.g., ALL.
NBME 10. 138Q. MDD symptoms disrupt everyday functioning.
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NBME 10. 138Q. The pathogenesis of MDD involves a genetic vulnerability combined with environmental stressors (eg, the death of a loved one).
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NBME 10. 138Q. MDD - most effective Tx?
The most effective treatment includes both psychotherapy and antidepressant medication
NBME 10. 138Q. MDD. all patients need to be screened for what?
suicidal ideation.
NBME 10. 138Q. MDD –> screening -> shows suicidal ideation. Next step?
If a patient endorses suicidal ideation with an active plan, then inpatient psychiatric hospitalization should be strongly considered.
NBME 10.138Q. MDD. KITI ATS.
Acute stress disorder. when occur?
within 1 month of a traumatic event such as physical or sexual violence.
NBME 10.138Q. MDD. KITI ATS. Acute stress disorder. CP?
Intrusive thoughts or memories, changes in arousal and reactivity (eg, hypervigilance), avoidance of reminders of trauma, and negative mood/thoughts.
NBME 10.138Q. MDD. KITI ATS.
Adjustment disorder with depressed mood. onset?
Onset of disproportionate distress within 3 months of an identifiable stressor with associated depressive symptoms.
do not experience a sufficient number of depressive symptoms to satisfy MDD criteria.
NBME 10.138Q. MDD. KITI ATS.
Dysthymic disorder (or persistent depressive disorder). definition/CP?
At least three depression symptoms (including depressed mood during more days than not) that have endured for at least 2 years.
do not experience a sufficient number of depressive symptoms to satisfy MDD criteria.
NBME 10.138Q. MDD. KITI ATS.
Normal bereavement (Choice E), or uncomplicated grief reaction. duration?
Symptoms typically endure less than 6 months.
do not experience a enough depressive symptoms to satisfy MDD criteria.
NBME 10.138Q. MDD. KITI ATS.
Normal bereavement (Choice E), or uncomplicated grief reaction. CP?
Include sadness, shock, anguish, guilt, regret, difficulty concentrating, decreased interest in usual activities, preoccupation with thoughts and memories of the deceased, and neurovegetative symptoms such as sleep, appetite, and energy disturbances.
NBME 10. 155Q. MDD. kiti ats.
NBME 10. 155Q. MDD. kiti ats. Generalized anxiety disorder. CP?
excessive and difficult to control worrying, hyperactivity, disordered sleep, fatigue, and trouble relaxing for at least 6 months.
NBME 10. 155Q. MDD. kiti ats. Generalized anxiety disorder. duration at least?
least 6 months.
NBME 10. 155Q. MDD. kiti ats
Primary insomnia or psychophysiological insomnia. definition?
Refers to difficulty sleeping that is related to psychological barriers to sleep rather than secondary to medical problems or other psychiatric diagnoses.
in the case: This patient’s insomnia is likely secondary to MDD.
NBME 10. 55Q. Persistent depressive disorder (dysthymia). Definition?/CP. duration?
At least three depression symptoms that have endured for at least 2 years
NBME 10. 55Q. Persistent depressive disorder (dysthymia).
By definition, patients must experience a depressed mood on more days than not. Other symptoms of persistent depressive disorder include neurovegetative symptoms (decreased energy, sleep disturbances, appetite disturbances), impaired concentration, low self-esteem, and hopelessness.
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NBME 10. 55Q. Persistent depressive disorder (dysthymia).
By definition, persistent depressive disorder symptoms must lead to clinically significant distress or impaired social or occupational functioning (eg, interpersonal friction).
NBME 10. 55Q. Persistent depressive disorder (dysthymia). Mx?
Should be managed similarly to MDD: antidepressant medication plus psychotherapy is most effective. SSRI are generally the first-line medications given their low adverse effect burden.
NBME 10. 55Q. Persistent depressive disorder (dysthymia). KITI ATS. Adjustment disorder with depressed mood. ONSET?
disproportionate distress within 3 months of an identifiable stressor with associated depressive symptoms
NBME 10. 55Q. Persistent depressive disorder (dysthymia). KITI ATS. Substance-induced mood disorder. Definition?
in case patient used heroin.
mood disturbance that developed during or within a month of intoxication with or withdrawal from a substance. This patient’s depressed mood preceded his cocaine use and therefore is unlikely to be secondary to cocaine use.
NBME 10. 55Q. Persistent depressive disorder (dysthymia). KITI ATS. Borderline personality disorder. CP?
Is a cluster B personality disorder, the emotional or dramatic cluster, that features an unstable sense of self, unstable emotions, and tumultuous relationships.
In case: his mood has been persistently depressed rather than unstable.
what respiratory pathology is HY for depresion?
Obstructive sleep apnea is another HY cause of depression.
M. Dysthymia. definition?
At least 2 years of depressed mood without fulfilling MDD criteria
M. Cyclothymia.
definition?
At least 2 years of oscillation between depressed mood and hypomania (discussed below).
