Module 14 - Diagnosing and Treating Depression Flashcards
Screening for Depression*
Secondary Screening
- Identified risk factors
- Unexplained somatic symptoms, chronic pain, anxiety, substance misuse
- Non response to therapy
Methods for Screening *
ELDERLY PHQ2
1. over past 2 weeks have you felt down, depression or hopeless?
2. have you felt little interest or pleasure in doing things
PHQ9: diagnostic and severity (can be filled out by patient)
Edinburgh: Postpartum
Geriatric Depression Scale: Older Adults
DSM5 Criteria for Major Depression *
5 or more symptoms occur in the same two weeks with change from previous function
1. Depressed mood most of the day, nearly every day as self reported or observed by others
2. Diminished interest or pleasure (anhedonia) in all or almost all activities most of the day ‘ nearly every day ‘
- Weight loss (decrease or increase in appetite) ‘ ‘
- Insomnia or Hypersomnia ‘ ‘
- Psychomotor agitation or retardation ‘ ‘
- Fatigue or loss of energy ‘ ‘
PHQ9 *
Item 10 assess functional impairment and may suggest need for psychiatric admission
Suicide Risk and Assessment *
- Assess acute risk for suicide AT EVERY VISIT
- Ask about and reduce access to lethal means
- Consult psych for any uncertainty regarding suicidal risk
- MENTAL HEALTH CONDITIONS AND ADDICTIVE DISORDERS (SUCH AS ALCOHOL ABUSE) ARE THE MOST POWERFUL RISK FACTORS FOR SUICIDE IN ALL AGE GROUPS. PRESENT IN 90% OF ALL SUICIDES
- PREVIOUS SUICIDE ATTEMPTS ARE THE BEST PREDICTOR OF COMPLETED SUICIDE
- ASSESS FOR SUICIDE AT EVERY SINGLE DEPRESSION APPOINTMENT
What is usually the major factor that explains variability in the energy needs of two healthy men of similar age and size?
a. brown adipose tissue metabolism
b. basal metabolism (wrong)
c. physical activity
d. type of diet consumed
32yo female presents to the office with the complaint of worry which she cannot control for the last six months. She tells you that she has symptoms of sleep disturbances, difficulty concentrating, and irritability.
What is the most likely diagnosis?
Generalized Anxiety Disorder
Feedback: Pt needs to have symptoms for more days than not for 6mo or more, need 3 of the 6 symptoms to diagnose GAD
Problems encountered with the use of drugs to lose weight include:
a. meds may produce serious side effects
b. many meds induce the loss of body fluids but not body fat
c. meds do not lead to permanent changes in eating habits
d ALL OF THE ABOVE (correct)
A divorced female pt presents for an employment physical. She states she has had a “run of bad luck” with jobs and has not been able to hold any job for longer than 2-3 mo. She also states she has been arrest several times for getting into fights when she is out with the girls. She states she drinks an occasional beer, but denies significant problems with etoh.
Which of the following labs would support your suspected diagnosis?
Increased mean corpuscular volume
Feedback: The pt most likely has etoh abuse as evidence by her social, occupation and legal issues. Lab tests will reveal the presence of an elevated mean corpuscular volume, triglycerides, serum uric acid, liver function tests.
The most important initial component of evaluating a patient with depressive illness is
Assessment of suicide risk
A reliable approach for weight loss is to
reduce daily energy intake and increase energy expenditure
Hx of hypertension is being treated with losartan. Currently presents complaining of chronic fatigue, insomnia, decrease appetite, difficulty concentrating for the past 3 weeks. Wife also notes that he no longer goes bowling with his friends and has lost interest in any sexual intimacy. PE is unremarkable. W
Which of the following is the most likely diagnosis?
Major Depression
Patient is being treated for depression and has been taking paroxetine for the past two and half months with marked improvement in symptoms. The patient reports problems with sexual function which is believes is related to the med.
Which of the following is an immediate concern with abrupt discontinuation of the med?
Risk of withdrawal symptoms
Feedback: The great risk of abrupt withdrawal of short acting SSRI’s is a withdrawal syndrome or withdrawal delirium which represents cholinergic rebound
35yo male comes to office for f/u. After 6 weeks on fluoxetine 20mg/day, he still feels depression but sees some improvement. He denies SI. What should you do to help this pt?
Increase dose of fluoxetine
wrongs:
switch to TCA
switch to depakote
admit to BH
Pt asks for something to help him sleep. Reports he has always had a problem with sleeping, admits to feeling nervous most days for last 2 years and has always been uptight and worrier. During the previous 8 months, he has frequently felt tense, shaky, sweaty, palpitations with frequent headaches. He reports being irritable with his 5yoson. Which is the best treatment?
Escitalopram
wrongs
alprazolam
haloperidol
diphenhydramine
