Section I. Disease Burden Flashcards
What is level 1 evidence?
Meta-analysis, narrow CI, 2+ RCTs with large sample size, preferably placebo controlled
What is level 2 evidence?
Meta-analysis, wide CI, 1+ RCT with adequate sample size
What is level 3 evidence?
Small sample RCT or non-randomized controlled prospective studies or case-series or high-quality retrospective studies
What is level 4 evidence?
Expert opinion, consensus
what is 1st line treatment?
Level 1 or level 2 evidence, plus clinical support
what is 2nd line treatment?
Level 3 evidence or higher, plus clinical support
what is 3rd line treatment?
Level 4 evidence or higher, plus clinical support
Anxiety, comorbid or as a specifier, with depression increases the risk of: (4)
- Increased rate of suicide
- Poor response to treatment
- Increased risk of chronicity
- Increased risk of recurrence
“With Peripartum onset” - what % of depressive episodes happen before delivery?
50% of postpartum depressive episodes have an onset prior to delivery
mixed features found in up to _____ of patients with MDE
1/3
what age group are mixed depressive episodes more common in?
Younger patients
what is the annual prevalence of MDE
4.7%
lifetime prevalence of MDE?
11.3%
why are women two times more likely to be depressed?
- hormone differences
- effects of childbirth
- different psychosocial stressors
- behavioural models of learned helplessness
Perinatal depression is associated with what adverse outcomes in their kids? (8)
- Emotional regulation
- Internalizing disorders
- Behavioural disorders
- Hyperactivity
- Reduced social competence
- Insecure attachment
- Adolescent depression
- Negative effects on cognitive development
what medical illnesses does depression increase risk for? (10)
Arthritis
Asthma
Cancer
Chronic lung disease
Chronic pain
Diabetes
Heart disease
Hypertension
Peptic ulcer
Stroke
what are the principles of clinical management? [9]
- Complete thorough biopsychosocial assessment, using clinical scales
- Get collateral information
- Formulate diagnosis and differential
- Establish therapeutic alliance
- Support education and self management
- Engage patient as partner to determine treatment goals
- Construct comprehensive management plan, including safety, with patient and family
- Deliver evidence-based treatments
- Monitor outcomes with the measurement based care
what effects management adherence?
Patient education
Supportive self-management
Collaborative care systems
Frequent monitoring
Weak therapeutic alliance
non-modifiable risk factors for suicide during MDE [6]
- Older men
- Past suicide attempt
- History of self harm behaviour
- Being a sexual minority
- Family history of suicide
- History of legal problems
modifiable risk factors for suicide during MDE [11]
- Active SI
- Hopelessness
- Psychotic symptoms
- Anxiety
- Impulsivity
- Stressful life event [financial distress, victimization]
- SUD [esp. EtOH]
- PTSD
- Personality disorders [esp. cluster B]
- Chronic painful medical conditions
- Cancer
Risk Factors for chronic or recurrent episodes of depression [10]:
- Earlier age of onset
- Greater number of previous episodes
- Severity of initial episode (defined by the presence of numerous symptoms, SI, and psychomotor agitation)
- Disruptions of sleep/wake cycle
- Presence of comorbid psychopathology
- Family history of psychiatric illness
- Presence of negative cognitions
- High neuroticism
- Poor social support
- Stressful life events
how long is the acute treatment phase for depression?
8 to 12 weeks
how long is the maintenance phase of treatment for depression?
6 to 24 months, or longer
What percentage of patients will have a chronic or recurrent course of depression?
50%
