SPE 3: Depression and Anxiety Flashcards
national lifetime prevalence of depression
12%
prevalence of depression in developed countries
18% (US major depression=17%, depressive disorder= 9%)
depression in developing countries
9%
is depression higher in females or males?
-higher in females (17 vs 9%)
what medical conditions is depression associated with?
x Traumatic Brain Injury (TBI) - head injury btw ages of 11 to 15 years is a strong
predictor of subsequently developing depression
x Heart disease or a history of stroke
x Diabetes
x Chronic obstructive pulmonary disease (COPD)
x Arthritis or other causes of ongoing pain
x Cancer
x Obesity
what is unipolar depression
Unipolar major depression (major depressive disorder) is characterized by a history of 1
or more major depressive episodes and no history of mania or hypomania. A major
depressive episode manifests with 5 or more of the following 9 symptoms for at least 2
consecutive weeks; at least 1 symptom must be either depressed mood or loss of
interest or pleasure:
what are the 9 sx used to classify unipolar depression?
1) depressed mood most of day, nearly every day
2) loss of interest or pleasure in most or all activities nearly every day
3) insomnia or hypersomnia nearly every day
4) significant weight loss or gain (5% in month) or decrease or increase in appetite
5) psychomotor retardation or agitation nearly every day observable by others
6) fatigue or low energy
7) decreased ability to concentrate, think or make decisions
8) thoughts of worthlessness or guilt
9) recurrent thoughts of death or suicidal ideation or suicide attempt
In addition, the symptoms cause significant distress or psychosocial impairment, and
are not the direct result of a substance or general medical condition. Bereavement does
not exclude the diagnosis of a major depressive episode.
what is the geriatric depression scale?
- Are you basically satisfied with your life?
- Do you often get bored?
- Do you often feel helpless?
- Do you prefer to stay at home rather than going out and doing new things?
- Do you feel pretty worthless the way you are now?
2 out of 5 depressive responses (“no” to question 1 or “yes” to questions 2 through 5)
suggests the diagnosis of depression
what are some comorbidity associated with generalized anxiety disorder (GAD)
ƔSocial phobia ± 23.2 and 34.4%
ƔSpecific phobia ± 24.5 and 35.1%
ƔPanic disorder ± 22.6 and 23.5%
what is GAD associated with
GAD may also be associated with increased rates of substance abuse, posttraumatic
stress disorder, and obsessive-compulsive disorder
Diagnosis of GAD
Based on the presence of generalized, persistent and excessive anxiety and a
combination of various psychological and somatic complaints.
what is the DSM-5 diagnostic criteria of GAD
A. Excessive anxiety and worry (apprehensive expectation), occurring more days than
not for at least six months, about a number of events or activities (such as work or
school performance).
B. The individual finds it difficult to control the worry.
C. The anxiety and worry associated with 3 (or more) of the following 6 symptoms (with
at least some having been present for more days than not for the past 6 months). Only
one item is required in children.
- Restlessness or feeling keyed up or on edge
- Being easily fatigued
- Difficulty concentrating or mind going blank
- Irritability
- Muscle tension
- Sleep disturbance (difficulty falling or staying asleep, or restless, unsatisfying
sleep)
D. The anxiety, worry, or physical symptoms cause clinically significant distress or
impairment in social, occupational, or other important areas of functioning.
E. The disturbance is not attributable to the physiological effects of a substance (e.g., a
drug of abuse, a medication) or another medical condition (e.g., hyperthyroidism).
F. The disturbance is not better explained by another mental disorder. Because the
majority of the anxiety symptoms are not specific to GAD, it is important to exclude the
other anxiety disorders before making the diagnosis
what is the best way to dx depression/anxiety
- patient hx
- use family members if present
- reserve lab work and imaging for pts if hx/PE suggest another etiology
evaluation of depression and GAD: FH
- may confer increased risk for particular disorders or suicide; thus, the pt
should be asked about family history of depression, suicide, psychosis (e.g., delusions
and hallucinations), and bipolar disorder. A family history of bipolar disorder suggests
the possibility that patients current depressive episode may represent bipolar
depression.
*A patient with a family history of bipolar disorder is at increased risk
of suicide.
evaluation of depression and GAD: suicide risk
All depressed patients must be queried specifically about suicidal
ideation and behavior. Asking about suicidal ideation does not increase risk of suicide.
Any positive or equivocal response should prompt clinicians to:
1)ask about specific nature of the ideation, intent, plans, available means (e.g.,
firearms), and actions.
2)asses pt for risk factors for suicide including prior hx of suicide
attempts, comorbid psychiatric and general medical illnesses, and family history of
suicidal behavior.
3)develop a safety plan for further evaluation and tx that depends on level
of risk and may range from continued primary care follow-up alone to outpatient
psychiatric or emergency room psychiatric evaluation.
In addition, if history or presentation suggest that the patient is at risk for violence
directed towards others, clinicians should ask about homicidal ideation and behavior.
