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Major Depression

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yixadoxi's version from 2017-01-29 08:02

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Chapter 13, Pages 129-132, 134-135
Major Depressive Disorder
Differential Diagnosis of Mood Disorders

Lecture

Question Answer
lifetime prevalence of MD5-10%
average age of MD onset40
depression is more common in (M/F)females (2x)
depression increases your risk fordeath, from all causes
what ethnic groups are more likely to have depression?no difference
what socioeconomic groups are more likely to have depression?no difference
____% of people with major depression eventually commit suicide15%
mood disorders account for ____% suicides50-70%
suicide is more common in (M/F)males
suicide is most common in what age group?elderly
- increasing in adolescents
risk of suicide is highest in what group of depressed adults?untreated
early treatment w/ antidepressants
what should clinician do if patient mentions suicide?follow up with open-ended question
assisted suicide is legal where?Oregon
Washington
Montana
death is defined asirreversible cessation of al functions of entire brain (including brainstem)
how is death certified?EEG
MDD is usually caused by combination of what factors?biological
psychosocial
biological factors in MDD- heredity
- NT activity
- abnormalities of limbic-hypothalamic-pituitary-adrenal axis
psychosocial factors in MDD- loss of primary attachment figure
- loss of loved one
- low self-esteem
- negative outlook
- learned helplessness
memorize

A. List the criteria for diagnosing Major Depression

Question Answer
DSM-IV categories of primary mood disorders- (MDD) major depressive disorder
- bipolar disorder (I & II)
- dysthymic disorder
- cyclothymic dosorder
what mood states characterize DSM-IV primary mood disorders (in varying combinations)?depression
mania
dysthymia
hypomania
definition of MDDone /recurrent episode(s) of major depression in an individuals lifetime
5 criteria for major depressive episode (DSM-IV)(A) at least 5 symptoms present in same 2 wk period

(B) mania absent

(C) significant distress / impairment in social / occupational functioning

(D) symptoms not caused by substance / medical condition

(E) symptoms not caused by bereavement
depression can't be diagnosed within ____ of loss of loved one2 mo
9 DSM-IV symptoms of depression(1) subjective report / observation by others of depressed mood
(2) decreased interest / pleasure in most activities
(3) change in appetite
(4) persistent insomnia / hypersomnia
(5) psychomotor agitation / retardation
(6) daily fatigue
(7) feelings of worthlessness / guilt
(8) problems concentrating / thinking
(9) recurrent thoughts about death / suicide
at least one of what 2 symptoms must be present for diagnosis of major depressive episode(1) subjective report or observation by others of depressed mood

(2) markedly decreased activity / pleasure in most activities
how is change in appetite quantified?5% in/decrease in weight / month
mnemonic for depressive symptomsSIGE CAPS

Suicide
Interest
Guilt
Energy

Concentration
Appetite
Psychomotor
Sleep
short mnemonic for depressive symptomsSWAG

Suicidaity
Weight loss
Anhedonia
Guilt
major depression involves not only unhappiness but alsodecreased interest & pleasure in usual activities

and decreased appetite for pleasurable stimuli (sex & food)
in atypical depression, patients are more likely to (gain/lose) weightgain
patients with _______ report leaden paralysis (heaviness of limbs)atypical depression
in elderly, depression is often misdiagnosed aspseudodementia
diurnal variationdepressed patients often feel differently at different times of day
what might be the best indicators for depression specifically?concentration
excess guilt

other symptoms can be secondary to disease
- e.g. hospitalization can cause energy loss, decreased appetite, weight loss, trouble sleeping, lack of access to hobbies...
memorize

B. Describe the risk of relapse in patients with Major Depression

Question Answer
cycle of despairdepression --> violence --> substance abuse --> ...
memorize

C. Differentiate between bereavement grief and major depression

Question Answer
weight loss < 5 lb/monormal grief
minor sleep disturbancesnormal grief
some guiltnormal grief
illusionsnormal grief
attempt to return to worknormal grief
cries & expresses sadnessnormal grief
severe grief < 2 monthsnormal grief
moderate grief < 1 yearnormal grief
weight loss > 5 lb/mopathologic grief
significant sleep issuespathologic grief
intense guiltpathologic grief
hallucinationspathologic grief
delusionspathologic grief
resumes few activitiespathologic grief
considers suicidepathologic grief
severe grief > 2 mopathologic grief
___% depressed patients have masked depression50%
what is masked depression?unaware or deny symptoms of depression
how does depression often present?patients visit PCP complaining of vague physical symptoms
how is atypical depression different?(1) weight gain
(2) excessive somnolence
seasonal affective disorder
- specifier used with MDD
- atypical symptoms
- winter, short days
memorize

D. Outline how to treat a suicidal patient

Question Answer
___% depressed patients seek & receive treatment25
(M/F) are more likely to seek treatment for depressionF
why might someone not seek treatment for depression?- don't realize symptoms are due to depression
- $$
- health insurance doesn't always cover
- cultural value of being stoic & uncomplaining
without treatment, depressive episodes usually last how long?6-12 mo
why is treatment recommended for depression, even though episodes often go away on their own?patients are at high risk for accidents, suicide, social problems, etc...
what puts someone at risk for chronic depression (instead of episodic)?- comorbid psychiatric disorders
- substance abuse
successfully treated episodes of depression last< 3 months
3 pharmacologic agents used to treat depression- SSRIs (selective serotonin reuptake inhibitors)

- heterocyclic antidepressants

- MOIs (monoamine oxidase inhibitors)
what types of medications are used as first-line agents?SSRIs (more + side-effects)
what type of drug is Prozac?SSRI
____ increases risk of suicide, especially in adolescentsSSRIs
what if patient doesn't respond to antidepressant?augmenting strategies
- adding lithium / thyroxine / atypical antipsychotic
why are psychostimulants used in certain patients?antidepressants take at least 3 weeks to work, and psychostimulants are faster
why are psychostimulants risky to use?dependence, tolerance
ECTelectroconvulsive therapy
what does ECT do?induce grand mal seizure
when is ECT used?- severe depression
- unresponsive to antidepressants
- side effects of antidepressants too unbearable
- active resolution needed (e.g. suicidal patient)
is ECT effective?yes, but socially maligned
psychological treatment for depression includes- psychoanalytic therapy
- interpersonal/ family therapy
- behavioral therapy
- cognitive therapy
therapy is especially helpful...alongside antidepressant medications
tricyclics have what side effect?anticholinergic
- tachycardia
- conduction disturbances
______ should be avoided in cardiac patientstricyclics
_____ is a good augmenting agent for antidepressant medicationslithium
what medication is found to decrease suicide risk?lithium
_____ decreases impulsivitylithium
memorize

E. Recognize the differential diagnosis of Major Depression

Question Answer
what prescription drugs can cause depressive symptoms?- antihypertensives
- antineoplastic agents
- steroids
withdrawal of what drugs can cause depressive symptoms?- stimulants
- opioids
- sedatives
when is adjustment disorder diagnosed?- mood symptoms don't meet full criteria for MDE
- are within 3-6 months of major stressor
when is bereavement diagnosed?- might meet MDE criteria
- within 2 months of significant loss
adjustment disorder must be at least ____ after significant stressor3 months
adjustment disorder must be within ____ months of termination of significant stressor6 months
bereavement must be within ____ months of major loss2 months
adjustment disorder (may / not) meet MDE criteriamust not
bereavement (may / not) meet MDE criteriamay
MDE symptoms must be distinguished from- substance use
- medical illness
- other psych problems
--- adjustment disorder
--- bereavement
patients who have MDD are sometimes misdiagnosed with what psychiatric illnesses?- anxiety disorder
- somatoform disorder
what type of MDD patient might be misdiagnosed with anxiety disorder?overly worried about imagined dangers
what type of MDD patient might be misdiagnosed with a somatoform disorder?unexplained physical complaints
how is MDD distinguished from anxiety & somatoform disorders?responds to successful treatment for depression
why are poor bipolar patients more likely than rich bipolar patients to be misdiagnosed with _______schizophrenia
- can't afford timely treatment
- wait until ill enough to show psychotic symptoms
memorize