Exam 2 Mood Disorders: Depression

Question 1

Major Depressive Disorder DSM criteria? (3)

Answer 1

A. Sxs ≥ 2wks including either depressed mood or anhedonia and 5+ sxs

B. Not attributed to drug, GMC, bereavement, other psych disorder

C. No hx of manic/hypomanic/mixed episodes

CHRONIC = > 2 yrs continuously

Question 2

Major Depressive Disorder DSM criteria SYMPTOMS include? (9)

Answer 2

1) Depressed most of day, nearly every day (NED), kids irritable
2) Anhedonia in most everything NED
3) Significant weight/appetite ∆
4) Insomnia or hypersomnia NED
5) Fatigue/↓ energy NED
6) ↓ ability to concentration/think/decide
7) Feel worthiness, excess.inappropriate guilt
8) Psychomotor agitation/retardation
9) Thoughts of death w/ or w/o plan or attempt

Question 3

Major Depressive Disorder (MDD) specifiers: Severity?

Answer 3

Mild, Moderate, Severe w/ or w/o psychotic features

Question 4

Major Depressive Disorder specifiers: Catatonic?

Answer 4

w/ immobility, echolalia, echopraxia

Question 5

Major Depressive Disorder specifiers: Melancholic?

Answer 5

Anhedonia worse in a.m.
w/ psychmotor ∆s,
wgt loss,
GUILT

C in elderly

Question 6

Major Depressive Disorder specifiers: Atypical?

Answer 6

Mood reactivity
Wgt gain
Leaden paralysis
Rejection sensitivity (C in kids)

Question 7

Major Depressive Disorder specifiers: Postpartum?

Answer 7

Onset w/i 4 wks

Question 8

Major Depressive Disorder specifiers: Part/Full Remission?

Answer 8

Part = no longer meets criteria or no sxs < 2mo

Full = no sxs 2+ mo

Question 9

Major Depressive Disorder specifiers: Seasonal?

Answer 9

Obviously comes and goes w/ season

Question 10

MDD screening: Pt Health Questionnaire 9?

Answer 10

+ for MDD if answered NED to mood/anhedonia
AND
5 other sxs as “more than half” or higher

Question 11

MDD screening: Pt Health Questionnaire 9 Scores

0-4 = ?

5-9 = ?

10-14 = ?

15-19 = ?

20-27 = ?

Answer 11

0-4 = Not/minimal depressed, no tx

5-9 = Mild, watch and reeval at F/U

10-14 = Moderate, refer for therapy and meds

15-19 = Mod Severe, start meds and refer for therapy

20-27 = Severe, start meds and expedite referral

Question 12

Dysthymia DSM Criteria? (7)

Sxs? (6)

Answer 12

A. Depressed most of day, more days than not for 2+ yrs

B. 2+ sxs while depressed:

1) ↑↓ Appetite
2) ↑↓ Sleep
3) Fatigue/↓ Energy
4) ↓ Concentration/Decisions
5) ↓ Self-esteem
6) Hopeless

C. No major depressive episode during 1st 2 yrs

D. No hx of manic/mixed episode

E. Not w/ psych disorder

F. Not from drugs or GMC

H. Significant distress/impairment

Question 13

MDD tx: Mild/Moderate?

Answer 13

SSRI/SNRI +
CBT (Cognitive-Behavioral Therapy) or
IPT (Interpersonal Therapy)

Question 14

MDD tx: Severe?

Answer 14

SSRI/SNRI
NaSSA (Mirtazapine/Remeron)
TCA

CBT

(P) ECT

Question 15

SUMMARY: MDD/Dysthmia have in common? (6)

Answer 15

1) Depressed mood
2) Appetite
3) Sleep
4) Fatigue
5) Concentration/Decisions
6) NO mania/hypo/mixed

Question 16

SUMMARY: MDD/Dysthmia differ:

MDD (6)

Dysth (5)

Answer 16

MDD:
2wks
5 sxs
Anhedonia
Psychmotor
Guilt
Death

Dysth:
2yrs
2 sxs
Hopeless
Self-esteem
No MMD