Depression / Bipolar Disorders Flashcards
How is depression identified and treated in a primary care setting?
Only recognized half of the time and only treated about half of those that are recognized.
Of patients who are diagnosed with Major Depression and started on pharmaceuticals, how many is treatment unsuccessful at improving their symptoms?
Only 2/3rds of patients improve with treatment and 1/3 of them do not improve and alternative should be pursued.
What are the most common somatic complaints in patients with depression?
- Sleep Disturbance
- Fatigue/Tiredness
- Nonspecific Musculoskeletal Pain
- Abdominal / Back Pain / Headaches
- Loss of sexual interest
If a patient states over the last 2-3 months he has been tired on almost a daily basis no matter how much sleep he gets, but admits his sleep isn’t the best quality frequently waking up. Additionally the patient complains of a vague back pain and headaches that are present most days without any agitating factors. What is the general rule in diagnosing mood disorders?
– Major Depressive Disorder
(This patient most likely has)
Usually the most somatic/physical symptoms present the higher chance the patient has a psychiatric disorder
What non-psychiatric chronic conditions the highest rate of being associated with mental illness?
- DM
- Stroke
- Cancer
What are the types of depressive disorders?
- Major Depressive Disorder
- Dysthymic – withdrawal from daily activities or stressful/anxiety provoking (on top of depressive symptoms)
- Agitated / Psychomotor Retardation
What is the criteria to diagnose depression?
-- Depressed mood or loss of interest/pleasure AND -- 4 of the following -- weight change -- changes in sleep (more or less) -- Psychomotor retardation/agitation -- Fatigue -- Worthlessness feeling -- Decreased concentration -- Thoughts, plans, acts of suicide
What are the conditions in which depression would be ruled out?
- Dereavement
- Substance use
What is the categorical tool to remember depression symptoms?
SIGE CAPS S -- Sleep Change I -- Interest loss G -- Guilt feeling of worthlessness E -- Energy Loss
C – Concentration loss
A – Appetite changes - loss
P – Psychomotor agitation/retardation
S – Suicidal, hopelessness
In primary care what is the best way to screen for depression?
Two-Question Screening Tool
- Over the past 2 weeks have you felt down or hopeless?
- Over the past 2 weeks have you felt less interest in doing things your typically enjoy?
if a patient is screened positive for depression, then what is the next step?
Conduct a thorough depression testing
- Patient Health Questionaire (PHQ-9) = Score
5-9 – None – education about depression
10-14 – Minor Depression – maybe start drugs, watch
15-19 – Major Depression – drugs or therapy
20+ – Severe Major Depression – drugs + therapy
What are the risk factors for suicide?
IS PATH WARM?
- Ideation – communication
- Substance – Substance Abuse
- Purposeless
- Anxiety
- Trapped
- Hopelessness
- Withdrawl from normal life
- Anger
- Recklessness
- Mood Changes
If a patient recently had a family member die and continually are blaming themselves, what stage are they in?
Stage 2 - Preoccupation with Deceased
What are the first symptoms to expect from a patient after a family member or close friend die?
Shock
- Numbness / Non-reality
Physical Symptoms – Crying, Emptiness, Denial, Disbelief
How can you tell a patient is recovering from bereavement?
Resolution
– Regaining interest in activities and forming new relationships
What are the most common side effects of Tricyclic Antidepressants?
–Anticholinergic – dry mouth, dry eyes, difficulty urinating
How do the courses of schizophrenia and bipolar differ?
Schizophrenia symptoms usually become worse, then go back to baseline or maintain at that higher level until the next peak of symptoms, then further increases baseline.
Bipolar symptoms usually include peaks and lows intermixed or just highs. Baseline symptoms/personality does not usually change.
What is one of the biggest concerns for bipolar individuals who are not being treated?
They have a very high rate of suicide ~15%
What are the common symptoms present if you are suspicious someone is in a manic episode?
Need 3-4 Symptoms to diagnose:
- Grandiosity
- Decreased need for sleep
- Pressured Speech, difficult to understand
- Flight of Ideas / Racing thoughts
- Easily Distracted
- Increased goal directed activity
- More pleasurable activities
If a patient is reported to abruptly leave town to travel to Vegas to “save everyone from sin” and while there stays up all night talking to people on the street about the savior. While out she maxes out credit cards and has sex with a multitude of prostitutes. What could she be experiencing?
Manic Episode
- Grandiosity
- Increased goal directed activity
- Sleeplessness
- Increased impulsive actions / pleasurable activities
What are the first symptoms that can be experienced by a person in a manic episode?
- Increased psychomotor activity / rate of speech
- Euphoria
- Expansiveness in thoughts
- Tangential
- Increased religiousness, spending, letter writing, sexual interest
How does the 1st and 2nd stage of mania differ?
2nd Stage
- Pressured speech much increased
- Hostility, explosive anger
- Flights of ideas
- Delusional
If left untreated, what can a manic individual experience?
Stage 3 - Rare
- Increased stimulation - more panic stricken
- Frenzied behavior
- Hallucinations
- Ideas of reference – thinks news/others are always talking about them when they are not. “loose associations”
Where is the nuclei / area that regulate norepinephrine neurons in the CNS?
Locus Coeruleus (Pons)
What does the Raphe Nuclei do?
Cell bodies of Serotonin-releasing neurons within the CNS
