Depression

Question 1

You should suspect depression when any of what Sx occur?

Answer 1

Depressed mood
Loss of interest/pleasure in most/all activities (anhedonia)
Insomnia/Hypersomnia
Change in appetite/weight
Low energy
Psychomotor retardation/agitation
Poor concentration
Thoughts of worthlessness or guilt
Recurrent thoughts about death/suicide

Question 2

Major depression is diagnosed when ** of the symptoms are present for ** nearly every day for minimum of ** consecutive **.

With ** or **!

Answer 2

Major depression is diagnosed when 2+ of the symptoms are present for most of the day nearly every day for minimum of 2 consecutive weeks.

With depressed mood or anhedonia!

Question 3

What are some common co-morbidities with depression?

Answer 3

Anxiety do
Dementia
Eating do
Personality do
Sleep do
Substance abuse
Chronic dz (neuro, cvd, CA, rheumotologic)

Question 4

When you are working someone up for depression what should they fill out in office and what # do they need to Dx?

Answer 4

PHQ-9

5+ and then confirm with DSM-4 criteria

Question 5

What are the stats numbers for PHQ-9 and what are the ranges?

Answer 5

Sens 61% (bad at ruling it out)
Spec 94% (ruling it in)
+LR 10.17 (when it is + they actually have dz)

5-9 mild
10-14 moderate
15-19 mod severe
20+ severe

Question 6

What are some risk factors for depression?

Answer 6

Chronic medical illness
Stress
Chronic pain
FHx depression
Female
Low income/job loss
Low self-esteem
Low social support
PMHx depression
Single/divorced/widow
TBI

Question 7

How do you screen for depression?

Answer 7

Pt with RF get PHQ-2

If (+) then PHQ-9

Question 8

What are some tests to consider with a new Dx of depression in a pt with potential co-morbid contributing conditions?

Answer 8

CBC
CMP
TSH
RPR
Serum B12, Folate
UA
EKG (Dysrhythmia)

Question 9

How should you Tx for depression?

When do you consider pharmacologic?

Answer 9

Diet, exercise, counseling, nutrition, supplements, botanicals, homeopathic.

Hypericum perforatum

Mod-severe (PAR-Q) and co-managed with mental health prof

Question 10

What things should be monitored at each visit with a pt with depression?

Answer 10

PHQ-9

Suicidality

Question 11

What are the risk factors for suicide?

Answer 11

20-24 yo or >65 yo

Male

Question 12

What are some psychological features of suicidality?

Answer 12

Anhedonia, Hx of suicide attempt, hopelessness, insomnia, irritability, psych hx, severe anxiety, substance abuse/dependence

Question 13

What are some environmental or social concerns regarding suicidality?

Answer 13

Availability of means (access to guns, meds)
Change of future plans (will, funeral)
Recent illness
Recent suicide in community, state, nation
Stressful life events
Unmarried/lack of social support

Question 14

What are the categories of suicide risk?

Answer 14

Low: no ideation or plan
Mod: ideation, vague plan, no intent, no past attempts, no self harm
High: ideation, plan, intent, self harm, attempts within 6 mo

Question 15

If a pt is high risk for suicide, who should you contact?

Answer 15

In portland Multnomah co mental health for emergency holds at hospital until pts stable (mental health crisis line)

Question 16

True/False. You should use a suicide prevention contract.

Answer 16

FALSE

Question 17

Criteria to refer a depressed pt for hospitalization?

Answer 17

Severe depression
SI or inability to care for oneself
Depression w/o Tx response
Psychotic depression
Depression with bipolar, schizophrenic, or other psych illness