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Behavioral Medicine > Depression 1 > Flashcards

Depression 1 Flashcards

1
Q

Two categories of mood disorders

A
  1. Depression
  2. Bipolar
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2
Q

Major depressive disorder (MDD) lifetime prevalence

A
  • Women: 10 to 15%
  • Men: 5 to 12%

(4th greatest cuase of global illness burden)

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3
Q

Major depressive disorder (MDD) Point prevalence

A
  • Women: 5 to 9 %
  • Men: 2 to 3%
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4
Q

MDD is most likely to be treated in the ______ setting

A

primary care

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5
Q

COVID risks for patients with psychiatric disorders

A
  • About 1.5 times the risk of getting COVID, being hospitalized or dying from COVID.
  • Risk of getting COVID: 1.6 times
  • Risk of hospitalization: 1.3 times
  • Risk of death: 1.5
  • Risk of developing psych disorder after COVID 18%

(they should be considered high risk for vaccines)

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6
Q

MDD is not always a ________ .

A

environmental stressor (it can’t always be prevented)

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7
Q

Only _____ of patients with depression are diagnosed and treated

A

one-third

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8
Q

___% of patients in primary care clinics are depressed but only half are diagnosed by a physician

A

20

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9
Q

Reasons for under-recognition of major depressive disorder

A
  1. Present as somatic complaints
  2. Difficult to separate depression from normal ups and downs
  3. Stigma: fear, criticism or ignoring mental illness
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10
Q

Mortality rate for major depressive episode

A

Up to 15% (if they died by suicide)

(Individuals over 55 have for fold mortality)

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11
Q

Depression: DSM-V dx criteria

A

****At least 5 of the following symptoms (and the first 2) during the same 2 week period (sig:ecaps)****

  1. Increased or decreased Sleep
  2. Loss of Interest in activities
  3. Inappropriate Guilt
  4. Decreased Energy
  5. Trouble Concentrating
  6. Increased or decreased Appetite
  7. Psychomotor agitation or retardation
  8. Suicidal ideation
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12
Q

Major depressive disorder exclusionary criteria (3)

A
  1. No manic, mixed or hypomanic episodes
  2. Symptoms not exclusively caused by a substance or another medical condition
  3. Episodes must not be better accounted for by psychotic illness
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13
Q

Depression: DSM-V criteria in children (9):

A

At least 5 of the following symptoms during the same 2 week period (out of norm):

  1. Depressed or irritable mood*
  2. Loss of interest or pleasure*
  3. Change in appetite and/or weight or failure to make expected weight gains
  4. Insomnia or hypersomnia
  5. Psychomotor agitation or retardation
  6. Fatigue / loss of energy
  7. Feelings worthlessness or guilt
  8. Poor concentration or indecisiveness
  9. Suicidal ideation
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14
Q

Symptoms of major depressive episode (outside of sig:ecaps) (7)

A
  1. Tearfulness
  2. Irritability
  3. Brooding or Obsessive Rumination
  4. Anxiety or Phobias
  5. Excessive worry over physical health
  6. Difficulties in sexual functioning
  7. Complaints of pain (HA, abdominal, joint, etch)
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15
Q

Mental status finding in depression: speech

A

slow or soft

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16
Q

Mental status findings in depression: mood

A

Depressed or irritable

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17
Q

Mental status findings in depression: affect

A
  • Normal range in mild cases
  • Blunted or labile in severe cases
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18
Q

Mental status findings in depression, and thought process (severe cases)

A

Blocking

(tangential in bipolar depression)

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19
Q

Mental status findings in depression : thought content

A
  • Suicide ideation
  • Delusions or hallucinations in severe cases
20
Q

Mental status findings in severe depression: memory

A

Impaired (pseudodementia)

21
Q

Mental status findings in depression: judgment for self-preservation

A
  • Often impaired in moderate to severe cases (“nothing matters”)
  • Passive wish for death (in absence of suicide ideation)
22
Q

Mental status findings in depression: insight

A
  • Usually intact in mild cases
  • Impaired in severe cases
23
Q

Cognition problems and depression

A
  • Perception and thoughts are best retained when they are associated with a strong emotional memory
  • Filter distorts normal perceptions and memories

(this filtering can dramatically affect the mood and feelings of self-worth)

24
Q

Define self-esteem

A

How positively a person feels about themselves (evaluation of the self)

(most people in the U.S. think they have “low self-esteem”, but our idea of this is inflated)

25
Q

Define self confidence

A

Belief that you can do certain things or bring about certain outcomes

26
Q

People that have a history of primarily acceptance tend to have a _____ self-esteem.

A

higher

(people who have been neglected, shown disinterest or rejection have lower self-esteem)

27
Q

Low self-esteem often leads to:

A

Negative emotions→ precipitates rejection

(therapy involves helping patients to improve the quality of social lives→ adequate support of relationships to maintain self-esteem)

28
Q

When is a major depressive disorder episode over?

A

Two months from the time of their last symptom

(pts may have a single episode or recurrent epidodes)

29
Q

Grading scales for major depressive disorder (4)

A
  1. Hamilton Depression Rating Scale (HAM-D)
  2. Geriatric Depression Scale (GDS)
  3. Montgomery-Asberg Depression Rating Scale (MADRS)
  4. Zung Self-Rating Scale (ZSRDS)
30
Q

Most commonly used depression rating scale in the US

A

Hamilton Depression Rating Scale (HAM-D)

(also, the geriatric scale is used)

31
Q

Genetic predisposition for major depressive disorder

A

Serotonin transporter gene

(short allele increases risk, 2 short alleles greatly increases risk, 2 long alleles = hardiness)

32
Q

Effective Early Childhood trauma on MDD (5)

A
  1. More severe illness course
  2. Early age of onset
  3. More hospitalizations
  4. More suicide attempt and completion
  5. More resistant to treatment
33
Q

Psychosocial effects of major depressive disorder

A
  1. Difficulty in Intimate Relationships and marital problems
  2. Occupational problems
  3. Academic problems

(sexual dysfunction as well)

34
Q

Greater than ____ physical symptoms may indicate likelihood of major depressive episode

A

nine

35
Q

Typical age of onset of depression

A

Late twenties

(twice as common in females than men)

36
Q

Puberty onset increases and ____ is associated with the development of depression

A

BMI

(pre-pubertal boys and girls are equally affected)

37
Q

Left untreated, major depressive episodes can last for ______.

A

6 months or longer

38
Q

If a patient has had one major episode, the probability that they will have another one is ______%. 2 episodes? 3 episodes?

A
  • 50-60%
  • 70%
  • 90%

(5-10% first episodes may develop bipolar disorder)

39
Q

______ factors play a greater role in precipitating Major Depressive Episode in the first and second episodes.

A

Psychosocial

(one year after mood disorder diagnossi: 40% no mood disorder, 20% do not meet criteria, 40% still meet criteria)

40
Q

Lab findings for depression: (plasma)

A
  • Challenge test: blunted growth hormone, prolactin and TSH
  • elevated glucocorticoid secretion (in urine)
41
Q

Sleep study findings in depression (6)

A
  1. Prolonged sleep latency
  2. Increased wakefulness
  3. Early morning Awakening
  4. Reduced stage 3/4 slow-wave sleep
  5. Decrease the REM latency
  6. Increased early REM sleep
42
Q

Lab findings associated with psychotic features and more severe depression

A
  • Glucocorticoid levels
  • EEG sleep disturbances

(not necessary for dx)

43
Q

Describe the “sick behavior” of depressive symptoms

A

Activation of microglia (involved in pruning process) → excess inflammatory cytokines → impaired synaptic plasticity → neuronal dysfunction/mental disorder

(usually activated by cytokines (macrophages) or increased level of glutamate due to acute stress)

44
Q

Conditions with high rates of depression (6)

A
  1. Thyroid disease
  2. Cancer
  3. Cardiovascular disease & stroke
  4. Autoimmune & inflammatory disorders
  5. Huntington’s, Parkinson’s, MS
  6. COPD
45
Q

Major depressive disorder: effect on associated medical conditions

A
  • Less favorable prognosis & recovery from medical conditions

(25% w/serious medical conditions will develop depression)

46
Q

Depression decreases life expectancy by _____.

A

8 years

47
Q

Patients with depression are at twice the risk of:

A
  1. Chronic daily headache
  2. Non-cardiac chest pain (atypical)
  3. MSK pain / fibromyalgia
  4. Low back pain / chronic radiculopathy

(60% of patients report pain)

Behavioral Medicine (35 decks)

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