Depression

Question 1

Physical illness causes of MDD?

Answer 1

cushing’s, Addison’s, Parkinson’s, Stroke, CAD, HypoThyroidism, Epilepsy

Question 2

5 axis of clinical features?

Answer 2

Reality axis
Appearance - behaviour axis
Thought-speech axis
Affect-interest axis

Question 3

Criteria for Recurrent depressive Disorder?

Answer 3

2 or more MDEs
Min 2 months w/o MDE

Question 4

Criteria for Cyclothymia?

Answer 4

Multiple episodes with hypomanic symptoms and depressive symptoms over min. 2 years.
These episodes do not meet full criteria for hypomania or depression.
Pt must have had no symptoms for min 2 months each time

Question 5

What is dysthymia?

Answer 5

Pervasive depressed mood for most part of days, for min 2 years
2 of:
- Low/too much oral intake
- insomnia/hypersomnia
- Low energy levels
- Low self confidence
- Attention/concentration difficulties
- Feeling life is worthless/hopeless

Basically milder and longer depression

Question 6

Features of atypical depression?

Answer 6

Reactive mood
Appetite increase
Interpersonal rejection sensitivity
Leaden paralysis
Sleep increase

RAILS mnemonic

Question 7

Comorbids in MDD?

Answer 7

Obesity
Dyslipidemia
DM
CVS
Stroke

Question 8

Invx in MDD?

Answer 8

Routine lab tests, e.g. B12/folate
Calcium panel
PTH
Sodium levels impt in elderly - prone to hypoNa due to SSRI

Urine drug screen, UFEME, Urine culture, Thyroid Ab, ANA, syphilis, HIV, CT/MRI

Question 9

What is DEP with psychotic featureS?

Answer 9

Symptoms occur after onset of depressive symptoms.
Like melancholia, more biological anomalies
Poorer long term outcome
May need antipsychotics + Anti-DEP/ECT

Question 10

What is DEP with melancholic features?

Answer 10

more severe form of MDD, no improvement of mood with good events + neurovegetative symptoms

Question 11

Criteria for DEP with melancholic features?

Answer 11

Requires at least 3 of the following symptoms:
1. Complete loss of pleasure
2. Psychomotor retardation
3. Lack of reactivity
4. Significant weight loss
5. Tend to awaken early, feeling worse than they do later in the day, feels guilty

Question 12

Do MDD symptoms vary over a continuum with age?

Answer 12

Yes. Kids: School refusal, declining grades, anger, irritability, defiant behaviour, physical complaints e.g. 복통
Elderly: Cognitive complaints, physical neglect, Social withdrawal, physical complaints e.g. generalized ache

Question 13

Symptoms of opioid withdrawal?

Answer 13

CNS arousal and sympathetic = tachycardia, HTN, anxiety, insomnia, irritability, agitation, mydriasis, lacrimation, hyperreflexia
Flu-like symptoms
GIT symptoms e.g. N/V, diarrhoea, abdo painn