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Flashcards in Depression Deck (69)
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1

lifetime prevalence of depression?

- major depression - US 17%
- persistent depressive disorder 3% (no remission of depression)

2

Epidemiology of depression?

- gender:
10-25% in women
5-12% in men
puberty to 50: women 2x rate of men
after 50 - men = women
- age:
prevalence decreases with age
becomes more common in odler adults with greater burden of medical illness
assist. living, skilled nursing, acute/chronic medical conditions esp high risk

3

Pathogenesis of depression?

- group of heterogenous disorders that are phenotypically similar
- final common pathway of diff disease processes that occur across biopsychosocial continuum
- genetics
- early life adversity
- social factors
- psychological factors
- secondary depression (gen medical disorders/meds/substance abuse)

4

pathogenesis - genetics?

- genes+enviro+enviro altered gene expression
- no specific genes linked to risk - mult small genetic effects
- epigenetics: changes in expression of genes caused by early life experiences or chronic stress
- concordance rate for major depression in monozygotic twins: 37%

5

pathogenesis - early life adveristy?

- predisposes to major depression by alt sensitivity to stress and response to negative stimuli
- early life stress: hyperactive corticotropin releasing factor cells in hypothalamus - increased stress response (HPA axis)
- stress responses can be set for life and modify the activation of certain genes (epigenetic) and transmitted to offspring

6

pathogenesis - social factors?

- may lead to depression onset or lead to depressive episodes
- isolation
- poor social relationships
- criticism from family members (expressed emotion)
- depression in social networks
- influence sxs expressed and willingness/ability to access care

7

pathogenesis - psychological factors?

- cognitive/behavioral: negative/distorted patterns of thinking predispose to depression
these patterns worsen in depressed person
- personality:
neuroticism - anxiety, moodiness, envy, frustration, loneliness - respond poorly to stressors, interpret ordinary situations as threatening, and minor frustrations as hopelessly difficult
- psychodynamic: early losses, interpersonal relationships

8

Pathogenesis - secondary depression?

- general medical conditions
- meds
- drugs of abuse

9

Medical conditions that can lead to depression?

- sleep apnea
- hypothyroidism/vit D def/diabetes
- chronic pain and opioid use
- stroke
- heart disease - ischemic, HF, cardiomyopathy
- parkinsons
- MS
- epilepsy
- head injury
- cancer
- COPD
- dementia
- HIV/neurosyphilis

10

Meds that can cause depression?

- interferon
- corticosteroids - more likely to cause bipolar
- benzos/opioids
- varenicline (chantix)/BBlockers

11

Drugs of abuse that can cause depression?

as you are withdrawing:
- PCP
- amphetamines
- cocaine
- marijuana
during intoxication:
- sedative-hypnotics
- alcohol
- opiates
- steroids

12

Neurobio of depression? - structure and fxn?

- altered brain structure and fxn: unknown if alterations represent cause or consequence of depression (mult episodes of depression causes structural changes in your hippocampus)
structure:
-increased ventricular - brain ratio
- smaller frontal lobe volumes
- smaller hippocampal volumes
- number/density/size of neurons and glial cells are abnormal

fxn:
-NTs - abnorm fxning
monoamines (serotonin, NE, dopamine), GABA, glutamate
- HPA axis: excess excretion of glucocorticoids may lead to suppression of neurogenesis and hippocampal atrophy
- abnormal neuronal networks
- sleep/circadian rhythms: decreased REM latency and slow wave sleep inflammation - higher levels of inflammatory markers

13

3 diff manifestations of sxs of major depression?

- psychological
- neurovegetative
- psychomotor/physical

14

Psychological sxs of major depression?

- depressed mood (dyphoria)
- numbness
- anhedonia - inability to experience joy
- decreased interest
- irritability/anxiety
- guilt/worthlessness
- suicidal ideation

15

neurovegetative sxs of major depression?

- appetite - wt loss
- sleep - can't sleep, wake up 3 am
- energy
- concentration

16

Pyschomotor/physical sxs of major depression?

- psychomotor:
retardation
agitation
- physical:
aches/pain
weakness/malaise
GI distress

17

Qualifers that rule in depression?

- sxs occur in same 2 weeks
- most of day nearly every day
- distress or impairment
- R/o substances/general med condition
- R/o bereavement

18

subtypes of depression?

- anxious
- atypical
- catatonic
- melancholic
- mixed features
- peripartum
- psychotic
- seasonal

19

Subcategories of depression?

- bipolar
- secondary:
medical illness
meds
drugs of abuse

20

comorbid psych conditions?

1. anxiety disorders:
generalized anxiety
panic disorder
OCD
PTSD
2. substance abuse

21

SIGECAPS?

S: sleep
I: interest
G: guilt/worthlessness
E: energy
C: concentration
A: appetite
P: psychomotor disturbance
S: suicidal ideation

22

Depression eval?

- chronology of current sxs
- sxs occur in same 2 weeks
- most of day nearly q day
- distress or impairment
- prior hx of depressive episodes
- impact of episode on occupational and interpersonal fxning
- alleviating and aggravating factors (stressful life events)
- address comorbidity (substance, illness, meds, psych)
- eval for mania/hypomania
- distinguish major depression from persistent depressive disorder (dysthymia) - 2 yrs w/o s free interval of 2 months
- suicide risk

23

depression eval cont. - History component?

- general medical illness
- family hx: depression, suicide, psychosis, bipolar
- social hx: interpersonal, occupational, financial stressors - sources of support, assessment of family/relationship dynamics

24

depression eval cont. - exam and labs?

- complete physical and neuro exam
- MMSE
- toxicological screen
- lab screen: CBC, TSH, LFTs, Chem7, Ca, B12, folate, HIV
- brain imaging (psychosis or neuro findings)
- +/- EEG, LP (psychosis or neuro findings)

25

Psychotic features of depression?
What ?s should you ask pt?

- delusions
- hallucinations
- disordered thought
- up to 20% of pts
- markedly higher suicide risk

?s:
does your mind ever play tricks on you?
do you ever hear things/see things?
do you ever feel like people are out to get you?

26


Suicide RFs?

- S: sex (male)
- A: age- elderly or adolescent
- D: depression
- P: prev. suicide attempts
- E: ethanol abuse
- R: rational thinking loss
- S: social supports lacking
- O: organized plan - suicide
- N: no spouse-div, wid, single
- S: sickness (physical illness)

27

How to ask about suicide attempts?

- organized plan?
- access to lethal means?
- previous attempts?
- family hx?
- non-suicidal self injury

- previous attempts:
who, what, when, where, why, how?
- what exactly did you do?
- was it planned?
- did you tell anyone?
- risk/rescue

28

suicidal ideation - assessment?

- do you feel hopeless?
- do you feel like life isn't worth living?
- do you think about suicide?
- Have you ever.....?

29

How to ask about suicide intent, plan and means?

- what specific thoughts have you had?
- do you have access to guns?
- have you been stock piling meds? Can you bring them in?

30

When should you hospitalize a potential suicidal pt?

- plan, intent, means = hospitalization
- less acute - safety plan
- crisis center, stay with family, more freq visits (even daily)