Depression

Question 1

What is disruptive dysregulation mood disorder?

Answer 1

A. severe recurrent temper outburst manifested verbally and/or behaviorally that are way out of proportion in intensity/duration to the situation

B. on avg, 3 or more outburst/wk

C. outburst are inconsistent with developmental level

D. usually irritable/angry

(A-D present for 12 mo)

Question 2

What is the age range for the first time dx of disruptive mood dysregulation disorder?

Answer 2

btwn age 1-18

onset before age 10

Question 3

What other psychiatric disorders can disruptive mood dysregulation disorder co-exist with?

Answer 3

ADHD

major depressive disorder

Question 4

disruptive mood dysregulation disorder course/prognosis?

Answer 4

chronic

high risk of progressing into major depressive disorder, dysthymic disorder and anxiety disorders

Question 5

How do we treat disruptive mood dysregulation disorder?

Answer 5

treat sxs

If resembles depression/anxiety: SSRIs and stimulants

If resembles bipolar disorder: antipsychotic and mood stabilizer

+cognitive-behavioral therapy

Question 6

Describe depressive disorder

Answer 6

depressed mood most of the time, diminished interest/pleasure, sig. weight loss when not dieting or weight gain, insomnia/hypersomnia, fatigue, diminished ability to concentrate, recurrent thoughts of death

Question 7

Who is more likely to have a major depressive disorder?

Answer 7

women (2:1)

more often in ppl w/o close interpersonal relationships or are divorced/separated

Question 8

What is the learned helplessness theory?

Answer 8

connects depression to experiencing uncontrollable events

those with depression may have internal causal explantations which produce self esteem loss after adverse external event

Question 9

Who is generally effected by major depressive disorder?

Answer 9

76% americans >12 yrs

Female > male

Question 10

What do pts with MDD usually present with?

Answer 10

some other complaint

don’t usually present with depression

Question 11

How do you dx MDD?

Answer 11

based on hx and PE

Question 12

Why do you need to perform a full medical evaluation on pts with MDD?

Answer 12

to r/o infection, medication effect, endocrine disorder, tumor, neurologic disorder

Question 13

What might you see on PE for a pt with MDD?

Answer 13

decline in grooming/hygiene, weight can change, flat affect, psychomotor agitation

Question 14

What screen tools can you use for MDD?

Answer 14

2-question test

Patient health questionnaire-9

Beck depression inventory

Question 15

Work up for MDD?

Answer 15

lab study to r/o organic causes, neuroimaging

Question 16

How can we treat MDD?

Answer 16

meds

psychotherapy

cognitive behavioral therapy

electroconvulsive therapy

bright light therapy

Question 17

What medications can be used to treat MDD?

Answer 17

SSRIs, SNRIs, atypical antidepressants, SDAMs, tricyclic antidepressants, MOAIs, St. John’s Work

Question 18

SSRI

Answer 18

Selective Serotonin Reuptake Inhibitor

Ex. Citalopram (Celexa), Escitalopram (Lexapro), Fluoxetin

Question 19

SNRI

Answer 19

Serotonin/norepinephrine Reuptake Inhibitors

Ex. Venlafaxine, Desvenlafaxine, Duloxetine

Question 20

Atypical antidepressants

Answer 20

Bupropion, Mirtazapine, Trazodone

Question 21

SDAM

Answer 21

Serotin-Dopamine Activity Modulators

Ex. Brexpiprazole, Aripiprazole

Question 22

Tricyclic Antidepressants (TCAs)

Answer 22

Ex. Amitriptyline, Clomipramine, Desipramine

Question 23

MAOIs

Answer 23

Monoamine Oxidase Inhibitors

Ex. Isocarboxazid, Phenelzine, Selegiline

Question 24

St. John’s Wort

Answer 24

Hypericum perforatum

herbal remedy OTC

may act as SSRI

mild - mod depression sxs

Question 25

What is electroconvulsive therapy?

Answer 25

highly effective, rapid antidepressant response, used in pts who fail drug therapies

Question 26

What is bright light therapy?

Answer 26

treats seasonal affective disorder 30-90 mins within 1 hr of awakening often combined with conventional medical therapy can precipitate manic or hypomanic episode

Question 27

What is the most significant risk factor for suicide?

Answer 27

past suicide attempt

Question 28

When should you hospitalize pts with MDD?

Answer 28

SI/HI, severe depression, gross thought disorganization, inability to care for self, failing medical status

Question 29

Dysthymia aka...

Answer 29

Persistent depressive disorder

Question 30

What is dysthymia?

Answer 30

depressed mood lasting most of the day and present almost continuously feelings of inadequacy, guilt, irritability, anger, withdrawal from society, lack of production "ill humored"

Question 31

Characteristics of dysthymia

Answer 31

ongoing for at least 2 yrs insidious onset (childhood/adolescence) persistent fam hx

Question 32

If a pt has met the criteria for both MDD and dysthymia, which dx should they receive?

Answer 32

MDD

Question 33

Dysthymia epidemiology

Answer 33

5-6% of gen pop coexists with other psychiatric illness no gender difference

Question 34

How do we treat dysthymia?

Answer 34

pharmacotherapy and psychotherapy

Question 35

What is Premenstrual Dysphoric Disorder (PMDD)

Answer 35

mood lability, irritability, dysphoria and anxiety sxs occurring repeatedly during time before onset of menstrual period

Question 36

Treatment of PMDD?

Answer 36

support/education about disorder treat sxs SSRIs and benzodiazepines

Question 37

What is substance/medication-Induced Depressive Disorder

Answer 37

depressed mood or markedly diminished interest or pleasure in all or almost all activities during or soon after substance intoxication or withdrawal or after exposure to a medication

Question 38

What are some depression co-morbidities?

Answer 38

heart disease, breast CA, immunological disease, chronic pain, multiple psychical disorders

Question 39

Pts with one lifetime episode of MDD who achieve remission on antidepressants should continue taking them for...

Answer 39

another 6-12 months

Question 40

Pts with 2 or more lifetime episode of MDD who achieve remission on antidepressants should continue taking them for..

Answer 40

15 months to 3 years

Question 41

Pts with chronic MDD or with concurrent dysthymia who achieve remission on antidepressants should continue taking them for..

Answer 41

15 months to 28 months

Question 42

How long can it take for pts to see improvement on antidepressants?

Answer 42

2-6 wks

Question 43

How often should you FU with pts on antidepressants?

Answer 43

after 1st month and then every 4-6 wks until stable individualize based on pt

Question 44

What can we do to improve pts adherence to medications?

Answer 44

understand the pts model of the illness identify social/financial barriers address pts concerns about meds discuss pts understanding about tx and ability to follow through

Question 45

How long should you trial a new medication?

Answer 45

8-12 wks if tolerated increase dose every 2-4 weeks until remission achieved, max dose