Flashcards in Depression, Anxiety, Bipolar Disorder Deck (173)
what is the leading cause of disability worldwide, and is a major contributor to the global burden of disease?
what is the purpose of the DSM?
-Original purpose was to collect statistics on mentally ill
-Used for billing
-Communication between providers (“common language”)
7 limitations of the DSM5
1. Very long, tedious (~947 pages!)
2. Discrete criteria for diagnosing individual disorders when people are more complex
3. Pathologizes normal experiences (ex: homosexuality)
4. Sx missing from criteria
5. Good resource but no replacement for clinical judgment
6. A patient does NOT need to perfectly fit DSM criteria in order to receive treatment
7. a controversial, ever-changing guide
what sx are missing from the DSM5 criteria for depression?
-Physical symptoms (loss of sex drive, HA, GI problems)
-Irritability/Anger (seen mostly in men)
how do you respond to a patient when asked "isn't this normal"
-All DSM disorders are on a spectrum
-"Normal” may need treatment while “abnormal” may not-- depends if it is effecting their lives
-Ask open-ended question(s) at beginning of encounter.
-Use SIGECAPS and other questions to gather specific information.
-Use targeted psychosocial questions to determine etiology of mood issues (ex. Fhx, substance abuse?)
-Come up with initial management plan
what is correlated with a high chance of mood disorder?
number of physical symptoms
goals of psychosocial history when assessing for depression?
2. Social Hx
3. Current circumstances
4. Physical stressors
what 3 things in Fhx are strongly associated w/ genetic depression?
3. alcohol abuse
what to ask about to determine if their depression is related to genetics
1. Fhx of depression, anxiety, ETOH abuse, bipolar, substance abuse, sucide
2. Pts past psych hx
3. Determine their BASELINE
Strong genetic component of depression is often tx how?
often a reason for pharmacologic management as a component of treatment
what to ask about to determine if their depression is related to their social history
1. family origin- marital status of parents, # siblings, overall experience in family
2. Place of birth and subsequent moves
3. Issues with friendships or relationships
4. Work/education history
5. Criminal/legal issues
7. Substance Use
how to treat depression with a strong social component
-Multiple stressors can take physical toll (pharmacology) or guide a referral to therapy/support
-Multiple stressors in the past likely need therapy eventually
how to treat medical Issues that mimic or exacerbate psych disorders
tx independently (ex. thyroid, anemia, injury)
what to ask about to determine if their depression is related to a current circumstance
-what brings patient in today for treatment?
-What are the current stressors in his or her life (if any)?
-What support does the patient have?
how to tx depression related to a current circumstance
-Significant stress/issues is indication for psychotherapy (and possibly meds)
-Encourage to get support around specific stressor
DSM5 criteria for treating Persistent depressive disorder (dysthymia)
*Remember rule of 2’s!
1. Depressed mood for most of the day, most days for at least 2 years
2. 2 or more of the following symptoms: appetite issues, sleep issues, low energy/fatigue, low self-esteem, trouble concentrating/making decisions, hopelessness
3. During 2 year period has not been symptom-free for 2 months or more
-Can co-occur with Major Depressive Episodes
**It is a milder depression that lasts most of the time, but it can “dip” down into major depression episodes at times
DSM5 criteria for treating Major depressive disorder
1. 5 or more symptoms present for at least 2 weeks:
SIGECAPS + depressed mood or anhedonia
2. Symptoms cause significant distress or impairment in social, occupational, or other important areas of functioning
3. Episode is not due to physiological effects of a substance or another medical condition
4. Occurrence is not better explained by other psychiatric disorder (ex. Bipolar)
5. There has never been a manic or hypomanic episode
what does SIGECAPS stand for?
-sleep (hypersomnia or insomnia)
-guilt (worthlessness, hopelessness, helplessness)
-Energy (high or low/fatigued)
-Concentration (difficulty focusing or making decisions)
-Appetite (changes/weight changes)
-Psychomotor (retardation or agitation)
-Suicidality (thoughts of death or wishing to be dead)
what is considered full remission
2+ months w/o symptoms
initial management plan for a pt with depression
1. treat physical sx
2. reassurance and education
3. therapy or lifestyle modifications
5. Combo of above
if the patient has a underlying medical condition that has not been treated at all or adequately (and is linked to mood issues), which do you treat first?
the underlying medical issue
what is the connection btwn physical and mental sx?
-there are seratonin receptors else where in the body that can be affected by depression--> can affect the whole body
*education is important!
what is the connection btwn depression and the immune system?
you can feel more depressed when your immune system is ramped up
**depression can precede diagnosis!!
what medical conditions are associated w/ depression
autoimmune disease, cancer, heart disease, diabetes, hepatitis C, stroke, Parkinsons, Alzheimers, MS
If the patient’s symptoms seem expected given his circumstances and likely to resolve on their own, how should you tx
-oftentimes you can educate him about them “negotiate a plan” for next steps
**F/U is key!!!
*best option for those w/ little or no mental health issues in their hx
examples of circumstances that will likely resole on their own
-major life changes (even if good)
when is therapy or lifestyle modification not a good option for depression?
-If patient’s mood or cognitive symptoms make it hard to participate (Ie. confused or delusional)
-If sx resolve completely with medication or other treatments
what are lifestyle modifications that can help w/ depression
when is therapy or lifestyle modification an ideal option for depression?
-ideal by itself if sx are mild to moderate and largely due to situation (ex: divorce) AND PMH not significant
-w/ meds if sx are severe, and patient has significant current/past stressors and significant PMH