Depression - Chan

Question 1

What are the 9 symptoms of major depressive disorder?

Answer 1

SIG E CAPS

• Sleep disturbance
• Interests gone
• Guilt
• Energy loss
• Concentration
• Appetite changes
• Pscyhomotor retardation
• Suicidal Ideations

Question 2

What timing characterizes a major depressive episode?

What symptoms are needed to meet the criteria?

Answer 2

Episodes are defined as at least 2 weeks of symptoms, usually lasting 6-12 months. It may be self-limited, it may not.

5 of the 9 SIG E CAPS symptoms are needed in addition to depressed mood.

Question 3

What timeline is seen in persistant depressive disorder?

How do the symptoms compare to major depressive disorder?

Answer 3

Symptoms last at least 2 years, but are often milder than in major depressive disorder.

Question 4

What is seasonal affective disorder?

What treatment is typically effective?

Answer 4

symptoms of depression associated with the winter season.

full-spectrum bright light exposure

Question 5

Sleep changes in depression:

• Slow-wave sleep?
• REM latency?
• REM early in the sleep cycle?
• Total REM?
• Nighttime awakenings?
• Early morning awakenings?

Answer 5

• Decreased Slow-wave sleep
• Decreased REM latency
• Increased REM early in the sleep cycle
• Increased Total REM
• Multiple Nighttime awakenings
• Increased Early morning awakenings

Question 6

How many patients with depression are diagnosed?

How many patients diagnosed with depression are treated?

Answer 6

Only half of patients with depression are diagnosed

Only half of diagnosed patients are treated

Question 7

What should be considered in patients with a chronic medical illness?

Answer 7

Depression! (what a shocking answer!)

About 25-50% of patients dealing with diabetes, cancer or stroke also have major depressive disorder.

Question 8

What two questions are an effective screen for major depressive disorder?

Answer 8

In the past two weeks, have you felt down or hopeless?

In the past two weeks, have you felt little interest in doing things?

Question 9

What is the PHQ-9?

How is it scored?

Answer 9

Patient Health Questionairre-9

9 symptoms ranging form not at all to nearly every day

0-27

Question 10

What PHQ-9 scores translate into diagnoses?

Answer 10

• 5-9 mild symptoms=> educate, but follow-up
• 10-14 minor depression => psychotherapy or pharmaceuticals
• 15-19 moderately sever major depression => pscyhotherapy or pharmaceuticals
• 20+ severe major depression => pyschotherapy & pharmaceuticals

Question 11

What is the menomic for suicide risk?

Answer 11

IS PATH WARM

Ideations

Substance abuse

Purposeless

Anxiety

Trapped

Hopelessness

Withdrawal

Anger

Risky behaviors

Mood changes

Question 12

What are the three stages of bereavement?

Answer 12

Shock

Preoccupation with the deceased

Resolution

Question 13

What are some non-pharmaceutical treatments for depression?

Answer 13

St John’s Wort

Psychotherapy

Electro convulsive therapy

Vagal nerve stimulation

Transcranial magnetic stimulation

Deep brain stimulation

Question 14

What are the 5 outcomes of treatment for depression?

Answer 14

5 Rs

• Response- improvement of symptoms occuring within 6-12 of treatment
• Relapse- return of symptoms 4-9 months after beginning of treatment
• Remission- no return symptoms 4-9 months after beginning treatment
• Recurrence- return of symptoms 1 year after beginning treatment
• Recovery- no return of symptoms 1 year after beginning treatment