depressive disorders Flashcards
(64 cards)
depression
treatable, freq, accompany other psych issues -> anx
PET scan -> less brain activity
depression epidemiology
F,
white = more prevalent, black = more severe
seasonally worse with less sun
ses -> lower (which came first?
depression etiology: bio
l/t tm methods
genetic
biochem abn: NT (serotonin, norepi, others), electrolytes, cortisol (higher), hormonal (estrogen: progesterone, thyroid - hypo)
inflam
diathesis - stress: predisposition to dep and stress can bring it out
depression etiology: psych
cog theory: thoughts lead to env, psychological predisposition, “-“ and/or unrealistic expectations and perceptions about future and env
learning theory: learned helplessness once repeatedly exposed to stressors and nothing helps
depression: contributing factors - child
need secure attachment
diathesis stress model: detachment of primary caregiver (emotional or phys), parental separation/divorce, death of loved one, pet, relocation, academic failure, phys illness
depression: contributing factors - teens
adults and child theories approach
conflict with independence and maturation, role confusion, grief/loss (death/breakup)
depression: contributing factors - OA
societal attitudes -> give less value to OA (money v wisdom)
self esteem, helpless, hopeless
major stressors: financial problems, life changes (job end, retire, relocate, lose connections to others), phys illness, grief /loss (bereavement overload), decreased functional ability
types
share s/s sadness, empty, irritable, somatic concerns, thinking impairment, all impact ability to function
major dep, disruptive mood dysreg, persistent dep (dysthymia), premenstrual dysphoric, substance/med induced, dep disorder d/t another med condition
major dep disorder: s/s
5+ daily in 2 wk period
must cause marked impairment in social/occupational functioning, cant be caused by substance/med condition
weight loss, appetite change, sleep disturbance, fatigue, psychomotor agitation or retardation, worthlessness or guilt, loss of ability to [], recurrent thoughts of death
+ at least 1 s/s is also either: dep mood or loss of interest of pleasure in almost all activities (anhedonia)
may or may not have psychotic s/s
major dep disorder: course
can be chronic (> 2yr)
recurrent episodes common (usually w/n 1st year), s/s cause distress or impaired functioning, episode not attributed to physiological effects, absence of mani or hypomanic episode
major dep disorder: children and teens - dx
look at behaviors (parents and school) and statements (may not have vocab to express)
5+ s/s in 2 wk: dep, irritable, cranky AND anhedonia
+ any 3: significant weight loss (<5% in 1 mo, dont meet expected gains), decrease in appetite, insomnia (<6hr) or hypersomnia, psychomotor agitation or retardation, fatigue, lack of E, worthless, guilt (no one cares), decreased [], indecisiveness (trouble with homework), recurrent thoughts of death or suicide
major dep disorder: children and teens - other s/s
cause significant distress or impairment in function
freq vague non specific phys complaints (tummy hurts), freq absence from school or poor performance (sick, wont get out of bed), bored, OH/substance abuse, increased anger or hostility, reckless behavior
major dep disorder: children and teens - s/s <3
FTT, feeding issues, lack of playfulness, lack of emotional expression, delay in speech/motor dev
major dep disorder: children and teens - 3-5 s/s
prone to accidents, phobias, aggressive, excessive self reproach for minor infractions
major dep disorder: children and teens - 6-8 s/s
vague phys complaints, aggressive, cling to parents, avoid new people and challenges, behind in social skills/academic performance
major dep disorder: children and teens - 9-12
morbid thoughts, excessive worry, lack of interest socially, think they have disappointed parents
disruptive mood dysregulation disorder
6 - 18 yo, onset must occur <10
decrease dx of bipolar
more common in males and children > adolescents
chronic, severe, persistent irritability
disruptive mood dysregulation disorder - s/s
chronic, persistent irritable/angry mood btw temper outbursts
s/s include anger and constant severe irritability
temper tantrums with verbal and behavioral outbursts at least 3x weekly
display temper tantrums in at least 2 settings: home, school, peers
comorbidities: oppositional defiant, ADHD, MDD
persistent depressive (dysthymia)
low level underlying dep feelings through most of each day, for majority of days
most respond favorably to antidep -> MAOI, SSRI
persistent depressive (dysthymia): s/s
s/s for at least 2 years in adults, 1 yr in children and adolescents
must have 2 of following: decreased appetite or over eating, insomnia or hypersomnia, decreased energy, poor self esteem, difficulty thinking, hopelessness, poor []/difficulty making decisions
premenstrual dysphoric disorders
s/s cluster in last wk prior to onset of a woman’s period
mood swing, irritable, dep, anx, overwhelmed, difficulty []
lack of E, overeating, hypersomnia, insomnia, breast tenderness, aching, bloating, weight gain
s/s decrease significantly or disappear with onset of menstruation
dont need constant meds, just during premenstrual period -> SSRI
substance induced dep dissorder
dont experience dep s/s in absensc of drug or OH use or withdrawal
only with substance use
dep disorder associated with another med condition
KF, PD, AD
from med dx or meds, not considered MDD
look at hx, labs, dx, etc
screening
many different tools
primary care: dont often go to pcp for dep, most present with somatic complaints - insomnia, fatigue, weight loss, etc. - need for conssitent dep screening for all pts every visit -> early tm = better outcomes
