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Depressive Disorders Flashcards

1
Q

What must be evident in the patients medical history to make a diganosis of “due to another medical condition”?

A

Causal relationship

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2
Q

Besides medical condtions, what other causes must be considered?

A

Substance induced depressive disorders

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3
Q

What medical conditions cause ONLY depression?

A 
Parkinson
Hypothyroid
Hyperparathyroid
Hypoparathyroid
Cushing
Addison
SLE
RA
Folate def.
HIV
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4
Q

What medical conditions casue ONLY mania?

A

Wilson

Temporal lobe epilepsy

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5
Q

Which medical conditions cause either depression or mania?

A 
Huntington
CVA
Cerebral tumor
Cerebral trauma
Encephalitis
MS
Hyperthyroid
Uremia
B12 def.
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6
Q

What can clue the clinician into metabolic changes that might be causing depression?

A

Weight gain without a change increased appetite

- Atypical depression will have increased appetite

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7
Q

What is the appropraite step if a patient presents with substance/medication induced depression?

A
  1. Stopping the substance is usually enough
    - May take several weeks
  2. Use of an antidepressant may be needed
  3. Substance abuse treatment
  4. Admit is SI, HI, or psychosis is present
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8
Q

What critera must be met to make a dx of S/M induced depression?

A
  1. Developed during use, intoxication, or withdrawal
    - May occur up to 1 month after use has stopped
  2. Subtance is known to cause depression
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9
Q

What disorders overide S/M induced depression?

A

Any depressive disorder not caused by a substance/medication

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10
Q

What symptoms, if present, disqualifies S/M induced depression?

A

Delirum

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11
Q

What are the signs and symptoms of cocaine withdrawal?

A

Fatigue
Low energy
Hypersomnia
Increased appetite

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12
Q

What kind of most is most likely to be present during cocaine use or intoxication?

A

Mania

- Depression occurs most often during withdrawal

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13
Q

What nonpsychiatric medications can cause mood distrubance?

A
  1. Antihypertensive agents
    - Beta blockers
  2. Interferon
  3. Cytotoxic agents
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14
Q

What other conditions should be ruled out if someone present with S/M induced depression?

A
  1. Primary mood disorder
    - MDD
  2. Depressive disorder due to another medical condition
  3. Bipolar disorder
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15
Q

When treating someone with co-occurring depression and cocaine use, what medication may be superior to an SSRI?

A

TCAs

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16
Q

How many attempts do patients usually need at substance abuse treatment before being successful?

A

10

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17
Q

What physical exam findings indicated the use of opioids?

A

Miosis
Slurred speech
Drowsiness

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18
Q

What physical exam findings indicate a patient has been using phencyclidine?

A

Nystagmus
Hypertension
Muscle rigidity

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19
Q

What physical exam findings indicates a patient has been using cannabis?

A

Conjucntival injection
Increased appetite
Dry mouth

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20
Q

What physical exam findings indicates a patient is going through opiod withdrawal?

A

Mydriasis
Gooseflesh
Rhinorrhea
Muscle aches

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21
Q

What are some substances that can induce depression?

A

Cocaine
Alcohol
Methamphetamine
Spray paint

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22
Q

What is the appropriate treatment plan for a patient who has MDD with severe features and mood-congruent psychosis?

A
  1. Offer psychiatric admission
  2. Start with an SSRI
  3. Add an atypical antipsychotic
  4. Discharge when stable
  5. Weekly follow-ups for 4 weeks after discharge
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23
Q

What symptoms would tip a diagnosis toward MDD vs Adjustment disorder?

A
  1. Vegetative symptoms
  2. Suicidal ideation
  3. Auditory hallucinations
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24
Q

How do children and adolescents with MDD typically describe their mood?

A

Angry or mad

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25
What things need to be considered inorder to "commit" somone to the unit for depression?
1. Are they an imminent danger to themself or others? | 2. Can they take care of themselves?
26
How many symptoms are need to meet criteria for MDD?
5
27
How long do the symptoms need to be present to meet critera for MDD?
2 week period
28
One of which two symptoms must be present to meet criterai for MDD?
Depressed mood or Anhedonia
29
What other areas are impacted by MDD (SiG E CAPS)?
Si- SI G- Guild or worthlessness E- Energy- Decreased C- Concentration - Impaired A- Appetite/Weight - Increased or decreased P- Psychomotor - Retardation or agitation S- Sleep - Increased or decreased
30
What other conditions supersede MDD?
1. Bipolar disorder 2. Due to medical illness or substance 3. Not normal bereavement
31
What are "mood-congruent delusion or hallucinations" for a patient with MDD?
Pertaining to being: - Defective or deficient - Diseased - Guilty and deserving of punishment
32
What is the key aspect of psychosis?
Ability to assess reality is impaired
33
What are the three catagorial symptoms present during depression?
1. Vegetative 2. Cognitive 3. Emotional
34
What are vegetative symptoms?
Anything related to body function
35
What cognitive symptoms?
1. Poor concentration 2. Low self-esteem 3.
36
What are emotional symptoms?
Crying speels
37
What are predictors of MDD in childhood and adulthood?
1. Genetics 2. Loss of a parent before the age of 11 3. Adverse early life experiences
38
How do children usually present with MDD?
1. Anger or irritability 2. Anhedoina 3. Decreased energy 4. Poor grades 5. Staying up late 6. Social isolation
39
Why are patients often diagnosed with a depressive disorder before bipolar disorder?
The patient often goes through several depressive episodes before mania occurs - Important to review clinical and family history of BP disorder
40
How long must a patient abstain from a substance before a diagnosis of S/M induced or MDD can be confirmed?
Several weeks
41
What are some indications that bereavement may be becoming MDD?
1. Guilt 2. Patient feels they caused the death 3. SI
42
What is a common symptom of bereavemnt in children?
Hallucinatory phenomena | - Usually reassuring and comforting
43
What type of hallucinations are usually more common with MDD?
Hostile accusatory hallucinations
44
At what point should an atypical antispychotic be tapered off?
3 months
45
At what point should an antidepressant be tapered off?
6 to 12 months | - Taper over 2 to 3 months
46
What type of therapy is most effective for MDD?
CBT | - Interpersonal therapy
47
At what time point does bereavement need to be evaluated as MDD?
Bereavemnt can present with all the same symptoms of MDD (excpet psychosis or SI/HI). If symptoms are still there after 4 months, MDD may be considered an appropriate dx.
48
According to the AACAP, what is the appropiate pharmacotherapy for a patient with MDD and psychosis?
SSRI and atypical neuroleptic | - Taper to effect, max dose, or side effects become an issue
49
What SSRIs are available for MDD?
``` Sertaline Citalopram Fluoxetine Fluvoxamine Paroxetine ```
50
What SNRIs are available for treating MDD?
Venlafaxine Desvenlafaxine Duloxetine Levomilnacipran
51
What other treatments for MDD are available?
Bupropion | Mirtazapine
52
What are the most common side effect of SSRIs?
``` GI upset Sleep disturbances Tremor Dizziness Increase prespiration Sexual dysfunction ```
53
What treatment for MDD is not associated with sexual dysfunction?
Bupropion
54
What side effect of TCAs can be leathal?
Cardiac arrhythmias
55
What is the time requirement to meet critera for MDD?
2 weeks
56
How many symptoms need to be present to meed MDD?
5+
57
What other conditions supersede MDD?
``` Bipolar disorder S/M induced Medical condition Schizophrenia Schizoaffective Delusional disorder Other psychotic disorder Bereavement ```
58
What critera qualify bereavement as MDD?
Symtpoms last longer then 2 months Marked functional impairment SI Psychotic symptoms
59
What other conditions can SSRIs be used to treat?
Eating disorders Panic attack disorder OCD Borderline personality
60
What other condtions can be treated with an SNRI?
GAD
61
What is the MOA of bupropion?
Blocks uptake of NE and DA
62
What conditions can be treated with bupropion?
Anxiety associated depression | Smoking
63
What is the MOA of mirtazapine?
TCA Acts on noradrenergic and serotonergic mechanisms Does not block uptake
64
What other conditions can be treated with mirtazapine?
Anxiety | Insomnia
65
How many people in the US will suffer from depression at some point in their life?
1 in 7
66
What are some warning signs of suicide?
Patient becomes quite and less agitated after a previous expression of SI Making a will Giving away personel property
67
What are risk factors for suicide?
``` Older age Alcohol or drugs dependence Prior suicide attempts Male gender Family history ```
68
What needs to be monitored in MDD patients being treated with an antidepressant?
Worsening depressed mood and suicidality - First couple of months - Whenever there is a dosage change
69
What are the key symptoms of the "baby blues"?
Sadness Strong feelings of dependency Frequent crying spells Dysphoria
70
How long do the "baby blues" typically last?
Days to 1-week
71
Can antidepressants get into the breast milk?
yes
72
What is the lifetime recurrence rate for MDD?
85%
73
What is the 1-year recurrence rate for MDD?
40%
74
What conditions increase the risk of MDD recurrance?
Residual symptoms between episodes Comorbid psychiatric disorders Chronic medical conditions
75
What not medical options are avaliable for the treatment of MDD?
ECT | Transcranial magnetic stimulation
76
Which two antidepressants are most commonly associated with sexual dysfunction?
SSRIs | Venlafaxine
77
What are the major side effects of TCAs?
Anticholinergic effects Orthostasis Cardiac effects
78
Why are MAOIs not used very often?
DDI | Dietary restrictions
79
What is the best indication for what medication will work in a patient with recurrent MDD?
Whatever medication put them in remission before
80
At what point does sexual dysfunction become an issue for patients taking SSRIs?
Weeks to months after being on the medication
81
What is the best medical therapy for persistent depressive disorder?
``` SSRI SNRI Bupropion Mirtazapine TCA MAOIs ```
82
What is the time critera for persistent depressive disorder?
Depressed mood on most of the day, for most of the days At least 2 years 1 year in children and adolescents No longer then 2 months symptoms free
83
How many symptoms need to be present to meet critera for PDD?
2+
84
What are the symtpoms for PDD?
CHASES ``` Concentration Hopelessness Appetite Self-esteem Energy Sleep ```
85
What conditions superscede PDD?
Bipolar Cyclothymia Any psychosis Substances or Medical condition
86
Which medical conditions often coexist with PDD?
MDD Anxiety- Especailly panic disorder Substance abuse Borderline personality disorder
87
What are important differences between PDD and MDD?
``` PDD - Earlier onset (Teenage to early adulthood) - More chronic course - Less intense and longer lasting MDD - Later onset - Episodic - More severe ```
88
What is the concept of "double depression"?
When PDD has an episode of MDD | - Poor prognosis
89
What non-medical therapy is available for PDD?
CBT Insight-oriented therapy Interpersonal therapy
90
What are key signs of serotonin syndrome?
Headache Rapid heartbeat Fever Chills
91
What medications can be used to manage PMDD?
SSRI are 1st line
92
What is the timeline requirement to meet critera for PMDD?
``` Majority of menstrual cycles 1 year Start the week before Improve within days after onset Minimal to absent postmenses ```
93
What two areas are assessed to determine critera for PMDD?
Mood | Associated symptoms
94
How many symptoms are required to meet critera for PMDD?
5+
95
What are the mood symptoms of PMDD?
1. Depression, hopelessness, and self-deprication 2. Affective instability, mood swings, and rejection sensitvity 3. Increased irritablity, anger, or interpersonel conflicts 4. Significant anxiety and tension
96
What are the associated symptoms of PMDD?
1. Anhedonia 2. Concnetration 3. Sleep disturbance 4. Energy 5. Overwhelmed 6. Appetite or specific craving 7. Weight gain, bloating, muscle/joint pain, breast tenderness, or swelling
97
What conditions supercede PMDD?
Substance or medication | Medication condition
98
What is affective lability?
Rapid change in affect (ie mood swings)
99
PMDD is a significant risk factor for what condition?
Postpartum depression
100
What conditions can manifest similar to PMDD?
Thyroid dysfunction Fibromyalgia IBS
101
What type of therapy is often prescibed for symptoms of PMDD, that can actually make it worse?
Exogenous hormones
102
What is the difference between PMS and PMDD?
PMS has fewer symptoms and is usually without mood changes
103
Which symptoms are most severe with PMDD?
Mood swings and irritability
104
When can SSRIs be taken to treat PMDD?
Continuously or only during the luteal phase
105
What is the only TCA that has shown any effectiveness in treating PMDD?
clomipramine
106
What type of therapy is useful for PMDD?
CBT

Case Files Psychiatry (10 decks)

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