Lecture 28 - Mood D/o: Depressive D/o Flashcards Preview

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Flashcards in Lecture 28 - Mood D/o: Depressive D/o Deck (17):
1

what are the depressive disorders


MDD
Persistent Depressive disorder (Aka Dysthymia)

Premenstrual dysphoric d/o

Substance and medication induced depressive d/o

Depressive d/o due to another condition

other
Unspecified

2

MDD - Inherited factors

Risk Factors for MDD (in general)

First-degree relatives of patients with MDD have a 2-4x higher risk of MDD

RFs:
History of prior episode of depression
FMHx
History of Suicide attempt
Post partum
absence of social support
stressful life events
adverse childhood
co-morbid illness

3

Psycholigicl theories of MDD etiology

Psychodynamic theories – Loss of loved one;

Interpersonal Theories -- absent of social bonds

Cognitive theory -- negative self-precept and outlook


Learned helplessness -- "I fail every time"



4

what test is non specific for MDD but may be suggestive of MDD? what is the findng?

Dexamethasone Suppression Test --


Giving dexamethasone should suppress the Hypothalamus/Adrenal Axis

MDD is associated with 40-50% of dexamethasone non suppression


5

what Hypothalamic-Pituitary-Thyroid findings have been reported or known to cause depresison

Hypercortisolemia -- associated in depressed pts


Thyroid disorders are found in 5-10% of people with depression.

6

MDD -- prevalence in the US?

men vs women?

7%

women are 1.5 - 3x higher than rates in men.

7

DSM Criteria for MDD (symptoms (how many), duration, rule outs...?)

○ 5 or more of the Characteristic symptoms, present most of the day, nearly every day, during the same 2-week period (SIGECAPS)

○ At least one of the symptoms is either:
• (1) depressed mood, or
• (2) loss of interest or pleasure


Not due to drugs
not due to other psychosis
not manic

8

what is SIGECAPS

Suicide
Interest in activities
Guilt
Energy
Concentration
Appetite/ weight change
Psychomotor
Sleep (insomnia is a very common symptom)

9

course of MDD -- % which have recurrent episode of depression? what incrases the odds? how long are typical episodes?

Remission -- 2 months

50% of patients experience a recurrence of MDE after their initial presentation

greater chance of recurrence -- (severe sx, inadequate tx, young, multiple previous episodes, highly expressive families, psychosis)


the longer sx are present, the harder to treat

10

what other illness typically presents with an MDD like appearance?

BP

11

what is the The lifetime risk of suicide in all mood disorders?


what % of attempted suicides eventually do kill themselves?


Men vs women?

The lifetime risk of suicide in all mood disorders is 10-20%.


10%


Men -- higher suicide rate (lethality)
women -- more attempted suicides, but lower lethality

12

Protective factors against suicide

involvement with kids or pets

Religion

Optimism about future

short term patient contracts for safety between visits with PCP

Previous response to treatment

13

Perseistent Deprsesive disorder

aka?

DMS Criteria (duration, symptoms, rule outs)

notable absence of what symptoms from this dx?

Dysthymia


Duration -- most of the day for 2 years; cannot go without symptoms for more than 2 motnhs

Symptms -- 2 of the following --
apptite, insomina, hypersomnia, low eneergy, self esteem, concentration, hopelessness

ABSENCE OF SUICIDALITY

Not explained by drugs or other illness
cause impairment
no other mania, mixed or hypomanic

14

Premenstrual Dysphoric Disorder

criteria

Majority of menstrual cycles
1 week before menses == 5 sx
Improve 1 week after menses

At least 1+ of the folliwng: Labile mood, irritable, depressed mood, hopeless, anxiety

1+ of the folliwng, AND a least a total of 5:
Interest
Concentration
Fatigue
Appetite change
Hypersomnia, insomina
physical symptoms -- breast tenderness, arthralgia, myalgias, bloating

15

Dx of Depressive disorders:

1) rule outs

medical conditions,
substance abuse
medication effects
other psych d/o -- BP, anxiety, psychosis



16

Antidepressnat -- name some classes of meds indicated

Psychotherapies: which have been proven to be effective in controlled studies?

SSRIs
SNRIs
MAOIs
TCAs

interpersonal psychotherapy and cognitive therapy

17

Brain stimulation therapies -- name

Brain Stimulation:
Vagus
Transcranial Magnetic Stimulation (TMS)