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Clinical Disciplines Exam 2 > Major Depressive Disorder > Flashcards

Major Depressive Disorder Flashcards

1
Q

What moods does Depressive Disorder include?

A

Mild depression, moderate depression, severe depression, severe depression with psychosis

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2
Q

What moods does Cyclothemia include?

A

Elation, normal mood, dysthymia

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3
Q

What moods does recurrent depressive disorder include?

A

normal mood, dysthymia, mild depression, moderate depression, severe depression, severe depression with psychosis

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4
Q

What moods does Bipolar affective disorder include?

A

All of them

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5
Q

Define mood disorders

A
  • disturbance of emotions that are severe or prolonged enough to cause impairment of functioning
  • magnification of normal rxn
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6
Q

Define depression

A

period of extreme sadness and helplessness

  • sadness
  • feelings of worthlessness
  • withdrawal from others
  • changes in sleep/appetite
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7
Q

Define mania

A

period of abnormally high emotion and activity

  • intense elation or irritability
  • hyperactivity, talkativeness, distractibility
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8
Q

What is the diagnostic criteria for Major depressive disorder?

A

sad mood or loss of pleasure for 2 weeks, along with at least 4 other symptoms

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9
Q

What is the diagnostic criteria for dysthymic disorder?

A

Mood is down and other symptoms are present atleast 50% of the time for at least 2 years

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10
Q

What are the three main causes of mood disorders?

A
  1. Biological vulnerability
  2. psychological vulnerability
  3. stressful life event
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11
Q

What three things can a stressful life event cause?

A
  1. stress hormone effect neurotransmitters
  2. sense of hopelessness and negative thought process
  3. problems in interpersonal relationships and lack of social support
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12
Q

What is the most common mood disorder?

A

major depressive disorder

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13
Q

When does MDD occur?

A

may occur at any age but likelihood increases after puberty

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14
Q

MDD is prevalent in which sex most and when?

A

Women between time of menstruation and menopause

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15
Q

Define MDD

A

occurrence of at least a single major depressive episode, although most patients will experience recurrent episodes.

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16
Q

What makes women more prone to MDD than men?

A
  • Hormones*
  • girls 2x as likely to experience sexual abuse
  • women have more chronic stressors
  • more likely to worry about body image
  • react more intensely to interpersonal loss
  • women spend more time ruminating; men distract
  • ruminating intensifies and prolongs sad moods
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17
Q

MDD risk factors

A 
alcohol dependence
comorbid chronic medical conditions
female sex
personal or fam hx of depression
recent childbirth 
recent stressful evetns
parental loss
trauma during childhood or adulthood
low parental warmth
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18
Q

Rate of depression is higher in which type of twin?

A

Identical (50%)

Fraternal is 20%

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19
Q

Why is the brain less active during MDD?

A

diminished neurotransmitter levels

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20
Q

Stable vs Temporary explanations

A

Stable: bad situation will last for a long time
Temporary: This is hard to take but I will get through this

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21
Q

Global vs. Specific

A

Global: my explanation applies to many areas of my life. ex: w/o my partner, I cant seem to do anything right.
Specific: i miss my partner but thankfully i have fam and other friends.

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22
Q

Internal vs External

A

Internal: our break up was all my fault
External: it takes 2 to make a relationship work and it wasnt meant to be

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23
Q

Learned helplessness

A

subjected to events with little or no control -> fails to succeed -> feels overwhelmed/powerless -> develop sense of helplessness -> give up and stop trying to improve the situation -> cycle repeats -> learned behavior develops

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24
Q

Who should be screened for MDD?

A

all adults that you can provide adequate resources for diagnosis, treatment and f/up.

  • pregnant/postpartum women, older adults
  • pts with risk factors
  • pts w/ unexplained symptoms, chronic pain, anxiety, substance misuse, or nonresponse to effective treatments.
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25
Q

MDD 1st step for depression screening

A
  1. Over the past 2 weeks, have you felt down, depressed, or hopeless?
  2. Over the past 2 weeks, have you felt little interest or pleasure in doing things (anhedonia)?

If pt answers yes to either question, this is a + screen.

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26
Q

MDD 2nd step for depression screening

A
  • dig deeper and engage in conversation about mood and changes in behavior
  • Have pt fill out PHQ9
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27
Q

Criteria for MDD on PHQ9

A
  • checked 1 or 2 at level of ‘nearly every day’ AND 5 items from 3 to 9 checked at level of ‘for more than half’ or ‘nearly every day’
  • SI (suicidal ideation) always counted if + response regardless of severity
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28
Q

PHQ9 score of 0-4

A

non-minimal depression

no treatment recommended

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29
Q

PHQ9 score of 5-9

A

mild depression

watchful waiting, reevaluate at f/up

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30
Q

PHQ9 score of 10-14

A

moderate depression

consider referral for psychotherapy and/or initiation of psychopharmacotherapy

31
Q

PHQ9 score of 15-19

A

moderately severe depression

initiate psychopharmacotherapy and/or refer for psychotherapy

32
Q

PHQ9 score of 20-27

A

severe depression
initiate psychopharmacotherapy
- if severe impairment or treatment resistant “expedite” referral for psychotherapy (collaborative management)

33
Q

DSM V Criteria

A

5 or more of the following symptoms must be present during the same 2 week period & represent a change from previous functioning.

At least ONE of the symptoms must be:

  1. depressed mood (sad, empty hopeless)
  2. Anhedonia (no pleasure in normal activities)

The rest:

  • significant weight loss/gain
  • dec/inc in appetite
  • insomnia/hypersomnia
  • psychomotor agitation/retardation
  • fatigue
  • feeling worthless
  • diminished ability to think or concentrate
  • recurrent thoughts of death
  • SI, suicide attempt, specific plan
34
Q

SIGECAPS

A 
sleep pattern changes
interest/activity changes
guilt
energy changes
concentration changes
appetite changes
psychomotor disturbances
suicidal ideation
35
Q

MDD specifiers

A
  • anxious distress
  • mania/hypomania
  • melancholic features: anhedonia
  • atypical
  • mood congruent: delusions/hallucinations
  • mood incongruent: delusions/hallucinations
  • catatonia
  • peripartum onset: during or within 4 wks of delivery
  • seasonal pattern: SAD
36
Q

How do you determine the severity of MDD?

A
  • clinical interview
  • PHQ-9
  • assessment of severity guides treatment
  • mild: may not require medication
  • moderate: responds equally to medication or psychotherapy
  • severe: benefits more from medication alone or combined with psychotherapy
37
Q

What 4 symptoms do MDD and PDD have in common?

A
  1. depressed mood (irritable mood)
  2. Insomnia/hypersomnia
  3. Fatigue
  4. Poor concentration or difficulty making decisions
38
Q

SSRI treatment

A 
citalopram
escitalopram
fluoxetine
paroxetine
sertraline
39
Q

Why are SSRIs our go to?

A
  • ease of dosing and low toxicity
  • good for children, adolescents and late onset depression
  • less adverse effects
40
Q

What are common adverse effects of SSRIs?

A
  • GI upset
  • Sexual dysfunction
  • fatigue/restlessness
41
Q

SNRIs

A

venlafaxine
desvenlafaxine
duloxetine

42
Q

SNRIs are 1st line for which patients?

A

Those with significant fatigue and/or pain syndromes

43
Q

When would you rx an SNRI?

A

if a patient is not responding to an SSRI

44
Q

SNRI adverse effects

A

noradrenergic side effects: HTN

45
Q

Atypical AD

A

bupropion
mitazapine
nefazodone & trazadone

46
Q

What advantage does Bupropion have over other SSRIs?

A

Causes less sexual dysfunction, GI distress and it is weight neutral

47
Q

Mitrazapine is associated with a high risk of _________

A

weight gain

48
Q

If a pt came in complaining about sexual side effects/erectile dysfunction due to their SSRI/SNRI, how would you treat?

A
  • pretreatment counseling

- sildenafil

49
Q

If a pt came in complaining about undesired weight gain due to their SSRI/SNRI, how would you treat?

A

switch to bupropion

50
Q

If a pt came in complaining about agitation due to their SSRI/SNRI, how would you treat?

A

switch to another SSRI/SNRI; consider mania

51
Q

If a pt came in complaining about insomnia due to their SSRI/SNRI, how would you treat?

A

add mirtazapine, trazodone, or sedative-hypnotic

52
Q

If a pt came in complaining about anxiety due to their SSRI/SNRI, how would you treat?

A

BENZOS during initiation of treatment

53
Q

What do we have to watch out for in the elderly when rx SSRI/SNRI?

A

hyponatremia because it may promote osteoporosis

54
Q

How long should you treat a patient with MDD?

A

atleast 6-9 mo with close follow up

55
Q

When should you f/up with pts after they start pharmacotherapy?

A

1-2 weeks

56
Q

If pt response to meds is inadequate, when should you modify treatment?

A

At 6 weeks

57
Q

Possible increased suicide risk in ________, _____, _______ who start pharmacotherapy

A

children, adolescents and young adults

58
Q

Why is there a high rate of nonadherance in the early months?

A
  • misperception regarding how long it would take to feel better -> 2-6 weeks
  • med side effects
  • didn’t understand the need to continue the meds
59
Q

What should you do if pt has partial response to the meds?

A

1st: maximize dose of initial agent
2nd: switch to another medication or add 2nd drug if needed

60
Q

If the partial response continues despite switching meds or adding a drug, what should you do?

A
  • add psychotherapy
  • change AD
  • augment with bupropion, mirtazapine
61
Q

How long should you maintain meds for pts who experience their first episode of depression?

A
  • treatment may take 1 to several months until remission

- continue for another 6-12 mos

62
Q

How long should you maintain meds for pts who experience their multiple episodes of depression?

A

15 mo-3yrs

63
Q

How long should you maintain meds for pts older than 70 who respond to an SSRI?

A

2 yrs to prevent recurrence

64
Q

What to do if relapse occurs after cessation?

A

use AD that previously led to remission

initiate long term maintenance therapy

65
Q

Life time therapy may be required for patients who have experienced greater than or equal to ___ episodes

A

3

66
Q

Risk factors for more than one recurrence of depressive episode

A 
fam hx of bipolar
recurrence < 1 yr
onset in adolescence 
severe depression
suicided attempt
67
Q

CBT

A

cognitive behavioral therapy

identifies and modifies dysfunctional or inaccurate thoughts and behaviors

68
Q

IPT

A

interpersonal therapy
targets conflicts and role transitions
pt needs capacity for psychological insight

69
Q

PST

A

problem solving therapy

practical approaches to coping with everyday problems

70
Q

St Johns Worth

A
  • treatment of mild depression only
  • serious adverse effects are uncommon
  • DO NOT USE WITH SSRIs: serotonin excess syndrome
  • may reduce concentrations of digoxin, theophylline, simvastatin and warfarin.
  • at high dose, may harm sperm cells, reduce fertility.
71
Q

When to consult with behavioral health provider

A 
diagnostic uncertainty
severe symptoms
heightened suicide risk 
need for hosp
treatment resistant depression
72
Q

Alternatives for Treatment resistant depression

A

electroconvulsive therapy

transcranial magnetic stimulation

73
Q

When to consider hospitalization

A 
SI
intent to hurt others
unable to care for self
close observation needed
detoxification or substance abuse treatment
electroconvulsive therapy initiated
dysfunctional family systems worse depression or interfere with treatment
patients life is in jeopardy

Clinical Disciplines Exam 2 (2 decks)

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