Major Depressive Disorder Flashcards
(75 cards)
1
Q
What 4 moods does Depressive Disorder include?
A
- Mild depression
- moderate depression
- severe depression
- severe depression with psychosis
2
Q
What 3 moods does Cyclothemia include?
A
- Elation
- normal mood
- dysthymia
3
Q
What 6 moods does recurrent depressive disorder include?
A
- normal mood
- dysthymia
- mild depression
- moderate depression
- severe depression
- severe depression with psychosis
4
Q
What moods does Bipolar affective disorder include?
A
All of them
5
Q
Disturbance of emotions that are severe or prolonged enough to cause impairment of functioning - magnification of normal rxn
A
Mood disorders
6
Q
- Period of extreme sadness and helplessness
- sadness
- feelings of worthlessness
- withdrawal from others
- changes in sleep/appetite
A
Depression
7
Q
- Period of abnormally high emotion and activity
- intense elation or irritability
- hyperactivity
- talkativeness
- distractibility
A
Mania
8
Q
The diagnostic criteria for Major depressive disorder is sad mood or loss of pleasure for ___ weeks w/ at least ___ other sxs.
A
- 2 weeks
- 4
9
Q
The diagnostic criteria for dysthymic disorder is mood is down and other sxs are present for at least _______.
A
50% of the time for at least 2 years
10
Q
What are the 3 main causes of mood disorders?
A
- Biological vulnerability
- psychological vulnerability
- stressful life event
11
Q
What 3 things can a stressful life event cause?
A
- stress hormone effect neurotransmitters
- sense of hopelessness and negative thought process
- problems in interpersonal relationships and lack of social support
12
Q
What is the most common mood disorder?
A
major depressive disorder
13
Q
When in life does MDD occur?
A
may occur at any age but likelihood increases after puberty
14
Q
MDD is prevalent in which sex most and when?
A
Women between time of menstruation and menopause
15
Q
- Occurrence of at least a single major depressive episode, (although most patients will experience recurrent episodes.)
A
MDD
16
Q
What makes women more prone to MDD than men?
(6 things)
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 tend to distract)
- ruminating intensifies and prolongs sad moods
17
Q
MDD risk factors (lots of em)
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
18
Q
Rate of depression is higher in which type of twin?
A
Higher in Identical (50%) than Fraternal is 20%
19
Q
Is the brain more or less active during major depression?
A
Less active, due to diminished neurotransmitter levels
20
Q
Stable vs Temporary explanations of MDD
A
- Stable: bad situation will last for a long time
- Temporary: This is hard to take but I will get through this
21
Q
Global vs. Specific MDD
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 family and other friends.
22
Q
Internal vs External MDD
A
- Internal: our break up was all my fault
- External: it takes 2 to make a relationship work and it wasn’t meant to be
23
Q
- 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 –>
A
Learned Helplessness (MDD)
*women are more likely to be abused and twice as likely to feel overwhelmed*
24
Q
Who should be screened for MDD according to USPSTF?
A
-
All adults that you can provide adequate resources for diagnosis, treatment and follow up are available
- including pregnant/postpartum women
- older adults
- Patients w/ identified risk factors
- Patient w/ unexplained somatic sxs, chronic pain, anxiety, substance misuse, or non-responsive to effective tx
25
MDD 1st step for depression screening
* Over the past 2 weeks, have you felt down, depressed, or hopeless?
* 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 and you need to move onto step 2 questions*
26
MDD 2nd step for depression screening
* dig deeper and engage in conversation about mood and changes in behavior
* Have pt fill out PHQ9
27
Criteria for MDD on PHQ9
* 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 always counted if + response regardless of severity
28
**PHQ-9 Score**
* None/Minimal
* What is tx?
* 0-4
* no tx
29
**PHQ-9 Score**
* Mild
* Tx?
* 5-9
* "watchful waiting"
* Reevaluate at FU appt
30
**PHQ-9 Score**
* Moderate
* Tx?
* 10-14
* Consider referral for psychotherapy / initiation of psychopharm therapy
31
PHQ9 Score
* Moderately Severe
* Tx?
* 15-19
* Initiate psychopharm therapy
* Refer for pschotherapy
32
**PHQ9 Score**
* Severe
* Tx?
* 20-27
* Initiate psychopharm therapy
* If severe impairment/tx resistant, then "expedite" referral for psychotherapy
33
**DSM dx of MDD requires:**
* __ or more of the following sxs and has been present for the same __ week period and represents a change from previous functioning.
* At least ___ of the sxs is either which 2 things?
* 5 or more
* 2 week period
* At least 1 of the sxs is either **Depressed mood** or **Loss of interest or pleasure** (anhedonia)
34
SIGECAPS
**Used for MDD**
* sleep pattern changes (cognitive)
* interest/activity changes (cognitive)
* guilt / increased worry
* energy changes (somatic)
* concentration changes (cognitive)
* appetite changes (somatic)
* psychomotor disturbances (somatic)
* suicidal ideation (cognitive)
35
* anxious distress
* mixed features: mania/hypomania sxs
* melancholic features: loss of pleasure
* atypical -
* mood congruent: delusions/hallucinations
* mood incongruent: delusions/hallucinations
* catatonia
* peripartum onset: during or within ___ wks of delivery
* -seasonal pattern
"MDD Specifiers"
* 4 weeks
36
How do you determine the severity of MDD?
(3 things)
* Clinical Interview
* Validated depression screening tool (PHQ-9)
* Assessment of severity guides the tx
37
What 4 symptoms do MDD and PDD have in common?
* depressed mood (irritable mood)
* Insomnia/hypersomnia
* Fatigue
* Poor concentration or difficulty making decisions
38
* citalopram
* escitalopram
* fluoxetine
* paroxetine
* sertraline
**SSRI**
| (Depressive Disorder Tx)
39
**Reasons to choose which drug?**
* ease of dosing and low toxicity
* good for children, adolescents and late onset depression
* less adverse effects
**Common adverse effects:**
* GI upset
* Sexual dysfunction
* Changes in energy (fatigue or restlessness)
SSRI
40
What are 3 common adverse effects of SSRIs?
- GI upset
- Sexual dysfunction
- fatigue/restlessness
41
* venlafaxine
* desvenlafaxine
* duloxetine
SNRIs
42
Which drugs are 1st line for those with significant fatigue and/or pain syndromes?
SNRIs
43
When would you rx an SNRI?
if a patient is not responding to an SSRI
44
SNRI adverse effects
noradrenergic side effects: HTN
45
* Bupropion
* Mitazapine
* nefazodone
* trazadone
Atypical Antidepressants
46
What 3 advantage does Bupropion have over other SSRIs?
* Causes less sexual dysfunction
* Less GI distress
* Is weight neutral
47
Mitrazapine is associated with a high risk of \_\_\_\_\_\_\_\_\_
weight gain
48
If a pt came in complaining about **sexual side effects/erectile dysfunction** due to their SSRI/SNRI, how would you treat? (2 things)
* pretreatment counseling
* sildenafil for ED
49
If a pt came in complaining about **undesired weight gain** due to their SSRI/SNRI, how would you treat?
switch to bupropion
50
If a pt came in complaining about **agitation** due to their SSRI/SNRI, how would you treat?
switch to another SSRI/SNRI; consider mania
51
If a pt came in complaining about **insomnia** due to their SSRI/SNRI, how would you treat?
* **Add:**
* mirtazapine
* trazodone
* or sedative-hypnotic
52
If a pt came in complaining about **anxiety** due to their SSRI/SNRI, how would you treat?
* Short course of benzodiazepines during initiation
53
What do we have to watch out for in the **elderly** when rx SSRI/SNRI?
Hyponatremia, because it may promote osteoporosis
(Sodium levels too low)
54
How long should you treat a patient with MDD?
atleast 6-9 mo with close follow up
55
When should you f/up with pts after they start pharmacotherapy for MDD?
1-2 weeks
56
If pt response to meds is inadequate, when should you modify treatment?
(MDD)
At 6 weeks
57
Possible increased suicide risk in \_\_\_\_\_\_\_\_, \_\_\_\_\_, _______ who start pharmacotherapy
* children
* adolescents
* young adults
58
Why is there a high rate of nonadherance in the early months of pharm tx for MDD?
* 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
What should you do if pt has partial response to the meds?
* 1st: maximize dose of initial agent
* 2nd: switch to another medication or add 2nd drug if needed
60
If the partial response continues despite maximizing dose, switching meds, or adding a drug, what should you do?
* add psychotherapy
* change antidepressants
* augment with bupropion, mirtazapine, non-traditional agent
61
How long should you maintain meds for pts who experience their first episode of depression?
* treatment may take 1 to several months until remission
* continue for another 6-12 mos
62
How long should you maintain meds for pts who experience multiple episodes of depression?
15 months - 3 yrs
63
How long should you maintain meds for pts older than 70 who respond to an SSRI?
2 yrs to prevent recurrence
64
What to do if relapse occurs after cessation of meds for MDD?
* use AD that previously led to remission
* initiate long term maintenance therapy
65
Lifetime therapy may be required for patients who have experienced greater than or equal to ___ episodes
3
66
5 Risk factors for first recurrence and more than one recurrence of depressive episode
* fam hx of bipolar recurrence
* \< 1 yr
* onset in adolescence
* severe depression
* suicided attempt
67
Identifies and modifies dysfunctional or inaccurate thoughts and behaviors
CBT
68
* Targets conflicts and role transitions
* pt needs capacity for psychological insight
IPT (interpersonal therapy)
69
Practical approaches to coping with everyday problems
PST
70
* treatment of mild depression only -
* serious adverse effects are uncommon -
* DO NOT USE WITH SSRIs: bc/ may lead to serotonin excess syndrome -
* may reduce concentrations of certain mends (digoxin, theophylline, simvastatin and warfarin.)
* at high dose, may harm sperm cells, reduce fertility.
St. John's Wort
71
5 reasons to consult with behavioral health provider
* diagnostic uncertainty
* severe symptoms
* heightened suicide risk
* need for hospitalization
* Treatment-resistant depression
72
Alternatives for Treatment resistant depression
electroconvulsive therapy transcranial magnetic stimulation
73
When to consider hospitalization (8)
* Significant SI or intent w/o safeguards
* Intent to hurt others is expressed
* unable to care for self
* close observation needed
* detoxification or substance abuse treatment
* electroconvulsive therapy initiated
* dysfunctional family systems worsen depression or interfere with treatment
* patients life is in jeopardy
74
**Severity of MDD**
* May not require tx
* Responds equally to meds or psychotherapy
* Benefits more from meds alone or combined w/ psychotherapy
* Mild
* Mild to Moderate
* Severe
75
Which drugs have a low toxicity in overdose?
Atypical Antidepressants
