Major Depressive Disorder Tx Flashcards Preview

Licensure > Major Depressive Disorder Tx > Flashcards

Flashcards in Major Depressive Disorder Tx Deck (16)
Loading flashcards...
1
Q

How to measure remission

A

Tools for symptom severity (PHQ-9)
Ask about side effects
Ask about adherence
Ask about functional status

2
Q

If no remission achieved, patient is vulnerable

A

More sig psychosocial disability
3x faster relapse
Signifies a more chronic illness if the was the first MDE
Even mild residual symptoms place patients at more risk for relapse than a history of MDE

3
Q

Continuation Phase: Goal of Treatment

A

Sustain Remission

4
Q

Continuation Phase: Treatment

A

Monitor for early signs of relapse
Systematic review of symptoms, side effects, adherence and functional status
Medications continued for 4-9 months
Depression-focused CBT to prevent relapse
If ECT was used in the acute phase, pharmacotherapy

5
Q

If ECT was used in acute phase, what pharmacotherapy is best?

A

Lithium and nortriptyline

6
Q

Which symptoms of depression will subside first?

A

Vegetative symptoms

7
Q

Maintenance Phase: Goal of treatment

A

Prevent recurrence

8
Q

Rate of MDE recurrence

A

50-85%

9
Q

MDE increases risk for…

A

Other affective episodes like mania and hypomania

10
Q

If ≥ 3 MDE or chronic MDE…

A

Some form of maintenance therapy will be needed indefinitely

11
Q

Each MDE increases risk of recurrence by…

A

16%

12
Q

Discontinuation Phase

A
Treatment free without recurrence
Taper meds over several weeks
Inform pt of chances of relapse, and make a plan if sx recur
Monitor for several months
How to measure remission
13
Q

Discontinuation Phase: What to do if recurrence of symptoms?

A

Initiate a full acute phase treatment plan.

14
Q

Risk for recurrence of MDD

A

Persistence of subthreshold symptoms
Prior Hx of multiple MDE
Severity of initial and subsequent episodes
Early age of onset
Additional non-affective psych diagnosis
Presence of chronic medical disorder
+ family history of psych illness, esp. mood disorder
Ongoing psychosocial stress and impairment
Negative cog style
Persistent sleep disturbances

15
Q

Psychotherapy for maintenance

A

Monthly Interpersonal Therapy
CBT over 2 years as effective as meds
Medication and psychotherapy may be more effective than either as single therapy
Some studies indicate that monthly therapy is as effective as maintenance meds

16
Q

Acute Phase Treatment Goals

A

Achieve remission
3 weeks of absence of sad mood and reduced interest
No more than 3 remaining symptoms