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Psychiatry 2023 > wamss notes depressive mood disorders > Flashcards

wamss notes depressive mood disorders Flashcards

1
Q

major depressive disorder (MDD)

A

Condition in which at least 2 weeks of low mood predominates resulting in significant distress or impairment in functioning

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2
Q

male to female ratio of major depressive disorder

A

M:F 1:2

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3
Q

classification of major depressive disorder (MDD)

A

A) 5 or more of the symptoms present in the same 2 week period, at least one symptom must be symptom 1 or 2
B). The Sx cause significant distress or impairment of functioning
C) Is not attributable to another medical condition
D) Not better explained by another psychiatric disorder
E) No episodes of mania or hypomania

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4
Q

what is the acronym used to remember the symptoms of major depressive disorder

A

SIGECAPS

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5
Q

what are the symptoms of major depressive disorder

A
  1. Depressed mood most of the day nearly every day
  2. Sleep Disorder
  3. Interest Deficit
  4. Guilt, worthlessness, hopelessness
  5. Energy deficit
  6. Concentration deficit
  7. Appetite disorder (↑↓)
  8. Psychomotor retardation/agitation
  9. Suicidality or recurrent thoughts of death
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6
Q

what might FBC show that would indicate a cause other than major depressive disorder

A

anaemia or infection

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7
Q

what might U&Es show that would indicate a cause other than major depressive disorder

A

electrolyte imbalances, hyponatraemia

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8
Q

what might LFTs show that would indicate a cause other than major depressive disorder

A

liver damage, ETOH, hepatic encephalopathy

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9
Q

severity of major depressive disorder

A

Mild: 2 symptoms
Moderate: 3 symptoms
Moderate-Severe: 4-5 symptoms
Severe: 2-5 Symptoms + psychomotor agitation

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10
Q

Ddx of major depressive disorder

A

Other psychiatric disorders: dysthymia, bipolar, stress related disorders adjustment/bereavement disorders, PTSD, anxiety disorders…
non psychiatric disorders

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11
Q

non-psychiatric Ddx of major depressive disorder

A

Neurological Disorders (dementia, Parkinson, MS, CVA, tumour)
Endocrine- (Addison’s, Cushing’s, hypothyroidism, menopausal, hypopituitarism)
Metabolic Disorder (hypoglycaemia, hypocalcaemia)
Substance misuse & medication related

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12
Q

treatment for mild major depressive disorder

A

psychological therapies are generally more effective

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13
Q

treatment of severe major depressive disorder

A

antidepressants and generally more effective although concurrent psychological therapies may be helpful If the pt engages

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14
Q

treatment of moderate major depressive disorder

A

psychological therapies and pharmacological are equally effective

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15
Q

non pharmacological intervention for major depressive disorder

A

Psychoeducation
Psychotherapy:
- CBT
- Interpersonal Psychotherapy (IPT)
Group therapy
Social work
Diet, exercise, lifestyle…
Psychologist

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16
Q

first line medication for major depressive disorder

A

SSRI, SNRI, NaSSA

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17
Q

SSRI options

A

Sertraline (zoloft)
Citalopram (celexa)
Escitalopram (Lexapro)
Paroxetine (paxil)
Fluoxetine (Prozac)

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18
Q

SNRI options

A

Venlafaxine (Effexor)
Desvenlafaxine
(Pristique)
Duloxetine

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19
Q

NaSSA options

A

Mirtazapine

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20
Q

how long might it take for medication to take effect in major depressive disorder

A

It may take 2-6 weeks to see a clinical response
If there is no initial or only a partial response then consider ↑ the dose: note relatively flat dose
response curve with SSRIs
If there is still no or partial response consider switching to a different first line medication

21
Q

second line choices for major depressive disorder

A

RIMA eg. Moclobemide
NRI eg. reboxetine
NDRI eg. bupropion

22
Q

third line choices for major depressive disorder

A

MAOI or TCA

23
Q

MAOI options

A

Selegiline Zelpar
Phenelzine Nardil
Tranylcypromine Parnate

24
Q

TCA options

A

Amitriptyline (endep)
Nortriptyline (allegron, noritren)
Imipramine (tofranil)
Clomipramine (anafrandil)

25
Q

mood stabilisation augmentation for major depressive disorder

A

Lithium, Sodium Valproate, Lamotrigine
+ SSRI + TCA

26
Q

if there is comorbid psychosis in major depressive disorder

A

antipsychotics should be added to Tx

26
Q

if there is comorbid psychosis in major depressive disorder

A

antipsychotics should be added to Tx

27
Q

prognosis for major depressive disorder

A

80% relapse at least once
15% chronic reoccurrence
Tx reduces chance of reoccurrence by 70%

28
Q

Tx for major depressive disorder reduces chance of reoccurrence by

A

70%

29
Q

life expectancy of major depressive disorder

A

shorter life expectancy (suicide and other)

30
Q

persistant depressive disorder (dysthymia)

A

Symptoms of depression lasting at least 2 years, less severe than MDD.

31
Q

criteria of persistent depressive disorder (PDD)

A

A. Depressed mood for most of the day, more days than not for >2 years
B. Presence, while depressed of 2 or more of the following:
- Appetite disorder
- Concentration deficit
- Hopelessness
- Energy Deficit
- Worthlessness ↓ self esteem
- Sleep Disorder (↑↓)
C. During the 2 years pt has net been without symptoms in criteria A&B for more than 2
months at a time

32
Q

while depressed, an individual with persistent depressive disorder may also experience

A
  • Appetite disorder
  • Concentration deficit
  • Hopelessness
  • Energy Deficit
  • Worthlessness ↓ self esteem
  • Sleep Disorder (↑↓)
33
Q

if a person meets the criteria of MDD during PDD

A

If full criteria for a major depressive episode have been met at some point during the
current episode of illness then they should be given a Dx of major depressive disorder at
that time as a specifier within the Dx of dysthymia

34
Q

melancholic depression

A

A subtype of MDD characterised by persistent & severe depression

35
Q

criteria of melancholic depression

A

One of the following is present during the most severe period of the current episode:

  • Loss of pleasure in all or almost all activities
  • Lack of reactivity to usual pleasurable stimuli (doesn’t feel good even temporarily
    when something good happens)
    3 or more of the following
  • Distinct quantity of depressed moon characterised by profound despondency, despair
  • Depression regularly worse in the morning
  • Early-morning awakening
  • Marked psychomotor agitation
  • Significant anorexia or weight loss
  • Excessive or inappropriate guilt
36
Q

atypical depression

A

Shares the criteria of MDD or dysthymia but is characterised by improvement in mood in response to positive events

37
Q

epidemiology of atypical depression

A

M:F 1:3

Tends to be more chronic

38
Q

adjustment disorder

A

Also called reactive or situational depression occurs when a pt is unable to cope with a particular stress or major life event

39
Q

criteria of adjustment disorder

A

Development of emotional or behavioural Sx to an identifiable stressor occurring within 3 months
Sx cause significant functional impairment or distress that is out of proportion to the severity
of the stressor
Does not meet the criteria of other mental disorders & is not an exacerbation
Once the stressor has ended the Sx do not persist for >6months

40
Q

once the stressor causing adjustment disorder has ended

A

the Sx do not persist for >6months

41
Q

after the identifiable stressor, adjustment disorder occurs within

A

3 months

42
Q

substance/medication induced depressive disorder

A

Prominent & persisted disturbance in mood characterised by depressed mood or markedly

diminished interest or pleasure in almost all activities
Evidence that that the symptoms developed soon after substance intoxication or withdrawal
The substance is capable of producing the symptoms
Is not better explained by a mood disorder

43
Q

depressive disorder due to another medical condition

A

Prominent & persisted disturbance in mood characterised by depressed mood or markedly diminished interest or pleasure in almost all activities
There is evidence that the Sx are a direct consequence of a medical condition
Disturbance is not better explained by another mental condition

44
Q

recurrent brief depression

A

Depressed mood & 4 other Sx of depression for 2-13 days at least once per month for at least
a year, but does not meet the criteria for MDD or other MD

45
Q

short-duration depression

A

Depressed mood & 4 other Sx of depression with clinically significant distress for 4-13 days, in
a pt who does not meet criteria for MDD or other MD

46
Q

depressive episode with insufficient Sx

A

Depressed affect with at least 1 Sx of depression associated with clinically significant distress
or impairment for at least 2 weeks in a pt who does not meet the criteria for MDD or other
MD

47
Q

unspecified depressive disorder

A

Sx characteristic of a depressive disorder that cause significant distress or impairment but do not meet the full
criteria for any of the disorders. Often used when there is insufficient information to make a more specific
diagnosis eg ; ED

Psychiatry 2023 (20 decks)

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