Term
A patient comes in to your office complaining of insomnia, weight gain, fatigue, diminished concentration and loss of interest/pleasure.
She explains that the symptoms have been going on for 3 months and occur nearly every day, impeding her social function.
Are they depressed? |
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Definition
Yes! They have 5 of 9 necessary DSM IV criteria (NEED 1 or 2)
Also need >2 weeks (nearly every day) with impedance to social function
SIGECAPS
1) SLEEP
2) Loss of INTEREST/pleasure (or irritability to children)
3) GUILT
4) ENERGY (loss)
5) CONCENTRATION
6) APPETITE (increased decreased)
7) PSYCHOMOTOR (retardation/agitation)
8) SUICIDAL THOUGHTS |
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Term
A patient comes into your office complaining of depressed mood and frequent thoughts of suicide.
She explains that the symptoms have been going on for 2 months and occur nearly every day, impeding her social function.
Are they depressed? |
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Definition
Maybe, but not conclusive yet! Need 5 of 9 (with 1 or 2)
Timing and impedance to social function fit.
1) Depressed mood
2) Loss of interest/pleasure (or irritability to children)
3) Insomnia/Hypersomnia
4) Weight loss/gain
5) Psychomotor agitation/retardation
6) Fatigue
7) Worthlessness/guilt
8) Diminished concentration
9) Recurrent thoughts of death/suicide |
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Term
| A patient presents with insomnia, depressed mood and fatigue. You are thinking depression, but what else should you consider? |
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Definition
1) Adjustment disorder with disturbance of mood
- Clear psychosocial stressor without full MDE criteria
2) Dysthmia
- Chronic depression (>2 years), but not significant enough severity to be MDE
3) Cyclothymia (ups and downs)
4) Bipolar
Others! |
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Term
| What is Dysthymia and how does it compare to MDD? |
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Definition
| Dysthymia is chronic, minor depression that arises earlier (early-20s vs. mid-30s) and does not fulfill severity criteria to be considered MDE. |
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Term
| What are some common subtypes of MDD? |
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Definition
1) Melancholic
2) Atypical (hypersomnia/hyperphagia)
3) Seasonal
4) Catatonic
5) Psychotic
6) Post-partum |
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Term
| What epidemiological characteristics define MDD? |
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Definition
1) Female 2X > Male
2) Age mid 30s
3) Poverty, Life stress and Personality d/o are all risks
4) Genetic component (monozygotic twins 30-50%)
5) 25% will experience manic episode later in life |
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Term
| What hints point to "masked" depression in primary care settings? |
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Definition
Unexplained physical symptoms or inadequate responses to medications.
Co-morbidity is common! |
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Term
| How does MDD presentation vary by age? |
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Definition
1) Young show Irritability and Dysphoria
2) Older deny mood changes but acknowledge Anhedonia. |
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Term
| What does the acronym "SIGECAPS" signify in DSV IV criteria for MDD? |
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Definition
1) SLEEP
2) Loss of INTEREST/pleasure (or irritability to children)
3) GUILT
4) ENERGY (loss)
5) CONCENTRATION
6) APPETITE (increased decreased)
7) PSYCHOMOTOR (retardation/agitation)
8) SUICIDAL THOUGHTS |
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Term
| What are the major treatment options for MDD? |
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Definition
Diagnose, Educate, Treat, Re-evaluate
1) Pharmacotherapy
- SSRIs (first line), SNRIs, bupropion, TCA's and MAOI's
2) Psychotherapy
- CBT
- Interpersonal therapy (IPT)
3) ECT (serious and/or refractory cases)
4) Surgery (ventral anterior cingulate DBS) |
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Term
| What should you look for in a Screen for depression? |
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Definition
Remember DETRE (Diagnose, Educate, Treat, Re-evaluate)
** FIRST, prioritize lethality issues**
If not, diagnose
1) Has the patient felt DEPRESSED or hopeless most of the day nearly every day?
2) Have they LOST INTEREST in or pleasure in doing things they used to enjoy |
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Term
Anhedonia is defined as:
a. Poor sleep cycle
b. Decreased interest in pleasurable activities
c. Rapid cycling
d. Measure of manic symptoms |
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Definition
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Term
All of the following are symptoms of major depression except:
a. Anhedonia
b. Poor sleep
c. Change in appetite
d. Pressured speech |
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Definition
D
Remember SIGECAPS
sleep
interest
guilt
energy
concentration
appetite
psychomotor fluctuations
suicidal thoughts |
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Term
A 26 year-old male presents to his primary care office with a CC of poor concentration. He has noticed his job performance decreasing for the past two months. He also endorses early morning awakening, anergia, anhedonia and a decreased appetite. Which of the following areas must be investigated prior to initiating SSRI therapy?
a. Past or present symptoms of mania or hypomania
b. Suicidal ideation
c. Drug and/or alcohol use
d. Psychosis
e. All of the above |
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Definition
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Term
One psychological theory of depresion posits that the activation of depressogenic schema trigger negative interpretations of self/world/future which in turn cause other symptoms of depression. This theory forms the basis of which therapy for depression?
a. Interpersonal therapy (IPT)
b. CBT
c. Psychodynamic psychotherapy
d. Family therapy |
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Definition
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Term
About 40 female first-year med students attend this calss. If lifetime prevalence rates of depression in this population parallel the general community, about how many women in the class are likely o experience an episode of major depression at some point in their lives?
a. One or two
b. About 5
c. About 10
d. About 20 |
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Definition
| B (its about 10% for women and 5% for men) |
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Term
All of the following groups are independently increased risk for developing major depression, EXCEPT:
a. African American
b. Female
c. Poor
d. Those with a family history
e. Those with a personal history of dysthmymia |
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Definition
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Term
Which statement about the likely course of depression is most accurate:
a. Having an acute onset predicts a worse course
b. Postpartum depression increases the risk for developing bipolar disorder
c. Having a history of dysthymia protects patients against recurrence of MDEs
d. The interval between depressive episodes increases as people age. |
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Definition
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Term
After a first episode of depression, remitted with the help of an antidepressant, what is the minimum amount of time a patient should remain on the antidepressant?
a. One week
b. One month
c. Six months
d. Twelve months |
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Definition
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Term
Whats the most concerning common side effect of ECT?
a. Fractures
b. Memory Loss
c. Nausea
d. Personality Change |
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Definition
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