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Flashcards in Depression Deck (30)
1

What is the disease burden of disability in the world rankings?

4th in disease burden worldwide behind perinatal conditions, RIs and HIV/AIDS

2

  • Which disease has the highest healthcare costs?
  • Which disease/disorder has the highest recognition rate?
  • Which disease/disorder is the most treatable?

3

What is the most common psychiatric symptom?

Depression

4

Depression

  • What is the 1 year prevalence rate?
  • How many people are affected in a given year?

  • 1 -year Prevalence Rate
    • Major Depression 5%
    • Dysthymic Disorder 5.4%
  • In a given year, 11 million people
    • 5 million Major Depression
    • 1.8 million Bipolar Disorder

5

Of those patients who suffer from depression, how many are:

  • Unrecognized: 
  • Untreated: 
  • Diagnosed & Treated: 

  • Unrecognized: 50%
  • Untreated: 25%
  • Diagnosed & Treated: 25%

6

How can depression present clinically?

  • Multiple Somatic Complaints
  • Anxiety
  • Cultural Influences
    • “Nerves”“Headaches”
      • Latino, Mediterranean
    • Weakness, Tiredness, “Imbalance”
      • Chinese, Asian cultures
    • “Heartbroken”
      • Hopi

7

What are common presenting somatic complaints in patients with depression?

  1. Disturbed sleep
  2. Tired all the time, “blahs”
  3. Headache
  4. Malaise
  5. Vague abdominal or joint pains
  6. Sexual dysfunction or loss of sexual interest
  7. “Stressed out”
  8. GI complaints (eg, constipation, diarrhea)

8

There is a strong correlation between ______ symptoms and prevalence of psychiatric disorders

There is a strong correlation between positive symptoms and prevalence of psychiatric disorders

9

What 3 medical illnesses have a high prevalence rate with depression?

  1. Stroke 
  2. Cancer 
  3. Diabetes
  • Note: Also Parkinson's disease, myocardial infarction and rheumatoid arthritis

10

What is the DSM-IV classification of mood disorders?

11

Major Depressive Episode: 

Symptom Criteria

Minimum 5 symptoms for at least two weeks

  • At least 1 of the following 2:
    1. Depressed mood (irritable in kids)
    2. Loss of interest or pleasure
  • 4 of the following:
    1. Weight loss or gain
    2. Insomnia or hypersomnia
    3. Psychomotor retardation or agitation
    4. Fatigue or energy loss
    5. Worthlessness or guilt
    6. Decreased concentration
    7. Death thoughts; suicidal thoughts, plans, acts

12

What are additional criteria for a major depressive episode?

  • Not Mixed Episode
  • Clinically significant distress or impairment
  • Not due to substance or general medical condition
  • Not Bereavement

13

DSM-IV Criteria for Major Depressive Episode

"SIG E CAPS"

 > 5 symptoms in the same 2-week period 

  1. Sleep: insomnia or hypersomnia
  2. Interest: depressed mood,* or loss of interest and pleasure*
  3. Guilt: feelings of worthlessness
  4. Energy: fatigue
  5. Concentration: diminished ability to think or make decisions
  6. Appetite: weight change
  7. Psychomotor: psychomotor retardation or agitation
  8. Suicidality: preoccupation with death, hopelessness

*Must include one of these

 

14

  • What is the importance of screening for depression?
  • How can depression be screened for?

  • US Preventive Services Task Force recommends screening for depression in practices able to then actively manage patients who screen positive
  • 2-question depression screen
    1. Over the past 2 weeks, have you felt down or hopeless?
    2. Over the past 2 weeks, have you felt little interest in doing things?
  • Patient Health Questionaire (PHQ-9)

A “yes”to either question is a positive screen for depression

15

How is a PH9 scored?

16

One person in the U.S. dies by suicide every....

One person in the U.S. dies by suicide every 17 minutes

17

What are the red flags for suicide?

"IS PATH WARM?"

"IS PATH WARM?"

  1. Ideation/threatened or communicated
  2. Substance Abuse/excessive or increased
  3. Purposeless/no reasons for living
  4. Anxiety, Agitation/Insomnia
  5. Trapped/feeling no way out
  6. Hopelessness
  7. Withdrawal from friends, family, society
  8. Anger (uncontrolled)/rage/seeking revenge
  9. Recklessness/risky acts -unthinking
  10. Mood changes (dramatic)

18

What are the 3 stages of bereavement?

  1. Shock
  2. Preoccupation with the deceased
  3. Resolution

19

Bereavement Stage 1: Shock

  1. Emotions 
  2. Somatic
  3. Thoughts 

  1. Emotions
    • Numbness
    • Sense of unreality
  2. Somatic
    • Crying
    • Abdominal pangs/emptiness
    • Sighing
    • Tightness in throat
  3. Thoughts
    • Denial
    • Disbelief

20

Bereavement Stage 2: Preoccupation with Deceased

  1. Emotions 
  2. Somatic 
  3. Thoughts 
  4. Motivational

  1. Emotions
    • Guilt
    • Anger
    • Sadness
  2. Somatic
    • Weakness
    • Anorexia
    • Insomnia
    • Fatigue
  3. Thoughts
    • Dreams
    • Thoughts of the deceased
  4. Motivational stage
    • Anhedonia
    • Introversion

21

Bereavement Stage 3: Resolution 

  1. Thoughts
  2. Motivational Stage

  1. Thoughts
    • Think of past with pleasure
  2. Motivational Stage
    • Regain interest in activities
    • Form new relationships

22

What is the pharmcotherapy for depression?

  1. Tricyclic antidepressant (TCA)
  2. Selective Serotonin Reuptake Inhibitors (SSRI)
  3. Atypical
  4. Monoamine Oxidase Inhibitors (MAOI)
  5. Others

23

List the Tricyclic antidepressants (TCA) (10):

  1. Imipramine (Tofranil)
  2. Desipramine (Norpramin)
  3. Clomipramine (Anafranil)
  4. Trimipramine (Surmontil)
  5. Amitriptyline (Elavil)
  6. Nortriptyline (Pamelor)
  7. Protriptyline (Vivactil)
  8. Doxepin (Sinequan)
  9. Amoxapine (Asendin)
  10. Maprotilene (Ludiomil)

24

What should be conisdered when using tricyclic antidepressants?

  • Effective First Line Treatment
  • Preferred by Managed Care
  • Compliance Issues Due to Side Effects
    • Dry mouth
    • Sedation
    • Orthostatic Hypotension
  • Cardiac arrythmias with overdose

25

List the Selective Serotonin Reuptake Inhibitors (SSRI) (6):

  1. Fluoxetine (Prozac)
  2. Sertraline (Zoloft)
  3. Paroxetine (Paxil)
  4. Citalopram (Celexa)
  5. Fluvoxamine (Luvox)-not approved for depression
  6. Escitalopram (Lexapro)

26

What should be considered when treating with SSRIs?

  • Dosage, Dosage, Dosage
  • Recurrence
    • increase dose or stop
  • Side effects
    • Headache, dizziness
    • Nausea, loose stools, constipation
    • Somnolence or insomnia
    • Sweating, tremor, dry mouth
    • Anxiety, restlessness
    • Sexual Drive
  • Persistence - if at first you don’t succeed

27

List the atypical anitdepressants (7):

  1. Bupropion (Wellbutrin/Zyban)
  2. Trazodone (Desyrel)
  3. Nefazodone (Serzone)
  4. Venlafaxine (Effexor)
  5. Mirtazapine (Remeron)
  6. Duloxetine (Cymbalta)
  7. Alprazolam (Xanax)

28

List the Mono-Amine Oxidase Inhibitors (MAOI) (5):

  1. Phenelzine (Nardil)
  2. Isocarboxazid (Marplan)
  3. Tranylcypramine (Parnate)
  4. Selegiline patch (Emsam)
  5. RIMA: meclobemide, others

29

List the other treatments available for depression (10):

  1. Lithium
  2. Augmentation therapy
    • Lithium
    • T-3 L-triiodothyronine Cytomel
  3. Psychotherapy 
  4. ECT (Electro-Convulsive Therapy)
  5. Vagal Nerve Stimulation
  6. Transcranial Magnetic Stimulation
  7. Deep Brain Stimulation
  8. St John’s Wort
  9. Sam-E (s-adenosylmethionine)
  10. Reboxetine (snri)

30

What are the 5 R's of the clinical course for depression?

  • Response
  • Remission
  • Relapse
  • Recovery
  • Recurrence