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Flashcards in Depression: Dr. Kelso Deck (70)
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1

Factors in Depression Pathogenesis

Genetics
Early life adversity
Social factors
Psychological factors
Secondary depression

2

Reasons for Secondary Depression

General medical disorders
Medications
Substance of abuse

3

Define Epigenetics

Changes in expression of genes caused by early life experiences or chronic stress

4

How does early life adversity potentially lead to depression?

Predisposes to major depression by altering sensitivity to stress and response to negative stimuli

5

Social factors that could play into depression

Isolation
Poor social relationships
Criticism from family members
Depression in social networks

6

Psychological factors that may lead to depression

Cognitive/Behavioral: negative/distorted patterns of thinking
Personality: neuroticism
Psychodynamic: early losses, interpersonal relationships

7

Symptoms of Neuroticism

Anxiety
Moodiness
Envy
Frustration
Loneliness
Respond poorly to stressors
Interpret ordinary situations as threatening
Minor frustrations as hopelessly difficult

8

Medical Conditions that may Lead to Depression

Sleep apnea
Hypothyroidism
Vitamin D deficiency
DM
Chronic pain
Stroke
HD: ischemic, HF, cardiomyopathy
Parkinson's
MS
Epilepsy
Head injury
CA
COPD
Dementia
HIV/Neurosyphilis

9

Medications that may Lead to Depression

Interferon
Corticosteroids
Benzodiazepines
Opioids
Varenicline (Chantix)
Beta-blockers

10

Drugs of Abuse that may Lead to Depression

PCP (withdrawal)
Amphetamines (withdrawal)
Cocaine (withdrawal)
Marijuana (withdrawal)
Sedative-hypnotics (intoxication)
Alcohol (intoxication)
Opiates (intoxication)
Steroids (intoxication)

11

Neurobiology of Depression

Altered brain structure and function

12

Altered Brain Structure in Depression

Increased ventricular-brain ratio
Smaller frontal lobe volumes
Smaller hippocampal volumes
Number/density/size of neurons and glial cells are abnormal

13

Altered Brain Function in Depression

Abnormal functioning of monoamines, GABA, glutamate
HPA axis- excess excretion of glucocorticoids may lead to suppression of neurogenesis & hippocampal atrophy
Abnormal neuronal networks
Sleep/circadian rhythms
Inflammation

14

Categories of Symptoms of Major Depression

Psychologica
Neurovegetative
Psychomotor/physical

15

Psychological Symptoms of Major Depression

Depressed mood
Numbness
Anhedonia: inability to experience joy
Decreased interest
Irritability/anxiety
Guilt/worthlessness
Suicidal ideation

16

Neurovegetative Symptoms of Major Depression

Appetite
Sleep
Energy
Concentration

17

Psychomotor/Physical Symptoms of Major Depression

Psychomotor: retardation, agitation
Physical: aches/pain, weakness/malaise, GI distress

18

Qualifying Symptoms for Major Depression

Occur in same two weeks
Most of the day, every day
Distress or impairment
R/O substances, general medical condition, bereavement

19

Subtypes of Depression

Anxious
Atypical
Catatonic
Melancholic
Mixed Features
Peripartum
Psychotic
Seasonal

20

Subcategories of Depression

Bipolar
Secondary: medical illness, medications, drugs of abuse

21

Co-morbid Psychiatric Conditions with Depression

Anxiety: generalized, panic disorder, OCD, PTSD
Substance abuse

22

What does SIGECAPY stand for?

S: sleep
I: interest
G: guilt/worthlessness
E: energy
C: concentration
A: appetite
P: psychomotor disturbance
S: suicidal ideation

23

Evaluation of Depression

Chronology of symptoms
Symptoms in the same two weeks
Most of the day, every day
Distress or impairment
Prior Hx of depressive episodes
Impact on functioning
Alleviating/aggravating factors
Address co-morbidity
Mania/hypomania
Distinguish major depression from persistent depressive disorder
Suicide risk
General medical illness
Family Hx: depression, suicide, psychosis, bipolar
Social Hx: interpersonal, occupational, financial stressors
+/- complete physical & euro exam
MMSE
Toxicological screen
Lab screen: CBC, TSH, LFT's, chem7, Ca, B12, Folate, HIV
Brain imaging
+/- EEG, LP

24

Types of Psychotic Features

Delusions
Hallucinations
Disordered though
20% of patients
Higher suicide risk

25

Suicide Risk Factors: SAD PERSONS

S: sex (male)
A: age
D: depression
P: previous suicide attempts
E: ETOH abuse
R: rational thinking loss
S: social supports lacking
O: organized plan
N: no spouse
S: sickness

26

When to hospitalize a patient with psychosis?

Plan
Intent
Plan

27

Possible Safety Treatment Plan Items

Crisis Numbers
ROI for family in chart
Commitment to adhere to meds, appts., contact office with concerns
Agree to remove lethal means

28

Alcohol CAGE Screening

C: cut down on drinking
A: annoyed by people criticizing your drinking
G: guilty about your drinking
E: eye opener

29

Other Scales to Screen for Depression

Beck depression inventory
Quick inventory of depressive symptomatology
Mood disorder questionnaire
Hamilton anxiety rating scale

30

Mental Status Exam Observation

Affect
Cognition
Psychomotor activity
Ruminative thought process
Speech
Psychosis
Suicidal thoughts