depressive disorders (329 E2)

Question 1

depression epidemiology

Answer 1

• 2x more common in women than men
• more prevalent in caucasians but more severe in African Americans
• seasonality worse in decreased sunlight
• socio economic status areas

Question 2

etiology of depression: biological factors

Answer 2

• genetic
• biochemical abnormalities (neurotransmitter, electrolyte, cortisol, hormonal imbalances)
• inflammatory process

Question 3

what type of thyroid disorder is commonly seen with depression

Answer 3

hypoactive thyroid
check T3, T4 & TSH levels

Question 4

etiology of depression: psychological factors

Answer 4

• cognitive theory psychological predisposition (negative and/or unrealistic expectations and perceptions)
• learning theory: learned helplessness

Question 5

contributing factors to depression: child

Answer 5

based on diathesis stress model

• detachment of primary caregiver
• parental separation or divorce
• death of loved one, including pet
• relocation
• academic failure
• physical illnesses

Question 6

contributing factors to depression: teens

Answer 6

adult & child theories apply as well

• conflicts w/ independence and maturation
• role confusion
• grief/loss

Question 7

contributing factors to depression: older adults

Answer 7

• societal attitudes: self esteem, helplessness
• major stressors: financial problems, life changes, physical illness, grief/loss, decreased functional ability

Question 8

Major depressive disorder (MDD)

Answer 8

5 or more daily in 2wk period

• wt loss & appetite changes
• sleep disturbances
• fatigue
• psychomotor agitation or retardation
• worthlessness or guilt
• loss of ability to concentrate
• recurrent thoughts of death

+ at least one sx is also either

• depressed mood
  OR
• loss of interest or pleasure (anhedonia)

Question 9

what is chronic MDD

Answer 9

lasting more than 2 years

Question 10

MDD cannot have

Answer 10

mania or hypomania episodes
would then be classified as a bipolar disorder

Question 11

MDD dx in children & teens

Answer 11

5 or more sx present during 2wk period

• depressed or irritable, cranky mood
• loss of interest or pleasure

and any 3 of the following

• significant wt loss or decrease in appetite
• insomnia or hypersomnia
• psychomotor agitation or retardation
• fatigue or lack of energy
• feelings of worthlessness or guilt
• decreased concentration or indecisiveness
• recurrent thoughts of death or suicide

Question 12

other symptoms of MDD in children and teens

Answer 12

• frequent, vague, nonspecific physical complaints (“my tummy hurts”)
• frequent absences from school or poor performance in school
• being bored
• alcohol or substance abuse
• increased anger or hostility
• reckless behavior

Question 13

depression symptoms in children: up to age 3

Answer 13

• failure to thrive
• feeding problems
• lack of playfulness
• lack of emotional expression
• delay in speech or motor development

Question 14

depression symptoms in children: age 3-5

Answer 14

• prone to accidents
• phobias
• aggressiveness
• excessive self reproach for minor infractions

Question 15

depression symptoms in children: age 6-8

Answer 15

• vague physical complaints
• aggressive behavior
• cling to parents
• avoid new people and challenges
• behind in social skills/academic performance

Question 16

depression symptoms in children: ages 9-12

Answer 16

• morbid thoughts
• excessive worrying
• lack of interest socially
• think they have disappointed parents

Question 17

disruptive mood dysregulation disorder (DMDD)

Answer 17

• ages 6-18 y/o
• onset before age 10
• sx include anger and constant, severe, irritability
• prevalence rate is 2-5%
• more common in males and in children than adolescents
• temper tantrums w/ verbal and behavioral outbursts at least 3x weekly
• display irritability, anger and temper tantrums in at least 2 settings

Question 18

persistent depressive disorder

Answer 18

• formerly known as dysthymia
• low level depressive feelings through most of each day, the majority of days
• sx for at least 2 years in adults, 1 yr in children/adolescents
• must have 2 or more: decreased appetite or overeating, insomnia or hypersomnia, low energy, poor self-esteem, difficulty thinking and hopelessness

Question 19

response to mediations in persistent depressive disorder

Answer 19

2/3 of individuals respond favorable to antidepressants, specifically MAOIs and SSRIs

Question 20

premenstrual dysphoric disorders

Answer 20

• sx cluster in last week prior to onset of a women’s period
• sx include: mood swings, irritability, depression, anxiety, feeling overwhelmed, and difficulty concentrating
• physical manifestations include lack of energy, overeating, hypersomnia or insomnia, breast tenderness, aching, bloating and wt gain
• sx decrease significantly or disappear with the onset of menstruation

Question 21

medication for premenstrual dysphoric disorders

Answer 21

give SSRIs just for the premenstrual periods, stop once period starts

Question 22

substance induced depressive disorder

Answer 22

person does not experience depressive symptoms in the absence of drug or alcohol use or withdrawal

Question 23

depressive disorder associated with another medical condition

Answer 23

• can be caused by kidney failure, parkinson’s disease, and alzheimer’s disease
• symptoms that result from medical diagnoses or certain medications are not considered major depressive disorder

Question 24

psychomotor retardation

Answer 24

• visible slowing of physical activity such as movement and speech
• slow talking or long pauses before beginning to talk, taking long time to cross a room or slow chewing / waiting longer between bites
• associated w/ severe depression

Question 25

psychomotor agitation

Answer 25

- increased in activity brought on by mental tension - restlessness, pacing, tapping of fingers or feet, abruptly starting and stopping tasks, meaninglessly moving objects around - associated w/ agitated depression

Question 26

general antidepressant mediation education

Answer 26

- May not see symptom improvement until 4-6 weeks. - Physiological symptoms improve before psychological symptoms **with increased energy danger of SI** - Look for improved sleep; less daytime fatigue and crying; & increased frustration tolerance. - Side effects may occur but handled by adjusting dosage or switching to different med in same class. - Discontinuing meds as soon as you feel better may result in relapse. Meds usually needed for 6-9 months past symptom relief- up to 12 -24 months. -Antidepressants are not addictive. -Abrupt stopping of meds will result in withdrawal- nausea, anxiety, insomnia, flu-like symptoms -Do not drink alcohol

Question 27

antidepressants

Answer 27

- SSRIs 1st line therapy & low risk for serotonin syndrome - SNRIs not as well tolerated better - tricyclic antidepressants anticholinergic adverse reactions - monoamine oxidase inhibitors effective for unconventional depression & has tyramine restrictions