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34 Cards in this Set
- Front
- Back
- 3rd side (hint)
When do you diagnose major depressive disorder (MDD)
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Episodes of depression of at least 2 weeks of duration
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How can you recognize a depressive episode
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It is a period of at least 2 weeks, when the patient complains of depressed mood or anhedonia with associated:
Decreased concentration Decreased energy Increased or decreased sleep Increased or decreased appetite Psychomotor retardation Agitation Feelings of worthlessness Guilt Recurrent thoughts of death or suicidal ideation |
None
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What is anhedonia
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Loss of pleasure in all or almost all activities
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What is SIG E CAPS
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It is a mnemonic for depression:
Sleep disturbances (mainly insomnia) loss of Interest excessive Guilt loss of Energy Concentration difficulty loss of Appetite Psychomotor retardation or agitation Suicidal ideation (or recurrent thoughts of death) |
None
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What is the prevalence of MDD
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5-12% for men and 10-20% for women, with a 2:1 female to male ratio
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What is masked depression
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It is when patients deny or seem unaware of the symptoms of depression. This condition can occur in up to 50% of patients
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Does MDD appear at a certain age
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The mean age of onset is 40
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What are the medical conditions that can cause or mimic a depressive episode
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Pancreatic cancer
Lung cancer Thyroid dysfunction (particularly hypothyroidism) Pneumonia Mononucleosis AIDS Syphilis Parkinson’s disease Stroke Multiple sclerosis Lupus Nutritional deficiency Menopause |
None
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Are there any medications that can cause depression
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Reserpine
Propanolol Steroids (eg prednisone) Methyldopa Interferons (used to treat viral hepatitis) |
None
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What is double depression
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This term is used when patients meet criteria for MDD and dysthymic disorder
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What is dysthymic disorder
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An illness where patients feel mildly to moderately depressed for a minimum of 2 years and over the 2 year period the patient has never been without symptoms for more than 2 months. It is not severe enough to meet the criteria for MDD
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None
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How can you differentiate dysthymic disorder from MDD
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Dysthymic disorder lasts for at least 2 years, is longer but with milder symptoms than MDD
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How do you treat depression pharmacologically
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The first-line treatment option is the SSRIs
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Are there any other antidepressants also considered as first-line treatment options
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Yes, there are other antidepressants with different mechanisms of action
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What are the tricyclics
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Older antidepressants (also known as heterocyclics) are currently considered a second-line treatment option
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Why are the tricyclics a second-line treatment option
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Because they are less tolerable due to their side effect profile and also because they can kill patients if they overdose on them
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What are the side effects of the tricyclics
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They include anticholinergic effects (dry mouth, blurred vision, constipation, and confusion), α-blocking effects (sedation also caused by antihistaminic effects, orthostatic hypotension, and cardiac arrhythmias), may lower the seizure threshold, are contraindicated in glaucoma, and have to be used with caution in urinary retention
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What are the most commonly used tricyclics
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Imipramine
Desipramine Amitriptyline Nortriptyline |
None
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Are there any other medications to treat depression
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Yes the MAOIs, considered third-line option. MAOIs rarely used any more. The main reason for not using them is due to the diet restrictions and drug-drug interactions
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Why are MAOIs a third line option
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Because they cause serotonin syndrome and hypertensive crisis
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What is serotonin syndrome
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A clinical entity that consists of hyperthermia, muscle rigidity, and altered mental status. This syndrome is seen when MAOIs are combined with SSRIs (mostly), Demerol, pseudoephedrine, and other medications that can increase serotonin and norepinephrine
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When does a hypertensive crisis occur in the context of MAOI use
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Hypertensive crisis originates when patients who are on MAOIs ingest food rich in tyramine, like wine and cheese
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Are there other ways to treat depression
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Yes, by using psychotherapy
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What type of psychotherapy is used to treat depression
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Psychodynamic psychotherapy, which focuses on self-understanding and inner conflicts
Cognitive-behavioral therapy, which attempts to recognize negative thoughts or behaviors and then tries to change them Interpersonal therapy, which examines the patients relationship and their relation to his or her symptoms |
None
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What is electroconvulsive therapy or ECT
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It is the induction of a generalized seizure by applying electric currents to the brain
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When is ECT used
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It is mainly indicated for patients with refractory depression but it can also be used for the treatment of mania
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What are the main side effects of ECT
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Short-term memory loss
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When do you diagnose a patient with bipolar disorder (manic-depression)
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When a patient presents with expansive, euphoric, or irritable mood associated with increased energy, decreased concentration, decreased need to sleep, talkative (clinically called pressured speech), increased activity/goal-directed behavior, racing thoughts, hypersexual, spending large amounts of money, and engaging in risky activities. Most of these symptoms last for at least 1 week
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What is the difference between hypomania and mania
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They present exactly the same but hypomania does not cause significant social and occupational impairment, while mania does. Also, hypomania does not result in psychotic symptoms or hospitalization
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What is bipolar I
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It is a diagnosis that is given when a patient presents with a manic episode with or without depressive episodes
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What is bipolar II
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It is also a diagnosis, given when a patient presents with a major depressive episode and hypomanic episodes, but no manic episodes
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Are there any drugs that induce mania
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Yes, steroids and appetite suppressant are the main culprits. Cocaine (crack) and amphetamines may also induce it
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What is cyclothymic disorder
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Many episodes of depression and hypomania occurring for at least 2 years, where depressive episodes are not severe enough to meet criteria for a major depressive episode
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What is the prevelance of bipolar disorder
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Bipolar I has a lifetime prevalence of 0.5% to 1% and a male to female ratio of 1:1. While bipolar II has a life time prevalence of 0.5% and is more common in women than in men
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