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34 Cards in this Set

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When do you diagnose major depressive disorder (MDD)
Episodes of depression of at least 2 weeks of duration
How can you recognize a depressive episode
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
What is anhedonia
Loss of pleasure in all or almost all activities
What is SIG E CAPS
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
What is the prevalence of MDD
5-12% for men and 10-20% for women, with a 2:1 female to male ratio
What is masked depression
It is when patients deny or seem unaware of the symptoms of depression. This condition can occur in up to 50% of patients
Does MDD appear at a certain age
The mean age of onset is 40
What are the medical conditions that can cause or mimic a depressive episode
Pancreatic cancer
Lung cancer
Thyroid dysfunction (particularly hypothyroidism)
Pneumonia
Mononucleosis
AIDS
Syphilis
Parkinson’s disease
Stroke
Multiple sclerosis
Lupus
Nutritional deficiency
Menopause
None
Are there any medications that can cause depression
Reserpine
Propanolol
Steroids (eg prednisone)
Methyldopa
Interferons (used to treat viral hepatitis)
None
What is double depression
This term is used when patients meet criteria for MDD and dysthymic disorder
What is dysthymic disorder
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
None
How can you differentiate dysthymic disorder from MDD
Dysthymic disorder lasts for at least 2 years, is longer but with milder symptoms than MDD
How do you treat depression pharmacologically
The first-line treatment option is the SSRIs
Are there any other antidepressants also considered as first-line treatment options
Yes, there are other antidepressants with different mechanisms of action
What are the tricyclics
Older antidepressants (also known as heterocyclics) are currently considered a second-line treatment option
Why are the tricyclics a second-line treatment option
Because they are less tolerable due to their side effect profile and also because they can kill patients if they overdose on them
What are the side effects of the tricyclics
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
What are the most commonly used tricyclics
Imipramine
Desipramine
Amitriptyline
Nortriptyline
None
Are there any other medications to treat depression
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
Why are MAOIs a third line option
Because they cause serotonin syndrome and hypertensive crisis
What is serotonin syndrome
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
When does a hypertensive crisis occur in the context of MAOI use
Hypertensive crisis originates when patients who are on MAOIs ingest food rich in tyramine, like wine and cheese
Are there other ways to treat depression
Yes, by using psychotherapy
What type of psychotherapy is used to treat depression
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
What is electroconvulsive therapy or ECT
It is the induction of a generalized seizure by applying electric currents to the brain
When is ECT used
It is mainly indicated for patients with refractory depression but it can also be used for the treatment of mania
What are the main side effects of ECT
Short-term memory loss
When do you diagnose a patient with bipolar disorder (manic-depression)
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
What is the difference between hypomania and mania
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
What is bipolar I
It is a diagnosis that is given when a patient presents with a manic episode with or without depressive episodes
What is bipolar II
It is also a diagnosis, given when a patient presents with a major depressive episode and hypomanic episodes, but no manic episodes
Are there any drugs that induce mania
Yes, steroids and appetite suppressant are the main culprits. Cocaine (crack) and amphetamines may also induce it
What is cyclothymic disorder
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
What is the prevelance of bipolar disorder
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