Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
120 Cards in this Set
- Front
- Back
|
5 reasons we need to diagnose depression?
|
1. it causes disability
2. it causes diminished quality of life 3. it increases health care costs 4. it can be fatal 5. it can be treated effectively |
|
|
Criteria and Rx for: Sadness
|
C: transient; normal
Rx: Support |
|
|
Criteria and Rx for: Bereavement
|
C: Sadness after loss < 2 months
Rx: Support, counseling |
|
|
Criteria and Rx for: Adjustment Disorder
|
C: Develops w/in 2 months of stressor-->functional impairment
Rx: Psychotherapy, maybe drugs |
|
|
Criteria and Rx for: Major Depressive Disorder
|
C: 5 of 9 sx's for at least 2 weeks
Rx: Psychotherapy and meds |
|
|
Criteria and Rx for: Dysthymia
|
C: Depressed/irritable for 2+ yrs (think mild chronic depression)
Rx: Psychotherapy, drugs |
|
|
Diagnostic Acronym for Depression?
|
SIGE CAPS
|
|
|
What does SIGE CAPS stand for?
|
Sleep disturbance (+/-)
Interest diminished/lost Guilt Energy low Concentration difficulties Appetite disturbance or wt change Psychomotor retardation/agitation Suicidal ideation |
|
|
How does SIGE CAPS work with diagnosing depression?
|
You need 5 or more of the symptoms
For at least 2 weeks Not due to meds, medical conditions, drugs, or grief |
|
|
what are some drugs that can cause depression?
|
Reserpine
Acutane Beta-Blockers |
|
|
What are some medical conditions that can cause depression?
|
MI
Stroke Mono Cancer (pancreatic) |
|
|
How do we describe the cause of depression?
|
biopsychosocial
|
|
|
What is the etiology of Depression?
|
decreased serotonin (and other monoamines)
|
|
|
But what causes a decrease in serotonin?
|
Genetics
Psychosocial: parental neglect/loss, adverse events |
|
|
What is one possible pathway that separation from a caretaker could take to depression?
|
1. Separation
2. Under or Over-arousal 3. Chronic Hyper-arousal 4. Increased cortisol 5. Can contribute to depression/anxiety |
|
|
Other Risk Factors for Depression
|
Female
20-40 yrs old Prior episodes of depression Concurrent Illness Substance use Childbirth (postpartum) |
|
|
What percent of population will suffer from a depressive episode and how many of these will be diagnosed and treated?
|
15% of population and 1/3 treated
|
|
|
How many suicide attempts in the US <18yrs old?
|
500,000
|
|
|
Suicide Risk Factors?
|
White
Male (women attempt more, we're more successful at it) Older Living Alone Substance Use Chronic Medical Illeness Depression w/ psychosis |
|
|
What are protective factors against suicide?
|
Having kids
Having a religion |
|
|
What kind of Dx do we make with depression?
|
clinical
|
|
|
How can medical disorders contribute to depression?
|
They can cause it BIOLOGICALLY (e.g. hypothyroidism)
They can cause it PSYCHOLOGICALLY (e.g. AIDS) |
|
|
Medical Conditions that can cause depression?
|
Stroke
Brain Tumor MS PD Dementia Anemia Hypo/Hyper-thryroidism Cushing's Addison's Hyperparathyroidism Hyperprolactinemia |
|
|
Medical Evaluation of Depression: what tests to run and stuff to do
|
ROS
Meds Physical CBC Electrolytes Liver Fxn Thyroid Fxn |
|
|
What provides the best outcome for a Major Depressive Episode?
|
combining Pharmacotherapy and Psychotherapy
|
|
|
What is the first line of pharmacotherapy?
|
SSRI
or Mixed Serotonin, noradrenergic reuptake inhibitor |
|
|
What are common SE's of starting antidepressants?
|
Initially N&V
|
|
|
What might you need to give if a person has psychotic depression?
|
hmmm maybe an ANTIPSYCHOTIC!
|
|
|
What is the main type of Psychotherapy for depression?
|
Cognitive Behavioral Therapy
|
|
|
What does the CBT encompass?
|
The Cognitive Triad
1. Negative self-esteem 2. Negative view of past and present 3. Hopeless outlook for future |
|
|
What about the behavoiral therapy part?
|
Increase Social Interactions
Diet and Exercise |
|
|
What's different about developmental depression?
|
There is also a tendency for irritability.
Dysthymia Dx only requires 1 yr of sx's |
|
|
What is also common with Pre-Pubertal Depression?
|
Somatic Complaints (stomach ache)
Anxiety Mood-Congruent Hallucinations Psychomotor agitation |
|
|
What is the kicker about adolescent depression?
|
High co-morbidity with substance use and suicide attempts
|
|
|
What is special about Rx of depression in children?
|
Evidence-based literature is limited
Multidisciplinary Therapy Antidepressants can increase risk of suicide attempts in children (prozac only one approved) |
|
|
Risk Factors for Postpartum Depression?
|
H/O depression or premenstrual dysmorphic disorder
Younger Age Living alone or limited support Marital Conflict Ambivalence about pregnancy |
|
|
Postpartum Blues prevalence, onset, clinical course, and Rx?
|
Affects 50-75% of women
Usually w/in first week after delivery Gone w/in 2 weeks w/o Rx |
|
|
Postpartum Depression
Prevalence Onset |
More Serious
1 in 10 new moms Onset w/in days and up to 1 yr later |
|
|
Rx for Postpartum Depression
|
Rx w/ psychotherapy or antidepressants
|
|
|
Postpartum Psychosis
how is it different from PP depression? |
it is more severe form
|
|
|
Postpartum Psychosis
prevalence |
1 in 1000
|
|
|
Sx of Postpartum Psychosis?
|
severe agitation
hopelessness insomnia paranoia delusions or hallucinations |
|
|
Rx for Postpartum Psychosis?
|
Immediate Medical Attention due to increased risk of suicide or harm to baby
|
|
|
Geriatric Depression
How might a geriatric depressed patient appear? |
Demented, but its pseudodementia
|
|
|
What are the Sx's of pseudodementia?
|
Concentration Impaired
Forgetfull NOT PROGRESSIVE |
|
|
What is the key to pharmacotherapy for depression in old folks?
|
Start Low
and Go Slow |
|
|
What is the clinical course like for depression secondary to substance use?
|
Last days to weeks
Often clear spontaneously |
|
|
What percent of alcoholics reported feeling sad during or after beind intoxicated?
|
80%
|
|
|
What percent of alcoholics meet the full criteria for depression?
|
30-40%
|
|
|
What is the number 1, anxiety-like Sx in alcoholics?
|
Withdrawal palpitations and/or dyspnea
|
|
|
Dx Criteria for Manic Episode
|
Elevated, Expansive, or Irritable Mood for one week
Distractible Involved in risky/dangerous behavior Grandiosity Flight of Ideas Activity increased Sleep decreased Talkative |
|
|
Morbidity of Bipolar Disorder
|
Recurrent in 90% of pts
Functional recovery often lags behind symptomatic recovery Recurrence may lead to progressive deterioration in functioning Number of episodes may alter response to Rx |
|
|
Bipolar Disorder
Onset? |
~30.4 yrs old
|
|
|
Bipolar Disorder
Lifetime prevalence? |
1.2%
|
|
|
Bipolar Disorder
Gender? |
Equal
|
|
|
Bipolar Disorder
Attempted suicide rate |
25%
|
|
|
Bipolar Disorder
Suicide Rate |
11-19%
|
|
|
Bipolar Disorder
When is suicide ideation the most common? |
In Mixed States of depression and mania
|
|
|
Bipolar Disorder
Rx |
MOOD STABILIZERS
Lithium Anticonvulsants (valproate, carbamazepine) Atypical Antipsychotics (olanzapine, risperidone) |
|
|
Define Multiple Sclerosis
|
It is an autoimmune disorder that affects (demyelinating) the CNS causing various neurological deficits over time
|
|
|
After demyelination of axons in MS, what can happen to the axons?
|
they can snap which leads to the formation of ovoid bodies
|
|
|
What are three things that can happen to axons in MS?
|
Dymyelinate
Snap (ovoid bodies) Degenerate to leave just the myelin behind |
|
|
What is the autoimmune mechanism in MS?
|
Activated T-Cells secrete cytokines that damage myelin and myelin-secreting cells
|
|
|
What do we still not know about the T-cell mechanism?
|
We don't know the Ag the T-cells are targeting
|
|
|
Under normal circumstances, why can't T-cells target the CNS?
|
B/c normally they can't pass through the BBB, but in MS they are able to
|
|
|
Who are the myelin-producing cells?
|
Oligodendrocytes
|
|
|
What type of diagnosis is made in MS?
|
CLINICAL diagnosis based on neurological complaints separated "in time and space."
|
|
|
What supportive evidence can be used to help diagnose MS?
|
MRI
Spinal Fluid Evoked Potentials |
|
|
What is the difference between signs and symptoms?
|
Symptoms are what the patients tell us about.
Signs are what we find |
|
|
Common Symptoms of MS?
|
Blurred/Double Vision
Loss of Vision in one eye Slurred or slow speech Easy Fatigability Problems Thinking Poor Balance Numbness or Tingling Poor bladder/bowel control Difficulty Walking TREMOR |
|
|
Common Signs of MS?
|
Altered Eye Movements
Abnormal Pupillary Response Pale Optic Disk Visual Field Disturbances Overactive Tendon Reflexes Abnormal speech patterns Sensory Disturbances Limb Spasticity Localized Weakness Gait Disorder |
|
|
What is one thing we can see in MS patients on an MRI?
|
Ovoid Bodies
|
|
|
Why are MRI's tough to rely on in MS patients?
|
They can't really tell us what sx's will be present.
A pt can be cured on an MRI and not in reality |
|
|
What is key to CSF analysis in MS patients?
|
Oligoclonal Bands (IgG)
|
|
|
What is Relapse in MS?
|
Appearance of new or worsening of old sx's lasting at least 24 hrs
|
|
|
Most common stressor to cause relapse?
|
HEAT
|
|
|
What is one of the most common Clinically Isolated Syndromes to progress to MS?
|
Optic Neuritis
|
|
|
What is going on microscopically when Relapse-Remitting MS becomes Secondary Progressive?
|
The T-cells are getting to the axons
|
|
|
What are the potential triggers of MS
|
Infectious Agent (mono, splenomegaly)
Genetic Predisposition Environmental Factors All three may lead to Abnormal Immunologic Response-->MS |
|
|
MS and gender
|
Female:Male is 4:1 in R-R MS
1:1 in Primary Progressive |
|
|
MS and Age of onset
|
90% onset between 15-50
Average 30 |
|
|
MS and gender
|
>90% are white
|
|
|
MS and geography
|
Temperate Climates further from the equator
|
|
|
Is MS a pathologically heterogeneous disease?
|
NO
Its very possible that in the future there will be MS Type 1, 2, etc. |
|
|
Key to Rx of MS?
|
Early Dx and Early Rx
|
|
|
Different Categories of Rx for MS?
|
Immune Modulating Agents
Symptomatic Rehabilitation Alternative Rx |
|
|
Why don't I have to learn the immune modulating drugs?
|
b/c they presently changing
|
|
|
What are some possible alternative treatments?
|
Marijuana
Bee Stings |
|
|
What are some possible drug types for MS?
|
Interferons
Glatiramer Acetate (probably don't need to memorize) |
|
|
Target of Interferons?
|
Stop the replication of T-cells
|
|
|
Target of Glatiramer Acetate
|
It has anti-inflammatory effects in the brain
|
|
|
What are two more drugs we could possibly use for MS?
|
Mitoxantrone
Natalizumab |
|
|
Mech of Mitoxantrone?
|
its a chemo drug that stops the replication of T-cells
|
|
|
Mech of natalizumab?
|
Stops the T-cells from crossing the BBB
|
|
|
SE of Interferons?
|
Flu-like syndrome
Injection-site rxns |
|
|
SE's of Glatiramer Acetate
|
Systemic Rxn
|
|
|
SE's of Mitoxantrone
|
Alopecia
Dysmenorrhea Cardiotoxicity Neutropenia |
|
|
Possible SE of natalizumab?
|
Progressive Multifocal Leukoencephalopathy
|
|
|
What are some of the Sx's targeted by Symptomatic Rx?
|
Fatigue
Bladder Control Spasticity Pain Depression etc |
|
|
What do 90% of MS patients say is their worse symptom?
|
FATIGUE
|
|
|
Rx approaches to Fatigue in MS patients?
|
1. Review Meds
2. Rule out comorbid condition (e.g. thyroid issue) 3. Non-Pharmacologic Techniques 4. Pharmacologic |
|
|
What are some non-pharm techniques for fatigue?
|
Cooling Techniques
Exercise Appropriate Assistive Devices |
|
|
Three types of Bladder issues
|
1. Failure to Store
2. Failure to Empty 3. Failure to Store and Empty |
|
|
What must you rule out with a acute change in bladder control?
|
New Neurological Event
UTI |
|
|
What are two issues with Chronic Bladder problems?
|
1. Don't Ask, Don't Tell (embarrassment)
2. Post-Void Residual |
|
|
What are some non-pharmacologic interventions for Bladder Issues?
|
Avoid Aggravators (caffeine, constipation, concentrated urine)
Bladder Training Hydration Kegels Catheritization (AAAAHHH) |
|
|
Pharmacological Interventions for Failure to Store
|
Anti-cholinergic Agents
Tolterodine (Detrol) Oxybutynin (Ditropan) enablex also Botox |
|
|
Pharmacological Interventions for Failure to Empty
|
Prostate Meds (off label: flomax)
|
|
|
Possible triggers to spasticity?
|
UTI
Skin Breakdown Pain |
|
|
Non-Pharm for Spasticity?
|
stretching
|
|
|
Pharm for Spasticity
|
Botox
Baclofen (intrathecal pump) Valium Klonopin |
|
|
Types of Pain associated with MS?
|
PAROXYSMAL PAIN
Trigeminal Neuralgia Lhermitte's Tonic Spasms |
|
|
What do these types of pain often respond to?
|
Anticonvulsants
e.g. carbamazepine, gabapentin, etc |
|
|
What is Lhermitte's?
|
Pain induced by bending head at neck which sends sensation down back and into limbs
|
|
|
What can you give for parasthesias?
|
Anticonvulsants
Antidepressants |
|
|
What do you give for Musculoskeletal Pain?
|
Appropriate Assistive Device
NSAIDs Narcotics |
|
|
What effect does MS have on a person's risk of suicide?
|
7x increase
|
|
|
Keys to Cognitive Impairment in MS
|
Recognize it Exists
Remove Exacerbating Factors (meds, fatigue, depression, other conditions) Cope |
|
|
Pharm for Fatigue
|
Amantadine
Prozac Provigil (modafinil) |
|
|
Other Medical Conditions to look out for...
|
Osteoporosis
UTI's and secondary hydronephoris Aspiration Pneumonia Flu Vaccine |
