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74 Cards in this Set
- Front
- Back
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What are the nine criteria symptoms for major depressive disorder?
Which one of them has to be present to make the diagnosis? |
- depressed mood
- anhedonia - change in appetite - insomnia or hypersomnia - psychomotor agitation or retardation - fatigue - feeling worthlessness/guilt - decreased concentration - suicide thought * either depressive mood or anhedonia has to be present to make the diagnosis. |
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In major depressive disorder, the symptoms cause marked impairment have to last for at least ___.
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6 months.
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T/F: Severe cases of major depression may experience hallucinations and delusions.
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True.
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What is the major complication of major depressive disorder?
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Suicide/homicide
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What are some associated features that might complicate the dignosis of major depression?
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anxiety
somatic complaints "masked depression": depressed patient does not complain about depressed mood. |
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The mean age of onset for major depressive disorder is ___.
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40s, but often earlier, marked increase after puberty.
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More prevalent in male or female?
Major depressive disorder. |
female
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The recurrence rate for major depression is ____.
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very high (especially during the 1st 12 months.
* 50% recurrence rate with history of 1 episode 70% recurrence rate with history of 2 episodes 90% recurrence rate with history of 3 episodes |
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Who are most at risk for suicide among people with major depressive disorder?
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Elderly males
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If a patient comes in and complains about lots of somatic symptoms,what should you suspect he/she has?
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mood disorder
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Major depressive disorder is a independent risk factor for ___.
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MI
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T/F: Major depressive disorder is more prevalent than arthritis, diabetes, or heart disease.
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T.
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When an elderly patient appears cognitively impaired, has poor attention and concentration, and indecisive, what is likely the cause? What treatment should you use first?
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This is pseudodementia, usually caused by depression.
So you should treat depression first and see if the cognitive symptoms go away. |
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Does beta blocker cause depression?
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No!
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Name some drugs that may cause depression.
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oral contraceptives
sedative-hypnotics |
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Which subtype of major depressive disorder is this?
- severe anhedonia - loss of reactivity to pleasurable stimuli - depressed mood worse at AM - early morning wakening - weight loss |
melancholia
* responde well to somatic therapy |
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Which subtype of major depressive disorder is this?
- significant weight gain - hypersomnia - leaden paralysis - rejection sensitivity |
atypical subtype
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Which subtype of major depressive disorder is this?
- depressive mood - command hallucination /delusion |
psychotic subtype
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Which subtype of major depressive disorder is this?
- depressive mood - motor immobility - excessive purposeless motor activity - echolia or echopraxia |
catatonic subtype
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Which subtype of major depressive disorder is this?
- onset within 4wks of partuition |
postpartum subtype
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Which subtype of major depressive disorder is this?
- depressive mood more frequent in winter - change from depression to mania in the spring |
seasonal subtype
* can use light therapy |
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What is the time criteria in chronic depressive disorder?
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2 yrs
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What are some risk factors for major depressive disorder?
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prior episodes
family history female postpartum period absense of social support comorbid conditions |
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What disorder is this?
A major depressive episode alternating with either manic or hypomanic episodes. |
bipolar disorder
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What is this?
inflated self-esteem grandiosity pressured speech/talkative flight of ideas distractibility Symptoms last more than 1 wk. caused marked impairment. |
manic episode
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What is this?
less severe symptoms of mania Symptoms last more than 4 days. no marked impairment, no psychosis. |
hypomania episode
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What is this?
both manic and depressive episode early everyday Symptoms last more than 1 wk. caused marked impairment. |
mixed episode
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Which type of bipolar disorder is this?
- mainly manic episodes - no history of depressive episodes |
type I
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Which type of bipolar disorder is this?
- mainly hypomanic episodes - history of major depressive episodes - no psychosis |
type II
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Which type of bipolar disorder is this?
- depression and mania/hypomania at the same time |
mixed type
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Which type of bipolar disorder is this?
- >4 mood episodes within a yr - more in female |
rapid cycling type
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More prevalent in male or female?
bipolar disorder |
equal
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What is the usual age of onset of bipolar disorder?
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18-21 yrs
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T/F: Suicide risk is high is both depression and bipolar disorder.
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T.
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T/F: In bipolar disorder, the interepisode time stays the same in the course of the illness.
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F. Interepisode time decreases.
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Why is there a 5-10yr time lag from symptoms to treatment od bipolar disorder?
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- children/adolescents are diagnosed with ADHD first
- comorbidity |
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What drugs cause mania?
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- corticosteroids
- stimulants |
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What systemic illness may cause mania?
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hyperthyroidism
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What neurological illness may cause mania?
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extrapyramidal system disease
CNS infection MS strokes (right frontal lobe) |
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What are the three types of cuase of secondary mania?
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- neurological illness
- systemic illness - drugs |
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How is dysthymic disorder different from the chronic subtype of major depressive disorder?
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dysthymic disorder only need to meet 2 of the symptom criteria.
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What does this person has?
Teenage girl has had insomnia, fatigue, and feelings of hopelessness for more than a year. Her mood is sometimes irritable. Her symptoms caused significant impairment to daily living. |
Dysthymic disorder.
*for children/adolescent: time criteria is 1 yr and mood may be irritable other than depressed. |
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What is "double depression"?
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Pre-exhisting dythymic disorder with superimposed major depressive episode.
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What does this person has?
30 yr old female has had periods of feeling depressed, anhedonia, hopelessness, and periods of high self esteem, pressured speech, distractable for more than 2 years. |
at least 2 yr duration of depression and hypomania.
This is cyclothymic disorder. |
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A patient complains about feeling depressed without other associated depressive symptoms. What might cause this?
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- substance intoxication within a month.
- cancer - diabetes - stroke - MI |
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A patient has expansive mood without other associated manic symptoms. What might cause this?
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substance intoxication
cancer diabetes stroke MI |
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A patient has a depressive mood for 2 months. History showed that he had a car accident 2 months ago. What does he has?
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Adjustment disorder with depressed mood.
* symptoms should not last more than 6 months. |
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How is bereavement different from major depressive disorder?
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Bereavement:
- not last longer than 2 months - not feeling guilt or worthlessness - no suicidal thoughts |
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What is this?
- depressed mood - anxiety - lethargy - affective lability - feeling overwhelmed These symptoms usually before menses. |
Premenstrual dysphoric disorder
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T/F: Premenstrual dysphoric disorder is common in women with dysmenorrhea.
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F. It is uncommon.
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How to treat premenstrual dysphoric disorder?
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SSRI
estrogen progesterone |
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What is the cause of premenstrual dysphoric disorder?
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estrogen, progesterone
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Which three areas showed evidence for the causes of major depressive disorder?
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- genetic
- social, environmental - neurobiology |
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Hypofunction of biogenic amine is considered as an etiology for major depressive disorder.
How does each explain the symptoms of major depressive disorder? (hint: mood symptom, behavior and appetite, pleasure and sex symptoms) |
mood symptoms: NE
behavior and appetite: serotonin pleasure and sex: dopamine |
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What metabolite level is low is the CSF of depressed people who completed suicide?
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5-HIAA
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Explain the mechanism of action of the following drugs:
- MAOI - tricyclic antidepressants |
MAOI: inhibit the breakdown of neurotransmitter
TCA: block the reuptake of neutotransmitters |
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What area of the brain is abnormal in people with major depressive disorder?
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- decreased volume of subgenual prefrontal cortex
- increased blood flow to amygdala |
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How does HPA explain major depressive disorder?
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normal negative feedback system is impaired leading to sustained decreases of CRF.
CRF: appetite, reproductive ACTH: response to stress, increases CRF |
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What is the sleep structure in major depressive disorder?
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- prolonged sleep latency
- shorted REM latency - decreased slow-wave sleep - decreased arousal threshold - early morning wakening |
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Describe the molecular cause of major depressive disorder.
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stress ->glucocorticoids (NMDA) -> glutamate by astrocytes -> dentritic atrophy -> synaptic loss
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CREB and BDNF levels are ___ (high/low) in people on long term antidepressants.
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high
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What is the single most effective therapy for major depressive disorder?
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ECT
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Name the 2 key elements to successful treatment of major depression.
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- achieve therpeutic dose
- maintain for at least 4 wks |
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What is the drug to use in depressive patients who had sexual impairment from other drugs?
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Bupropion: contraindicated in seizure patients.
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Which medication is first to used in treating major depression? why?
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SSRI (fluoxetine), because of better side effects: GI, sexual dysfunction.
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Why is TCA not a first line drug for treating major depression?
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worse side effects during 1st month.
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Name a selective inhibitor of serotonin which affects NE reuptake.
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Venlafaxine.
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What are the side effects of venlafaxine?
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insomnia
nervousness nausea elevate blood pressure (Duloxetine does not have this effect) |
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What is the mechanism of action of mirtazapine?
What are its side effects? |
mechanism: alpha2 adrenergic antagonist, enhance NE transmission, increase serotonin transmission, block 5HT.
Side effect: sedation, weight gain. |
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Why is MAOI not a first line drug for major depression?
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diet restriction (tyramine free)
side effects: orthostatic hypotension. |
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Psychotherapy is useful in which type of depression?
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mild to moderate
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What is the DOC for bipolar disorder?
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lithium carbonate
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What is the safest treatment for pregnant women with bipolar disorder?
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ECT
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Which biological system do you need to monitor in patients on lithium carbonate?
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blood count
thyroid function renal function |
