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45 Cards in this Set
- Front
- Back
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A child of an alcoholic has a __ x greater chance of becoming an alcoholic himself.
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9x
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By what age should a child control urine?
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3 yo
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By what age should a child control bowels?
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4 yo
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Inability to control urine at night is called ___? What age is diagnosis made?
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enuresis
5 yo |
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Inability to control bowels is called ___? What age is diagnosis made?
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encopresis
5 yo |
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What Erikson stage of development would a kid be at who bedwets (3 yo)?
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autonomy vs. shame & doubt
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How would you treat ADHD in a 5 yo?
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Rx and behavioral modification together
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What Erikson stage of dvlpmt would a 30 yo be at?
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intimacy vs. isolation
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What Erikson stage of dvlpmt would a 2nd grader be at?
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industry vs. inferiority
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What Erikson stage of dvlpmt would a 13 yo be at?
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identity vs. role confusion
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What Daniel Levinson stage of dvlpmt would a mid-30 yo be at?
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early adulthood, mid 30s transition
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What is the 2nd leading cause of disability?
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unipolar major depression
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What is the economic burden of depression annually?
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$44 billion
(mostly from absenteeism and loss of productivity) |
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What is the usual age of onset of major depression?
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15-30 yo
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Which gender is more likely to suffer depression? How much more often?
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women
2x |
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What are the 3 MAIN depressive disorders?
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major depressive disorder
dysthymic disorder depressive disorder NOS |
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What are the 2 SECONDARY mood disorders?
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mood disorder due to general medical condition
substance induced mood disorder |
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What is the lifetime prevalence of a major depressive episode in general population?
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17% or 1/6
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What's the most common psychiatric disorder in primary care clinics?
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depression
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What % of pts w/ major depressive disorder requiring hospitalization commit suicide?
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15% or 1/7
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There is a ___x increased mortality in post-MI patients with depression.
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5x
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If a patient presents with multi-system somatic complaints, what should you be thinking?
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depression, anxiety, or other mood disorder
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In pts with chronic medical illnesses, there is a ___x in incidence of depression.
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2-3x
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How long does the normal course of depressive episode last?
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9-12 months
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How long is the course of a treated episode of depression?
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16 wks
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What is the rate of recurrence of depression for a pt with 1 prior episode?
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50%
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What is the rate of recurrence of depression for a pt with 2 prior episodes?
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70%
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What is the rate of recurrence of depression for a pt with 3 prior episodes?
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90%
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What are 3 poor prognostic indicators for depression?
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-multiple episodes
-severity (psychoses, bipolar) -partial inter-episode recovery |
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What are risk factors for depression?
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-prior episodes
-family hx (genetics) -prior suicide attempts -female gender -recent childbirth -medical co-morbidity -EtOH/substance abuse -recent separation/bereavement |
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What % of women who are going to dvlp depression suffer a post-partum episode?
What's the % normally? |
60%
15% |
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What are some high-risk medical populations for depression?
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-MI/CHF (25% compared to 17%)
-stroke (50-70%) -neurological dzs like Parkinson's, MS (30-45%) -endocrine dzs like diabetes (25-30%), cushing's (40-50%) -HIV/AIDS (25-30%) -GI, Crohn's, IBS -Meds: alpha-interferon, immune suppressants |
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What are the DSM-IV diagnosic criteria for major depression?
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SIGE CAPS
5+ syx in 2 weeks Sleep: insomnia/hypersomnia Interest: depressed mood/loss of interest/pleasure (*required) Guilt: feeling worthless, hopeless Energy: fatigue Concentration: diminished Appetite: weight change Psychomotor: retardation/agitation Suicide: preoccupation w/ death |
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What is usually the chief complaint of depressed pts?
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SOMATIC/PHYSICAL
69% report only physical syx. |
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Should you ask a depressed pt about their suicidal thoughts/plan?
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YES. If you don't, it's malpractice.
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Risk factors for suicide?
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SAD PERSONS
Sex: females more attempted, males more completed Age: 15-24, 55+ women, 65+ males (bimodal distribution) Depression (15%) Prior attempt EtOH abuse/intoxication Rational thinking loss (audit hallucinations) Social support loss Organized plan (intent vs. ideation) No spouse Sickness, chronic |
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What are the 2 behavioral models of major depression?
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-cognitive behavioral (distortion of life events, i.e. negative self/life views, fatalistic about future)
-Learned Helplessness (external locus of cntrl) |
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What is the concordance rates for MZ twins with bipolar depression? For DZ twins/siblings?
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80%
10% |
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Is there just one gene involved in major depression?
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No, but one locus is on chromosome 18
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In the pathogenesis of major depression, what are the biological theories?
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-genetic predisposition
-biogenic amines & NTs -neuroendocrine abnormalities |
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What NTs are implicated in depression? Which theory is this?
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DA, 5HT, NE
biogenic amine |
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Which drug makes depression worse --> suicide?
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Reserpine, an anti-HTN Rx, lowers DA and NE
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Which drug makes depression better?
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Iproniazid, a MAO inhibitor. MAO breaks down DA and NE, so if you inhibit this, you increase conc and improve mood.
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If you deplete this in the diet, you have recurrence of depressive episodes?
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tryptophan (precursor to 5HT)
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Depressed patients have higher or lower density of 5HT2 receptors?
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higher (compensatory response to low synaptic 5HT levels)
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