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45 Cards in this Set

  • Front
  • Back
A child of an alcoholic has a __ x greater chance of becoming an alcoholic himself.
By what age should a child control urine?
3 yo
By what age should a child control bowels?
4 yo
Inability to control urine at night is called ___? What age is diagnosis made?
5 yo
Inability to control bowels is called ___? What age is diagnosis made?
5 yo
What Erikson stage of development would a kid be at who bedwets (3 yo)?
autonomy vs. shame & doubt
How would you treat ADHD in a 5 yo?
Rx and behavioral modification together
What Erikson stage of dvlpmt would a 30 yo be at?
intimacy vs. isolation
What Erikson stage of dvlpmt would a 2nd grader be at?
industry vs. inferiority
What Erikson stage of dvlpmt would a 13 yo be at?
identity vs. role confusion
What Daniel Levinson stage of dvlpmt would a mid-30 yo be at?
early adulthood, mid 30s transition
What is the 2nd leading cause of disability?
unipolar major depression
What is the economic burden of depression annually?
$44 billion
(mostly from absenteeism and loss of productivity)
What is the usual age of onset of major depression?
15-30 yo
Which gender is more likely to suffer depression? How much more often?
What are the 3 MAIN depressive disorders?
major depressive disorder
dysthymic disorder
depressive disorder NOS
What are the 2 SECONDARY mood disorders?
mood disorder due to general medical condition
substance induced mood disorder
What is the lifetime prevalence of a major depressive episode in general population?
17% or 1/6
What's the most common psychiatric disorder in primary care clinics?
What % of pts w/ major depressive disorder requiring hospitalization commit suicide?
15% or 1/7
There is a ___x increased mortality in post-MI patients with depression.
If a patient presents with multi-system somatic complaints, what should you be thinking?
depression, anxiety, or other mood disorder
In pts with chronic medical illnesses, there is a ___x in incidence of depression.
How long does the normal course of depressive episode last?
9-12 months
How long is the course of a treated episode of depression?
16 wks
What is the rate of recurrence of depression for a pt with 1 prior episode?
What is the rate of recurrence of depression for a pt with 2 prior episodes?
What is the rate of recurrence of depression for a pt with 3 prior episodes?
What are 3 poor prognostic indicators for depression?
-multiple episodes
-severity (psychoses, bipolar)
-partial inter-episode recovery
What are risk factors for depression?
-prior episodes
-family hx (genetics)
-prior suicide attempts
-female gender
-recent childbirth
-medical co-morbidity
-EtOH/substance abuse
-recent separation/bereavement
What % of women who are going to dvlp depression suffer a post-partum episode?
What's the % normally?
What are some high-risk medical populations for depression?
-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
What are the DSM-IV diagnosic criteria for major depression?
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
What is usually the chief complaint of depressed pts?
69% report only physical syx.
Should you ask a depressed pt about their suicidal thoughts/plan?
YES. If you don't, it's malpractice.
Risk factors for suicide?
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
What are the 2 behavioral models of major depression?
-cognitive behavioral (distortion of life events, i.e. negative self/life views, fatalistic about future)
-Learned Helplessness (external locus of cntrl)
What is the concordance rates for MZ twins with bipolar depression? For DZ twins/siblings?
Is there just one gene involved in major depression?
No, but one locus is on chromosome 18
In the pathogenesis of major depression, what are the biological theories?
-genetic predisposition
-biogenic amines & NTs
-neuroendocrine abnormalities
What NTs are implicated in depression? Which theory is this?
biogenic amine
Which drug makes depression worse --> suicide?
Reserpine, an anti-HTN Rx, lowers DA and NE
Which drug makes depression better?
Iproniazid, a MAO inhibitor. MAO breaks down DA and NE, so if you inhibit this, you increase conc and improve mood.
If you deplete this in the diet, you have recurrence of depressive episodes?
tryptophan (precursor to 5HT)
Depressed patients have higher or lower density of 5HT2 receptors?
higher (compensatory response to low synaptic 5HT levels)