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Flashcards in Depression Deck (91)
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1

Pathogenesis of Depression
5 factors that contribute?

1. Genetics
2. Early Life Adversity
3. Social Factors
4. Psychological Factors
5. Secondary Depression (general medical disorders/medications/substance of abuse)

2

How does ealry life adversity predispose pts to major depression?

by altering sensitivity to stress and response to negative stimuli

3

1. Pathologically how does early life stress affect the stress response?

2. How can this affect the child for life?

1. hyperactive corticotropin releasing factor cells in hypothalamus – increased stress response. (HPA axis)

2. Stress responses can be set for life and modify the activation of certain genes (epigenetics!) and transmitted to offspring

4

WHat are epigenetics?

Epigenetics – changes in expression of genes caused by early life experiences or chronic stress.

genes + environment + environmentally altered gene expression

5

Social Factors- May lead to depression onset or lead to depressive episodes. What are some examples of this?
4

How can this affect behavior about medical care and their own symtpoms?

1. Isolation
2. Poor social relationships
3. Criticism from family members (expressed emotion)
4. Depression in social networks

Influence symptoms expressed and willingness/ability to access care.

6

How can Cognitive/Behavioral factors lead to depression?

Negative/distorted patterns of thinking predispose to depression

- These patterns worsen in the depressed person

7

Describe Neuroticism (personality trait)

anxiety, moodiness, envy, frustration, loneliness – respond poorly to stressors, interpret ordinary situations as threatening, and minor frustrations as hopelessly difficult.

8

Pathogenesis - Secondary Depression
can be caused by?
3

1. General Medical Conditions
2. Medications
3. Drugs of Abuse

9

Medical conditions that can lead to depression?
Top 5

Other?

1. Sleep Apnea
2. Hypothyroidism/Vitamin D deficiency/Diabetes
3. Chronic Pain
4. Stroke
5. Heart Disease – ischemic, HF, cardiomyopathy

Parkinson's
MS
Epilepsy
Head injury
Cancer
COPD
Dementia
HIV/Neurosyphilis


10

Medications that may cause depresison?
5

1. Interferon
2. Corticosteroids
3. Benzodiazepines/Opiods
4. Varenicline (Chantix)/
5. Beta-Blockers

11

Drugs of abuse that may cause depression? 8

1. PCP
2. Amphetamines
3. Cocaine
4. Marijuana

5. Sedative-hypnotics
6. Alcohol
7. Opiates
8. Steroids

12

Neurobiology of Depression
Structural abnormalities that may cause this?
4

1. increased ventricular-brain ratio
2. smaller frontal lobe volumes
3. smaller hippocampal volumes
4. number/density/size of neurons and glial cells are abnormal

13

Hypothalamic-pituitary-adrenal axis (HPA axis) excess excretion of glucorticoids may lead to what?

suppression of neurogenesis and hippocampal atrophy

14

Sleep/Circadian rhythms – leads to decreased?

REM latency and slow wave sleep Inflammation – higher levels of inflammatory markers

15

Symptoms of Major Depression
three categories?

1. Psychological
2. Neurovegetative
3. Psychomotor/physical

16

Psychological symptoms?
7

1. Depressed Mood (Dysphoria)
2. Numbness
3. Anhedonia (inability to experience joy)
4. Decreased Interest
5. Irritability/Anxiety
6. Guilt/worthlessness
7. Suicidal Ideation

17

Neurovegetative symtpoms?
4

1. Appetite
2. Sleep
3. Energy
4. Concentration

18

Psychomotor symptoms? 2

Phsyical symptoms? 3

Psychomotor
1. retardation (walking through mud or having bricks tied to feet)
2. agitation

Physical
1. aches/pain
2. weakness/malaise
3. GI distress

19

Qualifiers for Dx of depression?
55

1. Symptoms occur in the same two weeks
2. Most of the day nearly every day
3. Distress or impairment
4. R/O substances/general medical condition
5. R/O bereavement

20

Subtypes of Depression

8

1. Anxious
2. Atypical
3. Catatonic
4. Melancholic
5. Mixed Features
6. Peripartum
7. Psychotic
8. Seasonal

21

What are the subcategories of depression?

1. Bipolar
2. Secondary

22

Secondary causes of depression? 3

1. Medical illness
2. Medications
3. Drugs of abuse

23

Comorbid Psychiatric Conditions
2

1. Anxiety Disorders

2. Substance Abuse

24

Types of anxiety disorders?
4

1. Generalized Anxiety
2. Panic Disorder
3. Obsessive compulsive disorder
4. PTSD

25

Evaluate Symptoms
3

1. Questions/Evaluation
--Major depression or a subtype
2. Scales
3. Observation

26

What is SIGECAPS?

Sleep
Interest
Guilt/worthlessness
Energy
Concentration
Appetite
Psychomotor disturbance
Suicidal Ideation

27

Depression Evaluation
4 steps?

1. Chronology of current symptoms
2. Symptoms occur in the same two weeks
3. Most of the day nearly every day
4. Distress or impairment

28

Depression Evaluation
Things to look for?
7

1. Prior History of Depressive Episodes (symptoms, course, treatment)

2. Impact of episode on occupational and interpersonal functioning

3. Alleviating and aggravating factors (stressful life events etc.)

4. Address comorbidity (substance, illness, medications, psychiatric)

5. Evaluate for mania/hypomania

6. Distinguish major depression from persistent depressive disorder (dysthymia) – 2 years without a symptom free interval of 2 months

7. Suicide Risk

29

What things should we ask about for family Hx?
4

1. depression,
2. suicide,
3. psychosis,
4. bipolar disorder

30

Social Hx questions to ask?
4

1. interpersonal,
2. occupational,
3. financial stressors –
4. sources of support, assessment of family/relationship dynamics