Lecture 28 - Mood D/o: Depressive D/o Flashcards
what are the depressive disorders
MDD
Persistent Depressive disorder (Aka Dysthymia)
Premenstrual dysphoric d/o
Substance and medication induced depressive d/o
Depressive d/o due to another condition
other
Unspecified
MDD - Inherited factors
Risk Factors for MDD (in general)
First-degree relatives of patients with MDD have a 2-4x higher risk of MDD
RFs: History of prior episode of depression FMHx History of Suicide attempt Post partum absence of social support stressful life events adverse childhood co-morbid illness
Psycholigicl theories of MDD etiology
Psychodynamic theories – Loss of loved one;
Interpersonal Theories – absent of social bonds
Cognitive theory – negative self-precept and outlook
Learned helplessness – “I fail every time”
what test is non specific for MDD but may be suggestive of MDD? what is the findng?
Dexamethasone Suppression Test –
Giving dexamethasone should suppress the Hypothalamus/Adrenal Axis
MDD is associated with 40-50% of dexamethasone non suppression
what Hypothalamic-Pituitary-Thyroid findings have been reported or known to cause depresison
Hypercortisolemia – associated in depressed pts
Thyroid disorders are found in 5-10% of people with depression.
MDD – prevalence in the US?
men vs women?
7%
women are 1.5 - 3x higher than rates in men.
DSM Criteria for MDD (symptoms (how many), duration, rule outs…?)
○ 5 or more of the Characteristic symptoms, present most of the day, nearly every day, during the same 2-week period (SIGECAPS)
○ At least one of the symptoms is either:
• (1) depressed mood, or
• (2) loss of interest or pleasure
Not due to drugs
not due to other psychosis
not manic
what is SIGECAPS
Suicide Interest in activities Guilt Energy Concentration Appetite/ weight change Psychomotor Sleep (insomnia is a very common symptom)
course of MDD – % which have recurrent episode of depression? what incrases the odds? how long are typical episodes?
Remission – 2 months
50% of patients experience a recurrence of MDE after their initial presentation
greater chance of recurrence – (severe sx, inadequate tx, young, multiple previous episodes, highly expressive families, psychosis)
the longer sx are present, the harder to treat
what other illness typically presents with an MDD like appearance?
BP
what is the The lifetime risk of suicide in all mood disorders?
what % of attempted suicides eventually do kill themselves?
Men vs women?
The lifetime risk of suicide in all mood disorders is 10-20%.
10%
Men – higher suicide rate (lethality)
women – more attempted suicides, but lower lethality
Protective factors against suicide
involvement with kids or pets
Religion
Optimism about future
short term patient contracts for safety between visits with PCP
Previous response to treatment
Perseistent Deprsesive disorder
aka?
DMS Criteria (duration, symptoms, rule outs)
notable absence of what symptoms from this dx?
Dysthymia
Duration – most of the day for 2 years; cannot go without symptoms for more than 2 motnhs
Symptms – 2 of the following –
apptite, insomina, hypersomnia, low eneergy, self esteem, concentration, hopelessness
ABSENCE OF SUICIDALITY
Not explained by drugs or other illness
cause impairment
no other mania, mixed or hypomanic
Premenstrual Dysphoric Disorder
criteria
Majority of menstrual cycles
1 week before menses == 5 sx
Improve 1 week after menses
At least 1+ of the folliwng: Labile mood, irritable, depressed mood, hopeless, anxiety
1+ of the folliwng, AND a least a total of 5:
Interest
Concentration
Fatigue
Appetite change
Hypersomnia, insomina
physical symptoms – breast tenderness, arthralgia, myalgias, bloating
Dx of Depressive disorders:
1) rule outs
medical conditions,
substance abuse
medication effects
other psych d/o – BP, anxiety, psychosis
