Depression 2

Question 1

Neurochemical link between emotional and painful physical symptoms in depression

Answer 1

5-HT & NE are involved in pain perception → depression decreases these → more pain is preceived

Question 2

Link between depression and cardiovascular disease

Answer 2

• Increase risk of development
• Worse prognosis

(possible increase in platlet activation & reactivity)

Question 3

Depression and risk of death in congestive heart failure

Answer 3

(less likely to recover from MI as well. They can’t take care of themselves)

Question 4

Depression and platelet activation link (in comorbid pts w/depression & ischemic heart dz).

Answer 4

• Enhance his baseline platelet activation & responsiveness

(Platelet Factor 4 & beta-thromboglobulin)

Question 5

Depression and diabetes link

Answer 5

• Increase risk of diabetes 20%
• Pts w/diabetes 30% risk of depression, 50 % if on insulin

(association not causation)

Question 6

Why do patients with develop (3)?

Answer 6

1. Diabetic management is stressful
2. Depression may interfere with blood sugar monitoring
3. Patients feel bad when they don’t comply with doctor’s instructions

(to help them, it is important to guide them away from negative thinking, i.e. “one more sign that I’m a failure”)

Question 7

Depression and anxiety increase the risk of hypertension by ____.

Answer 7

~ 1.8 xs

Question 8

How does depression hinder self-management of medical illness?

Answer 8

1. 40% less likely to quit smoking
2. Coronary artery disease patients less likely to take low-dose aspirin
3. Post MI patients less likely to stick w/exercise program

Question 9

Immunologic effects of depression (3).

Answer 9

1. Reduce natural killer cell activity
2. Decrease in adaptive immune measures
3. Decreased CD4 T-cells (HIV pts)

(Increased mortality for patients in skilled nursing facility & post-strok)

Question 10

Comorbidities with depression more common in men

Answer 10

Alcohol & substance use disorder

(ex: stim, weed, hallucinogens)

Question 11

Comorbidities with depression more common in women

Answer 11

1. Panic disorder
2. Generalized Anxiety Disorder
3. Social phobia
4. Bulimia
5. Thyroid disease
6. Migraine
7. Fibromyalgia
8. Chronic fatigue syndrome

Question 12

Depression: differential diagnosis: bereavement, dementia, _____(4).

Answer 12

1. Schizophrenia
2. Anxiety
3. Substance abuse
4. Bipolar disorder

Question 13

If a bereft person meets the criteria for major depressive disorder after _______, they are likely to develop depression.

Answer 13

2 months time

Question 14

What is the link between long-term brain injury and depression?

Answer 14

Prolonged depression may results in progressive and cumulative brain damage

(this may indicate that chronic depression may not be a fully reversible disorder)

Question 15

When do symptoms of seasonal affective disorder emerge?

Answer 15

fall and winter

Question 16

Symptoms of seasonal affective disorder

Answer 16

1. Lethargy
2. Fatigue
3. Hypersomnia
4. Overeating

Question 17

Persistent depressive disorder (dysthymia) onset and duration criteria

Answer 17

Depressed mood most of the day, and more days than not for at least 2 years

Question 18

Persistent depressive disorder (dysthymia) symptom criteria

Answer 18

Must have at least 2 of the following: (and not w/o sx > 2mo. out of the year)

1. low self-esteem
2. feelings of hopelessness
3. insomnia or hypersomnia
4. low energy or fatigue
5. poor concentration or difficulty making decisions
6. poor appetite or overeating

(low self-esteem & hopelessness aren’t in SIG:ECAPS; may also have had MDD in the past if it ended in remission)

Question 19

What are the differences in the DSM-V diagnosis for dysthymia in children?

Answer 19

1. Depressed or irritable mood most of the day, more days than not
2. For at least 1 year
3. Not w/o sx for 1 the year): Depressed + … 2 of the same symptoms seen in adults

(appetite, sleep, Energy, self-esteem, concentraion/decision making, hopelessness)

Question 20

Two groups of children that present with Dysthymia (old term = “depressive neurosis”)

Answer 20

1. Since childhood or late adolescence
2. Those who appear healthy when young but experienced major loss and fall into a state of demoralization

(10% each year will develop MD episode)

Question 21

Dysthymia (aka persistant depressive disorder) life prevalence

Answer 21

• Women: 4%
• Men: 2%

Question 22

Disruptive mood dysregulation disorder behaviors: (3)

Answer 22

1. Severe recurrent temper outbursts (verbal or physical)
2. Inconsistent with developmental level
3. 3 or more times per week

Question 23

Disruptive mood dysregulation disorder onset and course

Answer 23

1. Outburst is persistently irritable or angry most of the day, nearly every day
2. Sx present 12 or more months without a period of 3 months or more w/o sx
3. Age of onset before 10 y.o.

Question 24

Diagnosis of Disruptive Mood Dysregulation Disorder should not be made before the age of ____ or after the age of _____.

Answer 24

• Six
• Eightteen

Question 25

Premenstrual dysmorphic disorder symptoms

Answer 25

**At least 5 symptoms must be present in the *_week before the onset of menses_* (in most cycles of the year):** 1. **Labile Affect** 2. **Irritability/ anger** 3. **Depressed mood** (feel hopelessness, self-deprecating thoughts) 4. **Anxiety/tension** (feel on-edge) 5. ***_AND one of the following:_*** * **S**leep (too much/too little) * decreased **I**nterest in activity * lethargy/fatigue * feeling overwhelmed * difficulty **C**oncentrating * change in **A**ppetite * physical symptoms: breast tenderness or swelling, joint or muscle pain, bloating or weight gain

Question 26

Depression management: initial intake of patient

Answer 26

1. YOU must have a good attitude (they are sad, you need to give them hope that you can help. They must believe in YOU) 2. Assess symptom severity 3. ***_Assess risk of suicide (and reassess often)_*** (do not probe about childhood trauma. first establish rapport)

Question 27

Treatment for mild depression

Answer 27

Psychotherapy or somatic therapy (medication) (moderate to severe = somatic +/- psychotherapy)

Question 28

Negative placebo effect

Answer 28

* Expectations for the treatment to fail ("I've tried everything, and nothing works") * (As Physicians we can overcome this by the patient believing in *our ability to help them*)

Question 29

Define response to treatment

Answer 29

50% Improvement of symptoms (via HAMD-17) (does NOT mean remission)

Question 30

Define relapse of depression

Answer 30

They have responded to treatment and symptoms have come back before remission (within 2 months of the last symptom) (this is the same depressive episode)

Question 31

Define recurrence of depressive state / episode

Answer 31

Patient has reached recovery (two months since their last symptoms) and their symptoms return → this is a new episode

Question 32

Acute phase of depression: time frame & treatment goal

Answer 32

1. 1-2 months 2. Goal: achieve remission & restore baseline of symptomology and functioning

Question 33

Continuation phase of depression: time frame & treatment goal

Answer 33

1. 2-6+ months 2. Goal is to prevent ***_relapse_*** of episode → Medication dose that achieved remission should remain the same (in maintenance phase, the goal is to prevent ***_recurrence_***)

Question 34

Maintenance phase of depression management: time frame & treatment goals (recovery has been reached)

Answer 34

* 6+ months * Goal: prevent ***_recurrence_*** of new episode (in continuation phase, the goal = prevent ***_relapse_***) (this depends on the clinical condition of the patient: number and severity of prior episodes)

Question 35

Patients not treated to remission of symptoms by\_\_\_\_\_ are 3 times more likely to have a relapse / recurrence at long-term follow-up

Answer 35

3 months

Question 36

Depressed patients response to Physicians

Answer 36

1. Guilt: expect to be criticized or punished 2. Anger: feeling rejected 3. Dependent: hope for rescue (be careful when you hear a patient say "You're the best and if anyone can help, its you!". Take a professional approach: "I think I can help you and I'm going to do my very best.")

Question 37

Define remission of depression

Answer 37

Return to functional normality, indistinguishable from those without depression (only half of depressed patients achieve remission)

Question 38

HAMD17 (Hamilton Depression Scale) = severe MDD? moderate? mild?

Answer 38

* 28 * 20-28 * 15-19

Question 39

Why is it important for patients with depression to achieve remission (other than the risk of *other medical conditions*)? (3)

Answer 39

1. Greater risk of relapse / recurrence 2. More chronic depressive episodes 3. Continued impairment in work and relationships