MDD: Functional implications
- Impairment varies from mild to incapacitated
- Can become catatonic & unable to care for themselves
- Increased pain & physical illnesses
- Decreased social interaction, physical activity, & role fxn
MDD: What are Beck’s postulates? (3)
- View about self – negative
- Views about environment – views as hostile & demanding
- Views about future – expectation of suffering & failure
What does MDD commonly occur w/?
Substance-use disorders, panic disorders, obsessive-compulsive disorders, anorexia nervosa, bulimia nervosa, & borderline personality disorder
What is the work-up for mood disorders?
labs, neuro imaging, EEG, questionnaires, CXR, CT/MRI brain
Describe interpersonal psychotherapy (IPT). What does it focus on?
- Short term psychodynamic therapy
- Focus on current relationships
Describe cognitive therapy
- Monitor & identify automatic thoughts
- Behavioral activation
Describe mindfulness based cognitive therapy
Strategies, s/a meditation, to prevent relapse
What is the goal of behavioral couples therapy?
Enhance communication/satisfaction
What 2 tx are available for bipolar disorder? (2)
- Psychoeducational approaches
- Family-focused tx
Electroconvulsive therapy is reserved for ….
- Severe depression w/ high risk suicide
- Depression w/ psychotic features
- Tx non-responders
What is the fxn of ECT?
Induce brain seizure & unconsciousness
What is a side effect of ECT?
Memory loss
For pts in remission who experienced only 1 episode of MDD, how long should antidepressants be continued?
6-12 mos
For pts in remission who experienced 2 or more episodes of MDD, how long should antidepressants be continued?
15 mos - 3 yrs
In chronic MDD or MDD w/ concurrent dysthymia, how long should antidepressants be continued?
An additional 15-28 mos after acute phase of tx
Tx choice should be based on…
- Clinical assessment
- Presence of other disorders
- Stressors
- Pt preference
- Rxn to previous tx
Pts on antidepressants should be monitored closely for what? (3)
- Worsening
- Suicide
- Unusual changes in behavior
- Monitor esp. during initial few mos, or at time of dose changes.
When should pts on antidepressants follow up? What should be assessed?
- At least once within 1st month
- 4-8 wks after until stable
- After 6-9 mos on meds can f/u every 3-6 mos
- Assess for adherence, side effects, suicidal ideation, & response
What should you advise your pt?
- Most need to be on meds for at least 6 mos
- May take 2-6 wks to see improvement
- Important to continue taking med as prescribed, even after he/she starts feeling better
- Don’t stop meds w/out notifying provider 1st
- Changing dose or schedule can help manage side effects
What is the goal of tx w/ antidepressants in the acute phase?
Remission of MDD sx
How often should pts who start/switch to a new Rx be seen?
Every 2 wks until stable
How long should a medication trial last for?
8-12 wks
If no side effects, how often should you increase one’s dose?
Every 2-3 wks until:
- Remission achieved
- Max dose achieved
- Side effects limit titration
What are consequences of failing tx?
- Risk of relapse
- Continued psychosocial limitations
- Continued impairment at work
- More utilization of medical services
- Risk of suicide & substance abuse
- Risk of tx resistance
