mood + affect (test #1)

what are the symptoms of disruptive mood dysregulation disorder? (2)

constant/severe irritability and anger

what is the age range for diagnosis of disruptive mood dysregulation disorder?

-ages ___ to ___

-onset before age ___

6

18

10

how often must temper tantrums occur in disruptive mood dysregulation disorder?

at least 3 times a week

in which settings must symptoms appear for diagnosis of disruptive mood dysregulation disorder?

at least two of the following: (3)

home

school

with peers

is disruptive mood dysregulation disorder more common in males or females?

males

is disruptive mood dysregulation disorder more common in children or adolescents?

children

what medications may be considered if symptoms resemble major depressive disorder in disruptive mood dysregulation disorder?

antidepressants

what medications may be used to address irritability in disruptive mood dysregulation disorder? (3)

antidepressants

risperidone

aripiprazole

what is persistent depressive disorder formerly known as?

dysthymia

how long must depression last for persistent depressive disorder diagnosis in adults?

at least 2 years

how long must depression last for persistent depressive disorder diagnosis in children/adolescents?

at least 1 year

what additional symptoms must be present in persistent depressive disorder (at least 2)? (6)

decreased appetite/overeating

insomnia/hypersomnia

low energy

poor self-esteem

difficulty thinking

hopelessness

what type of distress does persistent depressive disorder cause?

social and occupational distress

when does persistent depressive disorder usually onset?

teenage years

how do patients with persistent depressive disorder often describe their depression?

they have "always felt this way" and see depression as normal functioning

can people with persistent depressive disorder also have major depressive episodes?

yes

is persistent depressive disorder more common in men or women?

women

what is treatment for persistent depressive disorder? (2)

psychotherapy (CBT)

antidepressants (SSRIs, SNRIs, TCAs)

cluster of symptoms in the last week before menstruation interfering with work or social life

premenstrual dysphoric disorder

what are symptoms of premenstrual dysphoric disorder? (6)

mood swings

irritability

depression

anxiety

feeling overwhelmed

difficulty concentrating

what are physical symptoms of premenstrual dysphoric disorder? (7)

lack of energy

overeating

hypersomnia/insomnia

breast tenderness

aching

bloating

weight gain

when do symptoms of premenstrual dysphoric disorder decrease?

with the onset of menstruation

when do symptoms of premenstrual dysphoric disorder cease?

after menopause (may return with hormone replacement therapy)

what lifestyle treatments help premenstrual dysphoric disorder? (6)

aerobic exercise

complex carbs

sufficient sleep

acupuncture

light therapy

relaxation therapy

which SSRIs have FDA approval for premenstrual dysphoric disorder? (3)

fluoxetine

sertraline

paroxetine CR

what other medication may help bloating and weight gain in premenstrual dysphoric disorder?

diuretics

what is substance/medication-induced depressive disorder caused by?

prolonged use or withdrawal from drugs/alcohol

how long do symptoms of substance/medication-induced depressive disorder last?

longer than expected physiological effects, intoxication, or withdrawal

when do symptoms appear in substance/medication-induced depressive disorder?

within 1 month of use

how long do symptoms last after substance removal?

few days to several weeks

what cns depressants are associated with depression? (4)

alcohol

barbiturates

benzodiazepines

clonidine

what cns medications are associated with depression? (5)

amantadine

bromocriptine

levodopa

phenothiazines

phenytoin

what psychostimulants are associated with depression?

amphetamines

what neurological conditions are associated with depression? (7)

epilepsy

parkinson

multiple sclerosis

alzheimer

huntingtons

tbi

stroke

what infectious or inflammatory conditions are associated with depression? (2)

neurosyphilis

HIV

what cardiac disorders are associated with depression? (3)

ischemic heart disease

cardiac failure

cardiomyopathies

what endocrine disorders are associated with depression? (4)

hypothyroidism

diabetes

vitamin deficiencies

parathyroid disorders

what neuroendocrine conditions are commonly accompanied by depression? (2)

cushing disease

hypothyroidism

one of the most common psychiatric disorders characterized by persistently depressed mood for at least 2 weeks

major depressive disorder

how long may a depressive episode last in major depressive disorder?

5 to 6 months

what are the DSM-5 criteria for major depressive disorder (criterion A)?

-___ or more symptoms in ___ weeks

-with at least ___ mood or loss of ___/___

5

2

depressed

interest/pleasure

what are the 9 symptoms of major depressive disorder (criterion A)?

1 ___ mood

2 loss of ___/___

3 weight/appetite ___

4 ___/___

5 psychomotor agitation/___

6 fatigue/loss of ___

7 worthlessness/excessive ___

8 poor ___/indecisiveness

9 recurrent thoughts of ___ or ___

depressed

interest/pleasure

change

insomnia/hypersomnia

retardation

energy

guilt

concentration

death

suicide

what does criterion C for major depressive disorder state?

symptoms cause clinically significant distress or impairment

what does criterion D for major depressive disorder state?

not attributable to substance or medical condition

what is the dsm-5 diagnosis for seasonal affective disorder (sad)?

major depressive disorder with seasonal pattern

when do depressive symptoms usually occur in sad? (2)

fall

winter

when is full remission usually seen in sad?

spring

what is required for a diagnosis of sad?

-___ seasonal depressive episodes within ___ years

-no nonseasonal episodes

2

2

what symptoms are associated with sad? (4)

hypersomnia

overeating

weight gain

craving carbohydrates

who is more commonly affected by sad? (2)

women

ages 18-30

why is adolescent depression concerning? (3)

higher prevalence than adults

high recurrence

lifelong risk

what are the primary risk factors for depression? (7)

female gender

adverse childhood experiences

stressful life events

first-degree family history

neuroticism

other psychiatric disorders

chronic/disabling medical conditions

what neurotransmitters are mainly involved in depression? (2)

serotonin

norepinephrine

what functions does serotonin regulate? (3)

sleep

appetite

libido

what dysfunctions occur with serotonin deficits? (5)

sleep disturbance

appetite decrease

low sex drive

poor impulse control

irritability

what functions does norepinephrine regulate? (2)

attention

behavior

what results from norepinephrine deficiency or imbalance? (3)

apathy

reduced responsiveness

slowed psychomotor activity

what other neurotransmitter is implicated in depression?

glutamate

increases neuron information transmission

glutamate

how does stress contribute to depression? (2)

depletes neurotransmitters

reduces neurogenesis

what hormones are elevated in depression? (2)

cortisol

corticotrophin-releasing hormone

what does hyperactivity of the hypothalamic-pituitary-adrenal (hpa) axis indicate?

major depressive disorder

negativistic thoughts about death, dying, or suicide

suicidal ideation

what increases suicide risk in depression? (5)

hopelessness

substance use

recent loss/separation

past suicide attempts

acute suicidal ideation

what are the key symptoms in depression? (2)

depressed mood

anhedonia

what appearance changes occur in depression? (3)

shabby/unkept

lack of bathing

no self-care

what eye contact and posture changes may occur in depression? (4)

little/no eye contact

slumped posture

head low

shoulders forward

what is psychomotor retardation? (3)

extremely slow movements

decreased facial expression

fixed gaze

what is psychomotor agitation? (4)

pacing

nail biting

finger tapping

tension-relieving activity

what are vegetative signs of depression? (4)

alterations in eating

elimination

sleeping

sex

how does appetite change in depression? (2)

loss of appetite (weight loss)

overeating (weight gain)

what bowel changes are seen in depression? (2)

constipation with retardation

diarrhea with agitation/anxiety

what sleep disturbance is hallmark of depression? (3)

insomnia

frequent waking

reduced deep sleep

what early morning pattern is common in depression?

waking at 3-4 a.m. and staying awake

increased sleep as escape, rarely restful

hypersomnia

what happens to sexual interest in depression? (3)

declines

loss of libido

impotence in men

general emotional condition/state

mood

how long can moods last?

hours to days

what mood is seen in depression?

depressed mood lasting weeks

what are terms to describe mood?

euthymic, euphoric, angry, irritable, anxious, apathetic

what feelings are common in depression? (5)

worthlessness

guilt

helplessness

hopelessness

anger

inability to feel pleasure or happiness

anhedonia

outward representation of internal state

affect

how is affect described in depression?

congruent or incongruent with mood

how is speech in depression? (4)

slow

soft

monotone

lacking spontaneity

how are insight and judgment affected in depression? (3)

negatively

poor judgment

indecisiveness

what behaviors may younger children show with depression?

suddenly refuse to go to school

what behaviors may adolescents show with depression? (3)

substance use

sexual promiscuity

preoccupation with death or suicide

what is the first assessment guideline for depression?

always evaluate patient's risk of harm to self or others

what should a medical/neurological exam help determine in depression assessment?

if depression is primary or secondary to another disorder

what vegetative signs of depression interfere with adls? (5)

impaired hygiene

sleep

nutrition

constipation

sexual functioning

what is always the highest priority in depression care?

safety

what are the three phases of treatment and recovery for depression?

-___ (6-12 weeks)

-___ (4-9 months)

-___ (1 year or more)

acute

continuation

maintenance

reduce depressive symptoms and restore psychosocial/work function

acute phase

what may be required in the acute phase? (3)

hospitalization

medication

biological treatments

what is the goal of the continuation phase?

prevent relapse through pharmacotherapy, education, psychotherapy

what is the goal of the maintenance phase?

prevent further episodes, decide whether to continue or phase out medication

why can silence still be meaningful with depressed patients?

it shows genuine interest and support

what health teaching points are key in depression care? (6)

1 depression is beyond voluntary control

2 it can be managed with meds/lifestyle

3 recognize signs of relapse

4 understand role/side effects of meds

5 combine meds with psychotherapy

6 cope with stress of relationships

what basic self-care issues must be assessed? (5)

caloric intake

fluids

sleep

hygiene

grooming