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What 5 medical problems can mimic depressive disorder?
hypothyroidism, substance abuse, low vitamin D, anemia, and low vitamin B 12
What are some other things that should be on the differential for depressive symptoms besides depression?
hypothyroidism, vitamin deficiencies, adjustment disorder, prodrome for psychotic disorder, depressive episode of bipolar disorder, and substance use
What are some labs to consider running for depressive symptoms?
thyroid functioning test, vitamin B 12 and folate levels, vitamin D levels, substance use, CBC, metabolic profile
What is the MDQ used for?
it is best for screening bipolar I disorder, and it is less sensitive for bipolar II and unspecified bipolar disorder
The MDQ is a screening tool or diagnostic tool?
screening (not diagnostic)
Why is it important to rule out bipolar disorder before treating for depression?
most antidepressants (especially when prescribed first) can worsen manic/hypomanic episodes
What are the diagnostic symptoms of depression?
SIGECAPS
sleep (insomnia or oversleeping), decreased interest, guilt/hopelessness, decreased energy, decreased concentration, decreased appetite (food and sex), psychomotor agitation or retardation, and suicide
What is the DSM-V criteria for major depressive disorder
symptoms present most days over the past 2 weeks
must impair functioning
can’t be explained by other illness or substance use
What is another name for major depressive disorder?
unipolar disorder
depression is associated with a decrease is ____ and if left untreated it can lead to _____
decrease in norepi and serotonin
untreated can lead to decrease in frontal lobe and hippocampal volume
What is the PHQ-9 used for? Is it a diagnostic or assessment tool?
used as a screening tool for depression, also can be a diagnostic tool, assessment of severity, and can show progression over course of treatment
What is persistent depressive disorder?
depressed mood for at least 2 years
depressed or irritable mood accompanied by 2+: appetite change, sleep disturbance, fatigue, low self-esteem, poor concentration, feeling hopelessness
basically its major depressive disorder but long term (2 weeks vs 2 years)
Substances like alcohol, opiates, cocaine, amphetamines, and corticosteroids can cause _____
substance/medication induced depressive disorder
What is premenstrual dysphoric disorder? (the card is long…don’t be overwhelmed, just get the basics)
symptoms begin 1 week before menses and end typically within the the first few days of meses
need 1: hopelessness, depressed mood, self-critical thoughts, tension, anxiety, on-edge feeling, increased sensitivity to rejection, anger, and irritability
need 1: anhedonia (loss of enjoyment from previously joyful things), poor concentration, fatigue, appetite change, sleep disturbance, overwhelmed feeling, breast tenderness, bloating, weight gain, or aches
need a total of 5 but one from each
What is disruptive mood dysregulation disorder?
this is a childhood diagnosis (not diagnosed 1st time after 18)
irritable mood with angry outbursts, physical or verbal aggression, symptoms for 1 year, symptoms occur in 2+ settings
What is the mortality rate with major depression?
21% attempt suicide
What is the criteria for mania?
DIGFAST
distractibility, irresponsibility, grandiosity (inflated self esteem), flight of ideas, activity increase, sleep deficit, and talkativeness
Explain mania vs hypomania
mania: 1+ week, can be admitted to psych unit or get arrested
hypomanic: 4 days at least but less than 7, often still functional and will not be admitted to psych unit or arrested
What is the prevalence of bipolar I disorder?
1%
How do we generally treat bipolar?
SGA (second gen antipsychotics) or mood stabilizers and therapy
treat for the phase they are in (mania or depression)
