Case 25: Major Depressive Disorder
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What are some important considerations when making the diagnosis of major depressive disorder?
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You must rule out other medical conditions with similar presentations such as hypothyroidism, anemia, and infectious processes. You should also rule out bipolar disorder, and ask about a family history of psychiatric disorders.
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In order to diagnose major depressive disorder, how long must the patient have had symptoms?
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2 weeks
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What is dysthymic disorder?
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Dysthymic disorder is a chronic depressed of mood for more days than not for at least 2 years. The person still has a loss of itnerest, a lack of appetitie or pleasure, and a loss of energy
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Which types of people are more susceptible to depression?
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Women and the elderly
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What are the diagnostic criteria for depression?
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5 of the following criteria plus depressed mood for at least 2 weeks: sleep disturbance, loss of interest, guilt, loss of energy, difficulty concentrating, appetitie changes, psychomotor agitation or retardation, suidical ideation
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What are some of the neurotransmitters that are thought to be involved in depression?
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Serotonergic, noradrenertic, and dopaminergic systems
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What have studies shown on the relationship between depression and cardiovascular disease?
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Persons with depression have a greater chance of developing or dying from cardiovascular disease
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Major depressive disorder plays a role in what percent of suicide attempts?
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50 percent of suicide attempts
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What is the most common method used for completed suicides?
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Firearms
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What is the most effective treatment for depression?
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A combination of pharmacotherpy and psychotherapy
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When a patient is treated with an antidepressant for their first bout of major depression, how long do they need to be treated for?
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Between 6 and 9 months
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Which amino acid is serotonin a derivative of?
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Tryptophan
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How long does it take for an SSRI to work?
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3 to 6 weeks
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What are some of the common side effects of SSRIs?
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Sexual dysfunction, weight gain, GI disturbance, fatigue, and agitation. 5033320056
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What are the two primary examples of SNRIs?
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Duloxetine and venlafaxine
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What are the common side effects of TCAs?
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Anti-cholinergic effects such as dry mouth, sedation, dry eyes, urinary retention. In addition there can be weight gain and sexual disturbances.
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Why are TCAs not used any longer?
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TCAs are highly toxic in overdose. Signs of TCA toxicity include cardiotoxicity and prolongation of the PR and QT intervals, seizures, and hallucinations
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If someone is taking a MAO inhibitor they should be instructed to avoid what in their diet?
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Tyramine, because this can lead to hypertensive crisis
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If a MAO inhibitor is taken with another antidepressant what is the serious risk?
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Serotonin syndrome
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What is a reason that bupoprion could be preferred compared to SSRIs?
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It does not cause sexual dysfunction
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Patients with what condition are contraindicated in taking bupropion?
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Patients with a seizure disorder or with bulemia because bupropion lowers the seizure threshold.
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What are some of the subtypes of anxiety disorder?
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Panic disorder, obsessive compulsive disorder, generalized anxiety disorder, posttraumatic stress disorder, and phobia
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What is the DSM criteria for generalized anxiety disorder?
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3 out of 6 of the following: difficulty concentrating, easily fatigued, restlessness, muscle tension, irritability, sleep disturbance for at least 6 months
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What is the definition of a panic attack?
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A period of intense fear of abrupt onset without a particular trigger
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How long is the normal duration of bereavement?
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2 months.
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What are the mood stabilizers that are most commonly used in bipolar disorder?
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Lithium, valproate, and carbamazepine
