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what is major depressive disorder MDD?
severe emotional disorder, presents with Hx of 1 or more major depressive episodes and No hx of manic/hypomanic episodes
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what are the subtypes of MDD?
- catatonic
- melancholic
- post partum onset
- seasonal affective disorder SAD
- atypical
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what is present in a catatonic feature?
extreme psychomotor retardation almost paralyzed, withdrawn, negativity, no speech
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what is present in melancholic feature?
severe endogenous depression not related to environmental stress, more associated with time of the day: worse early in the morning and tend to have suicidal ideation
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what is present in post partum onset ?
4wks after childbirth, mom have eexcessive rumination and delusional thoughts about baby indicating increased risk of harm
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what is present in season affective disorder SAD?
severe depressive episodes during fall/winter, ease up during spring/summer months
overeat, crave for carbs, no energy, reduced cerebral metabolic activity
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what is present in atypical feature?
- overeat or oversleep (vegetative signs), high level of anxiety
- occur in younger individual often misdiagnosed
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what is present in psychotic features?
presence of disorganized thoughts, delusions, hallucinations
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what is dysthymic disorder DD?
- mild to moderate signs of depression, present most of the day, more days than not, for at least 2 yrs
- diagnosed early childhood, early adulthood
- at risk for developing MDD
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what are statements given by pt and family related to DD?
- "Ive always been this way"
- "Theyve always been that way"
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differentiate MMD and DD
presenting signs are almost same, difference is duration and severity of symptoms
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what is one major health problem of elderly, at many times go untreated and increase their risk for suicide?
depression - not normal part of aging
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what are the causes of depressive disorder?
genetic
biochemical
hormonal regulation
diathesis stress model
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what neurotransmitters are involved in the depression mood of individuals?
serotonin
norepinephrine
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what is the function of serotonin?what is the effect of its deficiency?
regulate sleep, appetite, sex drives
sleep deprivation, decreased appetite/sex drive, poor impulse, irritability
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what is the function of norepinephrine?what are the effects of its deficiency?
modulates attention/behavior
apathy, decreased responsiveness, slowed psychomotor activity
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what are the other neurotransmitter believed to be involved in depressive moods?
acetylcholine, GABA, dopamine
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in relation to hormonal regulation, what abnormality is present?
hyperactivity of limbic-hypothalamic-pituitary adrenal cortical axis
high levels of urine cortisol
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what is diathesis stress model?
- take into account interplay of biology and environment
- people who are more at risk of developing MDD will not have full blown disease process unless an environment tirgger is present
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