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What is the recomendation of pyschatric screen by USPSTF
Every adult should be screen for depression but half still remain undiagnosed.
What is the precentage of patient with depression seen in PCP
1/3 of patient seen by PCP have depressive symptoms.
Is there a significant distribution seen among genders
Female are more likely to have depression than their counterpart.
What are possible presentation of depression
Somatic presentation of HA or pain are common symptoms associated with emotional state.
- Additional somatic symptoms are
- GI (pepsia)
- Vague ache and pain
- Heighten impairment not associated to current presentation
- Refactory symptoms not resolved by standard treatment
Is it important to do through physical exam
Yes. Purpose of r/o physiological and pathological changes that could be etiology of s/s.
In what comorbid condition is depression common associated with
Chronic pain, HIV, and fibromyalgia
Which professional is most likely to be informed of depressive emontions first
PCP are commonly first to hear of emotional distress and usually to begin treatment.
The etiology of depression is
Is genetic an etilogy of depression
Yes. Study have shown high concordance rates among family members with MAJOR DEPRESSION and BIPOLAR
What neurotransmitter are associated with depression
Serotoin, dopamine, GABA, norepinephrine
What are possible trigger related to depression
- Loss of job
- Hormonal influence
- Women more common
- Major deprssion s/p postpartum
- Premenstrual dysphoric disorder
- Medical conditions
- Pancreatic CA
- Crushing (adrenal)
What do PCP use as a screening tool
PCP use mood module of the Primary Care Evaluation of Mental Disorder to increase detection of condition
What does mood module of the Primary Care Evaluation of Mental Disorder evaluate
What is it based on
Based on Diagnostic and Stat Manual of Mental Disorder (DSM)
- SIGE CAPS
In additional to excluding hormonal and pathological etiology what else should be considered
- Drug abuse
- Withdrwal > depressive state
- Cocaine (<cathoamine = depressive state)
- Withdrwal > depressive state
- Beta Blocker
Chronic low grade depressive state > 2 yrs w/o exact recogition of event or trigger. Must evaluate for additional/coexisting personality disorder.
Very responsive to treatment with SSRI
What must be considered when s/s of major depression exist?
- Inquire about possible manic episodes.
- Must consider Bipolar affective disorder.
- Treatment of Bipolar requires mood-stablizer and not a monotherapy antidepressant (major depression therapy).
- Rationle: treatment of Bipolar with only monotherapy antidepressant causes cycling of manic episodes.
- Must differentiate between Bipolar and Major depression
Why is important to inquire about time and season of presenting episodes in depression
- Seasonal Affective Disorder is perpetuated by seasonal changes. Presentation of depressive on-set occurs in FALL and Early Winter with remission in the Spring.
- No pharmalogical therapy needed.
- Light therapy is benificial
Depressive s/s in a women
Treat with SSRI
- Consider mentrual cycle.
- Luteal phase "yes"
- Premenstrual Dysphoric Disorder
Patient having distress and functional impairment precipitated by identfiable stressor
Adjustment disorder with depress mood if criteria for Major depression is not fullfilled.
Pharmocolgical facts with treatment
- -No single agent proven to be better
- (66% chance or responing to agent)
- -efficay of antidepressant and family members
- -daily dosing (Ideal)
- -s/e (issues)
- -low dosing intially with titration
- -several weeks.
- -no abrupt stopping
- -suicidal concerns
- -Must continue theraputic dosing 6mo to 1 yr after theraputic lvls to prevent relapping
What determines indefinite treatment with antidepressant.
Having 3 or more episodes of Major Depression
Which are the most common prescribed antidepressant
S/E of SSRI
- -sexual dysfuction (dose related)
- Inappropriate antidiuretic horome
- Flu like symptoms during withdraw/ must tritrate dose slowly
- -St John 300 to 1000mg
- -Can inhibit CYP3A4 in liver
- -SamE 150-2400mg
- -Cognitive behavioral therapy
- -support group
ideal treatment is combo of phramo and pyscho therapy
Bipolar affective disorder treatment
- Mood stablizer agent
- -Lithium=(no ACE, ARB, NSAID,renal, hypothyroid)
- -Valproic acid (depakote) Hepatoxic, POCS Pancreatitis, thrombocytopenia
- -carbamazepone (tegretol) aplstic anemia, SJS, Hyponatermia,
- -Lamotrigine (lamictal) SJS
- -Olanzapine DM2, weight gain, HLD
Risk factor for suicide are
- White, female more but male more successful, loner, divorced/widowed or single, older
- HX or symptoms:
- Prior attempts, detailed plan, hopelessness, family HX of suicide, mentioned of the act, recent pysch troubles/hospitalization, own guns.
- Chronic illness, substance abuse, Axial II or II pyshc dx.
- acut alcohol intox, leagal problems, loss of job, financial problem, estranged from family, bereavement, lack of social support