Card Set Information
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
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
Women more common
Major deprssion s/p postpartum
Premenstrual dysphoric disorder
What do PCP use as a screening tool
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)
In additional to excluding
etiology what else should be considered
Withdrwal > depressive state
Cocaine (<cathoamine = depressive state)
Withdrwal > depressive state
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
What must be considered when s/s of major depression exist?
Inquire about possible
Bipolar affective disorder.
Treatment of Bipolar requires
and not a
(major depression therapy).
: 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
No pharmalogical therapy needed.
Light therapy is benificial
Depressive s/s in a women
Premenstrual Dysphoric Disorder
Treat with SSRI
Patient having distress and functional impairment precipitated by identfiable stressor
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)
-low dosing intially with titration
-no abrupt stopping
-Must continue theraputic dosing 6mo to 1 yr after theraputic lvls to prevent relapping
What determines indefinite treatment with antidepressant.
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
-Cognitive behavioral therapy
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