Professional Documents
Culture Documents
2. Co-morbidity:
-Dysthymic Disorder
alcohol and substance abuse
-Substance-Related Disorders
-Panic Disorder
CVD: lots of liturature
-Obsessive-Compulsive Disorder
-commonality, both effect each other
-Anorexia Nervosa
-using antidepressents treats MIs
-Bulimia Nervosa
-SSRI are anticoagulants too
-Borderline Personality
-Disorder Diabetes
-Myocardial Infarction
Psychosis: delusions, feel like they did a crime
-Strong Relationship between CAD and MDD Carcinomas (Lung, Liver, Pancreas)
halucinaitons that are accusitory
-Stroke
These tumors can present with depressive episode
3. Medical complications:
-Patients over 55 years of age with MDD die 4X as often as general population.
-Patients with MDD admitted to nursing homes have markedly increased likelihood of death in
the first year.
-Patients with MDD in general medical settings have more pain and physical illness than
non-MDD patients.
somatic complaints can reach delusional proportions
4. Epidemiology:
Point prevalence = 4.3%
Life-time prevalence = 8%-20%
Women:Men = 2: 1
High Previlence
Lifetime over the course of illness, the cost $$$ of MDD is close
to CVD (very expensive bc its so prevalent)
5. Etiology:
A. Psychological
Dysthymic Disorder
-occurrence of one or more manic or mixed episodes in patient who is likely to have had one or
more major depressive episodes
Essential features:
-chronically depressed mood -for most of the day
-more days than not
Manic episode:
-two years or more
Essential features: distinct period of abnormal, persistently elevated, expansive, or irritable mood
-poor appetite or overeating -insomnia or hypersomnia
-manic episode lasts at least a week
-low energy or fatigue
-grandiosity (inflated self-esteem)
-low self-esteem
dysthymic patients to not become psychotic
BPD: 2 pards
-decreased need for sleep
-poor concentration
-bipolar depressed looks like MDD
-pressured speech
-difficulty making decisions
Wash car at 3am
Smoldering depression
-bipolar
manic:
going
fast
-flight of ideas
-feelings of hopelessness
other people notice these people
-usually psychotic, not in touch with rea;ity
-distractibility
-low interest -self-criticism
-psychomotor agitation or acceleration
-feelings of inadequacy
-involvement in dangerous or potentially financially ruinous activity
-loss of interest or pleasure in general
-marked impairment in function or psychotic features (often requiring hospitalization)
-social withdrawal
-guilt feelings
-irritability or excessive anger
Bipolar sexual psychotic
Other signs and symptoms:
-decreased activity, effectiveness, or productivity
much more noticable, can be aggressive an assultive
-little insight, denial
-symptom-free periods last no longer than 2 months
feel inflative self esteem and grandiosity
-impulsivity
-after 2 years of disorder patient may have superimposed MDD ("double depression")
feel like they know more than the doctor
-lack of inhibitions (e.g. sexual)
-unethical behavior (uncharacteristic)
Co-morbidity
Bipolar people at their peak dont want treatment
-poor judgment
MDD
he has seen of 2 cases of post-partum mania
Substance dependence
10. Depressive episode: see MDD
Various personality disorders
erratic an unusual behavior
11. Complications:
EX: tearful patient explaining how awesome he is
-completed suicide (10-15%) -child abuse
-spouse abuse
-job loss
-divorce
-criminal activity
-excessive activity may be dangerous for patients with cardiac conditions
Epidemiology:
Lifetime prevalence = 6%
Point prevalence = 3%
12. Co-Morbidity:
-Anorexia nervosa
-Bulimia nervosa
Anxiety disorders
-ADD
-Panic Disorder
-Social phobia Substance-related disorders
Treatment:
Psychodynamic psychotherapy
Cognitive psychotherapy
Antidepressant agents
13. Epidemiology:
-Lifetime prevalence = .5-1 %
-Women: Men = 3: 2
MOOD DISORDERS
Overall Goal: recognize, evaluate, and state the treatments for patients with mood disorders.
Specific Objectives:
Students will be able to:
hypomanic + MDD
2) Bipolar II
-hypomanic episode
-major depressive episode
BPD (Bipolar)
Manic Episode
Mood
-Drug induced:
0-sedatives, hypnotics, anxiolytics (e.g. barbiturates, benzodiazepines)
-anti-hypertensives (e.g. reserpine, alpha-methyldopa)
-oral contraceptives
-steroids (and withdrawal)
both illicit and non-illicit
-anti-psychotics
antihypertensives, sedatives (barbs)
-stimulant withdrawal (e.g. cocaine)
BZDs, steroids, etOH
-alcohol
9. Treatment:
A. Psychotherapy -supportive
-psychodynamic
-cognitive
-interpersonal
BPD type 1
BPD type 2
Time: days - years
B. Pharmacotherapy
-anti depressant
-Augmentation Drugs
C. Electro-convulsive Treatments
D. Trans cranial magnetic Stimulation (TCMS)
E. Magnetic Convulsive Therapy
F. Vagal nerve stimulation
G. Phototherapy
H. Deep Brain Stimulation
I. Suicide Prevention
Euthymia
50% of patients
MDDR
MDD1E
Dysthymia
-Waxes and Wanes
-not as severe as MDD