What factors are associated with a poor prognosis for MDD: The percentage of patients recovering after repeated hospitalization
patients with mood disorders? decreases with passing time. Generally, as a patient experiences more and more
depressive episodes, the time between the episodes decreases, and the severity
of each episode increases.
Bipolar I: Have a poorer prognosis than do patients with major depressive
disorder. About 40 to 50 percent of patients with bipolar I disorder may have a
second manic episode within 2 years of the first episode. poor occupational
status, alcohol dependence, psychotic features, depressive features, interepisode
depressive features, and male gender were all factors that contributed a poor
prognosis. Short duration of manic episodes, advanced age of onset, few suicidal
thoughts, and few coexisting psychiatric or medical problems predict a better
outcome.
Bipolar II: The course and prognosis of bipolar II disorder indicate that the
diagnosis is stable because there is a high likelihood that patients with bipolar II
disorder will have the same diagnosis up to 5 years later. Bipolar II disorder is a
chronic disease that warrants long-term treatment strategies.
What is endogenous depression? depression with no apparent cause
What characteristics would the clinician see if a patient Catatonic features
presented with atypical features in a depressed patient? Postpartum onset
Rapid cycling
Seasonal features
Significant weight gain
Hypersomnia
Leaden paralysis
,What diagnostic criteria are required for a patient to *Five (or more) of the following symptoms have been present during the same 2-
receive a diagnosis of Major Depressive Disorder? week period and represent a change from previous functioning; at least one of
the symptoms is either (1) depressed mood or (2) loss of interest or pleasure.
Depressed most of the day, nearly every day as indicated by subjective report
(e.g., feels sad, empty, hopeless) or observation made by others (e.g., appears
tearful)
Markedly diminished interest or pleasure in all, or almost all, activities most of the
day, nearly every day (as indicated by subjective account or observation)
Significant weight loss when not dieting or weight gain (e.g., change of more than
5% of body weight in a month), or decrease or increase in appetite nearly every
day
Insomnia or hypersomnia nearly every day
Psychomotor agitation or retardation nearly every day (observable by others, not
merely subjective feelings of restlessness or being slowed down)
Fatigue or loss of energy nearly every day
Feelings of worthlessness or excessive or inappropriate guilt (which may be
delusional) nearly every day (not merely self-reproach or guilt about being sick).
Diminished ability to think or concentrate, or indecisiveness, nearly every day
(either by subjective account or as observed by others)
Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation
without a specific plan, or a suicide attempt or a specific plan for committing
suicide
The symptoms cause clinically significant distress or impairment in social,
occupational, or other important areas of functioning.
The episode is not attributable to the physiological effects of a substance or to
another medical condition.
The occurrence of the major depressive episode is not better explained by
schizoaffective disorder, schizophrenia, schizophreniform disorder, delusional
disorde
What are some common sleep disturbances experienced Insomnia, hypersomnia.
by patients with MDD?
What psychomotor changes would the clinician see when Psychomotor retardation is the most common.
interviewing a patient with MDD? Psychomotor agitation is also seen, especially in older patients.
Agitation: Hair pulling, hand-wringing.
Stooped posture; no spontaneous movements; and a downcast, averted gaze.
Symptoms of psychomotor retardation may appear identical to patients with
catatonic schizophrenia.
, What is the prevalence of MDD? How do sex and age of Prevalence of 5-17%.
the patient impact these rates? Twofold greater prevalence of major depressive disorder in women than in men.
The mean age of onset for major depressive disorder is about 40 years, with 50
percent of all patients having an onset between the ages of 20 and 50 years.
What is the risk of suicide for patients with MDD? About 10 to 15 percent of all depressed patients commit suicide, and about two-
thirds have suicidal ideation.
18. What are the difficulties in recognizing depression in Elderly people often have various co-morbid medical disorders that may have
the elderly population? similar symptoms to depression.
19. What are some common Differential diagnosis when Table 8.8-1
considering MDD?
20. How does the clinician differentiate MDD from Bipolar Episodes of mania-like symptoms, indicating bipolar I disorder (complete manic
Disorder? and depressive syndromes), bipolar II disorder (recurrent major depressive
episodes with hypomania),
21. What are some psychosocial therapies for the cognitive therapy, interpersonal therapy, and behavior therapy
treatment of MDD?
22. How does transcranial magnetic stimulation work? Short pulses of magnetic energy stimulate nerve cells in the brain.
Used in adult patients who have failed to achieve satisfactory improvement from
antidepressants.
Produces focal secondary electrical stimulation of targeted cortical regions.
It is nonconvulsive, requires no anesthesia, has a safe side effect profile, and is not
associated with cognitive side effects.
40-minute outpatient procedure that is prescribed by a psychiatrist and
performed in a psychiatrist office. The treatment is typically administered daily for
4 to 6 weeks. The most common adverse event related to treatment was scalp
pain or discomfort. TMS therapy is contraindicated in patients with implanted
metallic devices or nonremovable metallic objects in or around the head.
23. What are the indications for Phototherapy? Seasonal disorders, sleep disorders.
patients with mood disorders? decreases with passing time. Generally, as a patient experiences more and more
depressive episodes, the time between the episodes decreases, and the severity
of each episode increases.
Bipolar I: Have a poorer prognosis than do patients with major depressive
disorder. About 40 to 50 percent of patients with bipolar I disorder may have a
second manic episode within 2 years of the first episode. poor occupational
status, alcohol dependence, psychotic features, depressive features, interepisode
depressive features, and male gender were all factors that contributed a poor
prognosis. Short duration of manic episodes, advanced age of onset, few suicidal
thoughts, and few coexisting psychiatric or medical problems predict a better
outcome.
Bipolar II: The course and prognosis of bipolar II disorder indicate that the
diagnosis is stable because there is a high likelihood that patients with bipolar II
disorder will have the same diagnosis up to 5 years later. Bipolar II disorder is a
chronic disease that warrants long-term treatment strategies.
What is endogenous depression? depression with no apparent cause
What characteristics would the clinician see if a patient Catatonic features
presented with atypical features in a depressed patient? Postpartum onset
Rapid cycling
Seasonal features
Significant weight gain
Hypersomnia
Leaden paralysis
,What diagnostic criteria are required for a patient to *Five (or more) of the following symptoms have been present during the same 2-
receive a diagnosis of Major Depressive Disorder? week period and represent a change from previous functioning; at least one of
the symptoms is either (1) depressed mood or (2) loss of interest or pleasure.
Depressed most of the day, nearly every day as indicated by subjective report
(e.g., feels sad, empty, hopeless) or observation made by others (e.g., appears
tearful)
Markedly diminished interest or pleasure in all, or almost all, activities most of the
day, nearly every day (as indicated by subjective account or observation)
Significant weight loss when not dieting or weight gain (e.g., change of more than
5% of body weight in a month), or decrease or increase in appetite nearly every
day
Insomnia or hypersomnia nearly every day
Psychomotor agitation or retardation nearly every day (observable by others, not
merely subjective feelings of restlessness or being slowed down)
Fatigue or loss of energy nearly every day
Feelings of worthlessness or excessive or inappropriate guilt (which may be
delusional) nearly every day (not merely self-reproach or guilt about being sick).
Diminished ability to think or concentrate, or indecisiveness, nearly every day
(either by subjective account or as observed by others)
Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation
without a specific plan, or a suicide attempt or a specific plan for committing
suicide
The symptoms cause clinically significant distress or impairment in social,
occupational, or other important areas of functioning.
The episode is not attributable to the physiological effects of a substance or to
another medical condition.
The occurrence of the major depressive episode is not better explained by
schizoaffective disorder, schizophrenia, schizophreniform disorder, delusional
disorde
What are some common sleep disturbances experienced Insomnia, hypersomnia.
by patients with MDD?
What psychomotor changes would the clinician see when Psychomotor retardation is the most common.
interviewing a patient with MDD? Psychomotor agitation is also seen, especially in older patients.
Agitation: Hair pulling, hand-wringing.
Stooped posture; no spontaneous movements; and a downcast, averted gaze.
Symptoms of psychomotor retardation may appear identical to patients with
catatonic schizophrenia.
, What is the prevalence of MDD? How do sex and age of Prevalence of 5-17%.
the patient impact these rates? Twofold greater prevalence of major depressive disorder in women than in men.
The mean age of onset for major depressive disorder is about 40 years, with 50
percent of all patients having an onset between the ages of 20 and 50 years.
What is the risk of suicide for patients with MDD? About 10 to 15 percent of all depressed patients commit suicide, and about two-
thirds have suicidal ideation.
18. What are the difficulties in recognizing depression in Elderly people often have various co-morbid medical disorders that may have
the elderly population? similar symptoms to depression.
19. What are some common Differential diagnosis when Table 8.8-1
considering MDD?
20. How does the clinician differentiate MDD from Bipolar Episodes of mania-like symptoms, indicating bipolar I disorder (complete manic
Disorder? and depressive syndromes), bipolar II disorder (recurrent major depressive
episodes with hypomania),
21. What are some psychosocial therapies for the cognitive therapy, interpersonal therapy, and behavior therapy
treatment of MDD?
22. How does transcranial magnetic stimulation work? Short pulses of magnetic energy stimulate nerve cells in the brain.
Used in adult patients who have failed to achieve satisfactory improvement from
antidepressants.
Produces focal secondary electrical stimulation of targeted cortical regions.
It is nonconvulsive, requires no anesthesia, has a safe side effect profile, and is not
associated with cognitive side effects.
40-minute outpatient procedure that is prescribed by a psychiatrist and
performed in a psychiatrist office. The treatment is typically administered daily for
4 to 6 weeks. The most common adverse event related to treatment was scalp
pain or discomfort. TMS therapy is contraindicated in patients with implanted
metallic devices or nonremovable metallic objects in or around the head.
23. What are the indications for Phototherapy? Seasonal disorders, sleep disorders.
