Learning Objectives

1.	Describe the prevalence of depressive illnesses in the population at large. Depressive illnesses affect the lives of million of Americans and cost billion of dollars. "In the United States, nearly 10 million people experience a depressive i
2.	Pinpoint symptoms of depressive illness. "Persistent sad, anxious or “empty” feelings" "Decreased energy, fatigue, being “slowed down”" "Loss of interest or pleasure in usual activities, including sex" "Sleep disturbances (i
3.	List symptoms exhibited by a manic-depressive individual during the manic phase. Decreased need for sleep Increased risk-taking Increased energy Unrealistic beliefs in their own abilities "Increased talking and physi
4.	Provide a 3-step clinical evaluation of depressive illnesses. physical examination which includes a neurological examination and lab tests. a medical and psychiatric history a mental status examination
5.	Discuss causes of depression listing genetic, biochemical, environmental and other factors. high incidence of depressive illness could be inherited mood disorders could be a function of a biochemical disturbance and could be treated with dr
6.	Discuss treatments for depressive illnesses using drug, psychosocial and electroconvulsive therapies. "Three categories of drugs are most often prescribe: tricyclics, monoamine oxidase inhibitors (MAOIs) and lithium." "There are “talking” t
7.	Discuss childhood depressions, adolescent’s depression and depression among the aged. "Childhood depression may be recognized or misdiagnosed when depressive symptoms are mixed with other type of behavior, such as hyperactivity, delinquency, school
8.	Describe the scope of depression in women and contrast it with depression "Women are disproportionately affected by depression, experiencing it at roughly twice the rate of men." Research continues to explore how the illness affects women a
9.	Identify varies factors unique to women that contribute to depression. "Varied factors unique to women’s lives are suspected to contribute to depression–developmental, reproductive, hormonal, genetic, and other biological factors; abuse and oppress
10.	Answer patient’s questions about depression. Who gets depressed? What is depression? How will I know if I am depressed? What should I do if I have these symptoms? How will I treatment help me? What type of tr
11.	List classes of health care providers who can treat depression. General health care provider physician physician assistant nurse practitioner Mental health specialists psychiatrist psychologist
12.	Compare the effectiveness of three kinds of treatments for major depressive disorder. antidepressant medicine psychotherapy antidepressant medicine combined with psychotherapy. "How well each of these treatments works depend
13.	Classify unipolar forms of primary into three groups. Major depressive disorder consists of one or more moods disorders episodes of major depression with or without full recovery between episodes. "Dysthymic disorder features a low-grade, m
14.	Classify bipolar disorders into three groups. Bipolar I disorder features at least one manic episode along with (nearly always) major depressive episodes. "Bipolar disorder not otherwise specified is a residual category that includes bipola
15.	List 3 risk factors for major depressive disorder. "Risk factors for major depressive disorder include female gender, a history of depressive illness in first-degree relatives, and prior episodes of major depression." List 10 risk factors f
16.	Provide a differential diagnosis of depressive disorders. Conduct a clinical interview to determine whether the nine specific signs/symptoms of major depressive disorder according to DSM-III-R are present. Interview the patient to investiga
17.	Describe clinical features and course of major depressive disorder. "Major depressive disorder may begin at any age, although it usually begins in the mid-20s and 30s. Symptoms develop over days to weeks. Some people have only a single episode, wit
18.	Discuss the epidemiology of major depressive disorder. The point prevalence for major depressive disorder in the Western Industrialized nations is 2.3 to 3.2 percent for men and 4.5 to 9.3 percent for women. The lifetime risk for major depressive d
19.	Explain the costs of untreated major depressive disorder. "Patients with major depressive disorder have substantial amounts of physical and psychological disability, as well as occupational difficulties."
20.	List 5 major depressive disorder subgroups and for each subgroup describe essential features diagnostic treatment and prognostic implications. Melancholic Atypical Postpartum psychosis/depression Seasonal Postpartum
21.	Describe psychotic features. Psychotic features refer to the presence of delusions or hallucinations. They occur in 15 percent of patient with major depressive disorders.
22.	Describe melancholic features. Psychomotor retardation or agitation Loss of interest or pleasure Lack of reactivity to usually pleasant stimuli Worse depression in the morning Early morning awakening
23.	Describe atypical features. overeating oversleeping weight gain a mood that still responds to events (reactive mood). extreme sensitivity to interpersonal rejection a feeling of heaviness in the arms and legs
24.	Describe seasonal pattern. "episodes are recurrent (at least two episodes by some criteria, three by other criteria)." there has been a regular temporal relationship between the onset of the major depressive episodes and a particular period
25.	Describe clinical features and course dysthymic disorder. "The essential feature of dysthymic disorder is a chronic of mood disturbance (sadness in adults; sadness and, possibly, irritability in children and adolescents) present most of the time fo
26.	List the causes of manic or hypomanic episodes. "Psychoactive substances, such as cocaine and amphetamines; head trauma; certain neurologic diseases; endocrinopathies; and some other disorders can produce secondary manic and hypomanic episodes simi
27.	List features of cyclothymic disorder. "Cyclothymic disorder features numerous, alternating hypomanic and mild depressive periods, lasting days-to weeks and nearly continuous. There are few truly symptoms-free periods. The symptoms fluctuate, but n
28.	Describe anxiety disorders. "Depressive symptoms or syndromes often accompany anxiety, panic, or phobic disorders. Furthermore, anxiety disorder may be the forerunner of and part of the longitudinal course of a mood disorder. The presence of both a
29.	Provide a diagnosis of eating disorders. "The practitioner is advised to ask about anorexia nervosa and bulimia nervosa in young women who present with any mood disorder, especially those with amenorrhea. If present, the eating disorder is the prin
30.	Describe the diagnosis and treatment of obsessive-compulsive disorders. "For those depressed patients whose disorder has some obsessive features, the mood disorder is the initial focus of treatment. If full-blown OCD is present with depressive symp
31.	Define somatization disorder. "Somatization is defined as the presentation of somatic symptoms by patients with underlying psychiatric illness or psychosocial distress. These somatic symptoms have no, or insufficient, underlying organic cause."
32.	Explain personality disorder. "Personality disorders are not uncommon among mood-disordered patients. The presence of a personality disorder does not exclude diagnosis of a mood disorder, if present. When both a major depressive and personality dis
33.	Explain the relationship between major depressive and other current general medical disorders. "The general medical disorder biological causes depression for example, hypothyroidism may cause depressive symptoms." "The general medical disor
34.	List 8 risk factors that predispose cancer patients to develop depressive disorders. social isolation recent losses a tendency to pessimism socioeconomic pressures a history of mood disorder alcohol or substa
35.	List medications reportedly associated with depression. Cardiovascular drugs Hormones Psychotropics Anticancer Agents Anti-inflammatory Anti-infective agents
36.	Provide a differential diagnosis of depression. assess the patient for the nine specific sings/symptoms of major depressive disorder investigate the possibility of concurrent substance or alcohol abuse detect the existence of medica
37.	List 7 steps in detecting and treating conditions. Maintain high index of suspicion and evaluate risk depressive factors Detect depressive symptoms with clinical interview and/or self-report questionnaire "Define mood syndrome (clin
38.	List 3 key objectives of treatment. to reduce and ultimately remove all signs and symptoms of the depressive syndrome to restore occupational and psychosocial function to that of the asymptomatic state to reduce the likelihood of re
39.	List disadvantages of medications in the treatment of major depression. Need for repeated medical visits to monitor response and adjust dosage. Unwanted side effects "More severe (but infrequent) medication reactions, such as allerg
40.	List 3 advantages of psychotherapy. "Lack of physiologic side effects, such as those found with medication or ECT." Logical possibility that psychotherapy is effective for some patient for whom medication are not effective. Theoreti
41.	Describe disadvantages of psychotherapy. Psychotherapy has rarely been tested in patients with severe or psychotic depressions. Many patients (10 to 40 percent) fail to follow through with the full treatment. "Many time-limited form

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