Depression: Difference between revisions
ClaireLewis (talk | contribs) |
No edit summary |
||
| Line 1: | Line 1: | ||
==Background== | ==Background== | ||
==Clinical Features== | ==Clinical Features== | ||
Must have 5 of the following features | Major Depressive Disorder (MDD) - Must have 5 of the following features for >2 wks<ref>American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), American Psychiatric Association, Arlington, VA 2013.</ref> | ||
*Depressed mood or anhedonia (must be present) | *Depressed mood or anhedonia (must be present) | ||
*SIGECAPS | *SIGECAPS | ||
| Line 23: | Line 24: | ||
==Management== | ==Management== | ||
*Consult with psychiatric team | *Consult with psychiatric team | ||
*Pharmocologic agents | *Pharmocologic agents (typically not started in ED due to need for monitoring and adjustment) | ||
**SSRIs (citalopram, fluoxetine, paroxetine, sertraline) | **SSRIs (citalopram, fluoxetine, paroxetine, sertraline) | ||
**SNRIs ([[duloxetine]], [[venlafaxine]], milnacipran) | **SNRIs ([[duloxetine]], [[venlafaxine]], milnacipran) | ||
| Line 32: | Line 33: | ||
==Disposition== | ==Disposition== | ||
==See Also== | ==See Also== | ||
*[[SAD PERSONS score]] | |||
==External Links== | ==External Links== | ||
Revision as of 04:00, 3 June 2017
Background
Clinical Features
Major Depressive Disorder (MDD) - Must have 5 of the following features for >2 wks[1]
- Depressed mood or anhedonia (must be present)
- SIGECAPS
- Sleep decreased (Insomnia with 2-4 am awakening)
- Interest decreased in activities
- Guilt or worthlessness (Not a major criteria)
- Energy decreased
- Concentration difficulties
- Appetite disturbance or weight loss
- Psychomotor retardation/agitation
- Suicidal thoughts
Differential Diagnosis
General Psychiatric
- Organic causes
- Psychiatric causes
Evaluation
Depression screening with PHQ-9, the PHQ-2, the Beck Depression Inventory for Primary Care, and the WHO-5
General ED Psychiatric Workup
- Point-of-care glucose
- CBC
- Chem 7
- LFTs
- ECG (for toxicology evaluation)
- ASA level
- Tylenol level
- Urine toxicology screen/Blood toxicology screen
- EtOH
- Urine pregnancy/beta-hCG (if female of childbearing age)
- Consider:
- Ammonia (see Hepatic encephalopathy)
- TSH (hypo or hyperthyroidism may mimic mental illness)
- CXR (for Tb screen or rule-out delirium in older patient)
- UA (for rule-out delirium in older patients)
- Head CT (to rule-out ICH in patients with AMS)
- Lumbar puncture (to rule-out meningitis or encephalitis)
Management
- Consult with psychiatric team
- Pharmocologic agents (typically not started in ED due to need for monitoring and adjustment)
- SSRIs (citalopram, fluoxetine, paroxetine, sertraline)
- SNRIs (duloxetine, venlafaxine, milnacipran)
- Serotonin modulators (trazodone)
- Atypical (bupropion, mirtazapine)
- TCAs (amitriptyline, clomipramine, desipramine, doxepin, imipramine, nortriptyline, trimipramine)
- MAOIs (isocarboxazid, phenelzine, selegiline)
Disposition
See Also
External Links
References
- ↑ American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), American Psychiatric Association, Arlington, VA 2013.