Depression
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
Evaluation
- Evaluate suicide risk
- 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
- Psych consult or admission if high risk of suicide
- Consider consult with psychiatric team in other cases, particularly if severe symptoms and patient not already plugged into psych care
- Pharmacologic 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.
This article is issued from
Wikem.
The text is licensed under Creative
Commons - Attribution - Sharealike.
Additional terms may apply for the media files.