1: Mood Disorders Flashcards
what are the four types of mood episodes?
- major depressive episode (MDE)
- manic episode
- mixed episode
- hypomanic episode
what is a mixed episode?
over a 1 week period, patient satisfies criteria for both manic and MDE
what is a hypomanic episode?
shorter, less severe than manic episode
what are mood disorders defined by?
a pattern of episodes over time, with each episode being defined by a pattern of symptoms and signs
MDE - symptomatic definition
at least 5 of the following nearly every day for 2 weeks, and the symptoms must be causing distress/impairment:
- *depressed mood (irritability in adolescents)
- anhedonia (don’t enjoy things as much as before)
- change in weight/appetite
- insomnia or hypersomnia
- psychomotor agitation (crying spells) or retardation
- fatigue or loss of energy/ lastitude
- feelings of worthlessness or guilt
- diminished ability to think or concentrate
- recurrent thoughts of death or suicide
-anxiety and mixed state are now specifiers; bereavement is no longer an exclusion
describe the pathophysiology of MDE
- 3 nt’s: serotonin, norepi, dopamine
- increased cortisol/ CRH secretion
- hypothesized adaptive changes in second messengers and transcription factors
epidemiology of MDE
15% of population will have MDD in lifetime
20% women and 10% of men affected
what are the 3 important parts of a history to address when a new patient comes into a psych clinic?
- sleep
- pain (chronic)
- meds with psychotropic effects
definition of lastitude
not able to initiate things, but fine doing them once initiated
what 3 things do MDE people have negative thoughts about? what is the significance of this?
- themselves
- the world
- the future
increased risk of suicide
what is a nihilistic delusion?
“don’t think my heart is beating anymore”
what groups of people are at high risk of suicide?
SAD PERSONS Sex (male) Age (teenager or elderly) Depression Previous attempt Ethanol or drug use Rational thought loss Sickness (medical illness or >3 prescription meds) Organized plan No spouse (divorced, widowed, or single, esp. w/o child) Social support lacking
women try more often; men succeed more often.
manic episode - symptomatic definition
elevated or irritable mood characterized by the following: (manics DIG FAST) Distractibility/ Delusions and/or hallucinations Irresponsibility/impulsivity Grandiosity (can lead to delusions) Flight of ideas (thoughts racing) Activity/Agitation increase Sleep need decrease* Talkative/pressured speech
mixed state and anxiety are now specifiers
time and symptomatic differentiation of mania vs. hypomania
mania: one week, 3-4 sx
hypomania: 4 days, 3-4 sx
why is it hard for some people to accept that hypomania is a problem?
it may include mild or moderate impairment, but may also be associated with enhancement of function
what is a good symptomatic question to ask to distinguish hypomania?
do you have energy swings?
what is dysthymic disorder?
pattern of chronic ongoing mild depressive symptoms
treatment of MDD
-CBT -> rational defeat concept concerning automatic negative thoughts (mild/moderate depression)
- SSRI’s
- SNRI’s
- TCA (tricyclic antidepressants)
- MAOi
- ECT (electroconvulsive therapy)
- TMS (transcranial magnetic stimulation)
-adjunct tx: augment with atypical antipsychotics (Abilify/Flutiapine)
ECT vs. TMS
ECT more effective, but major issue = memory loss
TMS not as good, but much less harmful to patient
what are the 4 biggest adverse effects of SSRI’s?
- anxiety
- insomnia
- GI effects
- decreased sexual function
what are two things you must ALWAYS ask about in a psych evaluation of depression? (or probably in general)
- suicide
- substance abuse
when do you follow up with a MDD patient?
re-evaluate at 2 weeks for compliance and side effects, then again at 2 months b/c takes that long for meds to work
3 major subtypes of bipolar disorders and how to distinguish them
Bipolar I - mania + mild depression
Bipolar II - hypomania + major depression
cyclothymia - cyclic hypomania + mild depression
what is the ‘kindling effect’ of bipolar disorder pathogenesis?
over time, episodes can be more easily stimulated/increased susceptibility to an event
do you ever question depressed patients about mania?
yes - most bipolar patients start by just showing depressed symptoms then progress
bipolar disorder treatment
for mania/hypomania: mood stabilizers
- lithium carbonate
- valproic acid
for depression: atypical antipsychotics
- Seroquel (quetiapine)
- Symbyax (fluoxetine/olanzapine)
- Latuda
psychiatric co-morbidities in bipolar patients
- substance abuse disorders (alcohol, marijuana)
- anxiety disorders (panic, social phobia, simple phobia)
- eating disorders (bulimia, anorexia)
describe health utilization among persons with affective disorders
if have a psych disorder, more likely to have more medical problems
if treat psych disorders, you decrease medical utilizations
specific organic causes of depression: drugs/meds
catecholamine depletion or blockade
- reserpine
- propranolol
- cocaine withdrawal
cholinergic agonists
- physostigmine
- insecticide poisoning
CNS depressants
- valium
- barbituates
steroids
H2 blockers
analgesics
specific organic causes of depression: endocrine disease
- hypothyroidism (rarely hyperthyroidism)
- Cushing’s disease
specific organic causes of depression: neurologic disease
- CVA (cerebrovascular accidents), esp. frontal
- Parkinson’s
- Huntingtons
- Alzheimers
specific organic causes of depression: infectious disease
- HIV
- hepatitis
- mono
- flu
specific organic causes of depression: neoplastic disease
- lung
- pancreas
- CNS
specific organic causes of depression: metabolic disease
- folate or B12 deficiency
- high calcium
- low magnesium
specific organic causes of depression: other disease
- alcoholism
- any condition causing CNS depression
specific organic causes of mania: drugs/meds
sympathomimetics -stimulants
- amphetamine
- cocaine
- decongestants
- weight loss preps
dopamine agonists
- L-DOPA
- bromocriptine
antidepressants
steroids
specific organic causes of mania: endocrine disease
-hyperthyroidism
specific organic causes of mania: neurologic disease
- temporal lobe seizures
- temporal lobe CVA
- MS
- Huntington’s
specific organic causes of mania: infectious disease
- HIV
- encephalitis
specific organic causes of mania: neoplastic disease
CNS tumors
specific organic causes of mania: metabolic disease
- hypocalcemia
- dialysis encephalopathy
