1- Mood Disorders Flashcards
Low mood, loss of interest/enjoyment, neuro vegetative disturbance, reduced energy, irritability/temper outbursts, and social/occupation dysfunction are sx of what disorder?
Major depressive disorder
Is MDD more common in men or women?
Women
What is the DSM5 criteria for MDD?
A. 5+ sx present for at least 2 weeks. 1 sx is either depressed mood or loss of interest or pleasure
- Depressed mood most of day, nearly every day,
- Diminished interest/pleasure
- Weight change
- Insomnia/hypersomnia
- Fatigue
- Feelings of worthlessness/inappropriate guilt
- Diminished ability to concentrate
- Thoughts of self harm/SI
B. Clinical impairment in social/occupation functioning
C. no due to physiologic effect of substance or GMC
D. Not better explained by schizophrenia/other disorder
E: Never had manic or hypomanic episode
What is disorder is Sig-E-Caps a pneumonic for? What does is stand for?
MDD
Sleep Interest Guilt Energy Concentration Appetite Psychomotor changes SI
What disorder is PHQ-9 screening used for?
MDD (score of ≥ 10)
What is the DSM5 criteria for Persistent depressive disorder?
A. Depressed mood for most of the day for most days for at least 2 yrs
B. Depressed + 2+ of the the following:
- appetite changes, sleep changes, energy changes, low self esteem, poor concentration, feelings of hopelessness
C. During 2 yr period (1 for peds), pt has never been w/o sx in Criteria A and B for more than 2 months
D. Criteria for MDD may be continuously present for 2 yrs
E. Have never been mania, hypomania, or cyclothymia
F. Does not occur during course of psychotic disorder
G. Not due to GMD or substance induced
H. Sx cause clinically significant distress/impairment
If pt has a response to tx of a depressive disorder this will result in what % improvement in sx?
50% (will be reflected by 50% increase in PHQ-9 score)
What does it mean if pt is in remission for a depressive disorder ?
SX w/in “normal” range of tests PHQ-9 ≤ 4
If pt is in remission for ≥ 6 months for a depressive disorder, what is this considered?
Recovery
What is the tx for mild to mod MDD?
- Antidepressant (SSRI, SNRI)
- Psychotherapy (CBT - individual, couple, group)
- Combined therapy (synergistic)
What is the goal of CBT therapy in pt w/ MDD?
- Education, coping skills, stress management
- To ID and correct incorrect beliefs
What is the goal of behavioral therapy for MDD?
Thought exercises or real experiences to reduce sx
What is the tx for severe MDD?
- Antidepressant (SSRI, SNRI)
- Psychotherapy (CBT )
- Combined therapy (synergistic)
- ElectroConvulsive therapy (if SI or food refusal)
What is the antidepressant course for antidepressants?
- SSRI (Prozac, Zoloft, Paxil)
- SSNI/SSRI (Effexor, Cymbalta)
- Miscellaneous (Wellbutrin)
- Combo w/ atypical antipsychotics
What is the DSM5 Criteria for Bipolar I?
A. At least 1 manic episode
B. Occurrence of manic and/or MDD episodes not better explained by other d/o on schizophrenia spectrum
How is a manic episode defined?
A. Distinct period of abn/persistently elevated mood ≥ 1 wk
B. During mood disturbance must 3+ of the following sx:
- Inflated self esteem, decreased sleep, more talkative, flight of ideas, distractibility, increased goal directed activity, excessive involvement in pleasurable activities
C. Marked functional impairment or hospitalization to prevent harm to self/others
D. Not due to drug or GMC
What disorder is DIGFAST a pneumonic for? What does is mean?
Mania
Distractibility Impulsivity Grandiosity Flight of ideas Activity (increased, goal directed) Sleep (decreased need) Talkative
What is the DSM5 criteria for Bipolar II disorder?
A. Presence/hx of at least 1 hypomanic episode & 1 MDD episode
B. Never had a manic episode
C. Not better explained by schizoaffective d/o
D: Depressive sx causing clinically significant distress/impairment in functioning
What is the criteria for hypomania?
A. Persistently elevated mood, lasting ≥ 4 days that is clearly different from non-depressed mood
B. During period of mood disturbance, 3+ Mania/DIGFAST sx
C. Clear change in function, uncharacteristic of person
D. Change in mood/function is observable by others
E. not severe enough to cause marked impairments. No psychosis
F. No due to drug or GMC
What disorder is the MDQ screening used for? Is is diagnostic?
Mood disorders (depression or biopolar)
Not diagnostic, only screening tool. If positive must be evaluated for depressive or bipolar disorder w/ DSM criteria
What is the med tx for Bipolar 1 (severe mania)?
1st line: Lithium or Valproate. AND 1st gen or atypical neuoleptic (Aripiprazole, Risperidone, olanzapine, quetiapine)
2nd line: Different anticonvulsant &/or atypical
3rd line: ECT
What is the med tx for Bipolar II (hypomania)?
1st line: Risperidone or olanzapine
2nd line: Different atypical or 1st gen antipsychotic or anticonvulsant
3rd line: Benzodiazepines
What is the non-med tx for Bipolar I and II?
- Psycho-education (depression bipolar support)
- Importance of med compliance/avoidance of substance abuse
- Circadian stability (regular sleep patterns)
What is a mood episode?
Distinct period of time when some abn mood is present (depression, mania, hypomania)
What is a mood disorder?
Patterns of mood episodes (MDD, Bipolar I /II)
Is a manic episode a psych emergency?
Yes. Pt w/ severely impaired judgment that can make dangerous to self or others
What are the differences b/w manic and hypomanic episodes
Mania:
- lasts at least 7 days
- Severe impairment in social/occupation functioning
- +/- hospitalization or psychotic features
Hypomania:
- Lasts at 4 days
- No marked social/functional impairment
- Does not require hospitalization
- No psychotic features
What disorder have chronic course that are marked by relapses w/ relatively normal functioning b/w episodes?
Mood disorders
Stroke pts are at risk for developing what disorder leading to a poorer outcome overall?
Depression
What is the most common disorder among those that commit suicide?
Depression
What is anhedonia? What disorder is it most common in?
The inability to experience pleasure.
Most common in depression
The following sleep disturbances are associated w/ what disorder?
- Multiple awakenings
- Initial & terminal insomnia (most common)
- Hypersomnia
- Reduced REM
Depression
What is the cause of depression?
Unknown. Believed to be combo of biological, genetic, environmental and psychosocial factors
What disorder is associated w/ high cortisol, abn thyroid axis, GABA, genets and psychosocial/life events?
MDD
All antidepressant meds are equally effective but differ in SE profiles. How long do they take to become effects?
4-6 weeks
What is the disease progression if MDD is left untx?
Depressive episodes are self-limited (resolve in 6-12 mos), episodes will become more frequent, highly likely to eventually commit suicide
When is pt w/ MDD hospitalized?
Pt at risk for suicide, homicide, or unable to care for him/her self
What syndrome is marked by autonomic instability, hyperthermia, hyperreflexia, seizures, coma or death?
Serotonin syndrom
When is adjunctive therapy used in the tx of MDD?
When multiple 1st line txs fail
Postpartum women at are risk for what?
Depression
W/ ECT what is the avg # of treatments?
6-12 (7 is avg) over 2-3 wks period
What are the common SEs of ECT?
Retrograde and anterograde amnesia (resolved w/in 6 months), +’- HA, nausea, muscle soreness
What form of MDD is characterized by onset of episodes related to a time of year this follows what pattern and characterized by irritability, carb craving and hypersomnia?
Seasonal affective disorder
What is bereavement? Is this a mental illness?
Simple grief as a reaction to major loss of a loved one (self-limited and last for several months and does not meet criteria for MDD)
NOT a mental illness
If pt with bereavement meets criteria for MDD should a dx be made?
Yes
Bipolar I disorder involves mania and major depression episodes. Are episode of major depression required for DX?
No
Onset of Bipolar I disorder is usually before what age?
30 (1st episode usually at 18)
Is there a genetic link for Bipolar I disorder?
Yes, has highest genetic link of all major psychiatric disorders
What is the best tx for pregnant women w/ Bipolar 1 disorder having a manic episode?
ECT
What is the gold standard med for Bipolar I disorder?
Lithium
A pt w/ hx of postpartum mania is at a high risk of relapse w/ future deliveries, what is the tx?
Mood stabilizing agents as prophylaxis
Bipolar II disorder is aka what?
Recurrent major depressive episodes w/ hypomania
If pt has hx of 1 full manic episode, even if in the past, what is the dx?
Bipolar I
What is the difference b/w MDD and persistent depressive disorder?
MDD is episodic while PDD is pervasive
What is the definition of rapid cycling?
At least 4 mood episodes w/in 12 months
What is the “2 D” pneumonic for Persistent Depressive disorder?
2 yrs of depression
2 listed criteria
Never asx for > 2 months
Persistent depressive disorder is aka what?
Dysthymia
What is the TX for pt w/ Bipolar I or II w/ a depressive episode (acute bipolar depression)?
- +/- Antidepressants (not recommended if new manic state or previously unsuccessful)
- Caution pt on risk of affect switching w/ use of antidepressants (manic to depressive cycles)→ may use mood stabilizer or antipsychotic as adjunct
