108/109. Depression/BPD Flashcards
What is the DSM 5 Criteria for Major Depressive Episode?
A. 5+ of SIGECAPS during 2 week period with feeling in depressed mood most of the days
B. Sx cause distress/fx impairment
C. Not attributable to effects of substance/medical condition
SIGECAPS S - sleep disturbance I - interest loss (anhedonia) G - guilt/worthlessness E - energy (fatigue) C - concentration A - appetite changes P - psychomotor retardation S - suicidality
What is the difference between the two subtypes of MDE?
MDE with Melancholic Features: Either loss of pleasure in activities or lack of reactivity to pleasurable stimuli with 3+ of the following sx: despair, worse in AM, early morning awakening, weight loss, guilt
MDE with Atypical Features:
- needs mood reactivity
- 2+ of: weight gain, hypersomnia, leaden paralysis, interpersonal rejection sensitivity
DSM 5 Criteria for Manic Episode
A. 1+ week of abnormally/persistently elevated/expansive/irritable mood & persistently elevated activity/energy
B. 3+ sx of: high self esteem/gradiosity, less capacity for sleep, more talkative than normal, racing thoughts, distractibility, more goal directed activity, more involvement in activities
C. causes marked impairment in fx
D. Not attributable to substance use/other medical condition
What is different about hypomanic episodes?
Same sx as mania, but duration only 4 consecutive days (shorter)
Observable change by others
Not severe enough to cause marked impairment or require hospitalization
What is “Mixed Features”?
What is the hallmark of MDE with mixed features?
What occurs in mood episodes w/ psychotic features?
MF: 3 subthreshold sx from opposing pole present during mood episode
MDE w/MF: Hallmark: irritability and agitation (fatigue/anxiety/rapid thoughts/insomnia) - poorer prognosis, tx with mood stabilizers/atypical antipsychotics
MDE w/PF: delusions/hallucinations
mood congruent: mania w/grandiosity/paranoia; depression with guilt/nihilism
Mood incongruent: less consistent mix of themes
What is the DSM 5 Criteria for Major Depressive Disorder?
What is the DSM 5 Criteria for Persistent Depressive Disorder?
MDD
1. Meets criteria for 1 MDE (A-C)
D. MDE not better explained by another psych disorder
E. NEVER had manic/hypomanic episode
PDD
A. Depressed mood for 2+ years
B. 2+ sx of SIGECAPS
C. during 2 years, never w/o sx for more than 2 mo, never had mania/hypomania episode
What is Bipolar I, Bipolar II and Cyclothymic Disorder?
BPD I: severe, hx of manic episodes
BPD II: less severe, hx of hypomanic episodes (no manic episodes)
Cyclothymic disorder: recurrent mild depressive sx and hypomanias lasting 2+ years (no fully syndromal MDE)
co-morbidities of BPD/MDD
- Alcohol/Substance abuse
- OCD/Anxiety Disorders
Worsens prognosis of medical illnesses
Early onset MDD: increased medical morbidity later in life
BPD: increased obesity, metabolic syndromes, CVD
What is the stress-diasthesis model of MDD?
What is the recurrence rate for MDD?
1st event assoc with stressor, later episodes not triggered by external event
> 50% recurrence after 1 MDE, 80-90% after 2
(Kindling - increased occurance with each episode)
What is the pathogenesis of MDD? (Neurobiology, Role of 5HT, Recurrent MDD0
Neurobio: 5HT and NE systems implicated; reduced neurogenesis/atrophy/cell damage with subsequent stressors
5HT: depression worsens with 5HT depletion and assoc with alterations of receptor and transporter density
Recurrent MDD: due to decreased immune functioning, dysregulation in hypothalamic-pituitary-thyroid axis, volume reduction in BG/hippocampus/frontal cortex, decreased activity in left prefrontal cortex
What is the pathogenesis of BPD?
Complex multi-gene-environment interactions
- depletion of NE in depression and excess in mania
- DA/Glu implicated
- circadian dysreducation
- pro-inflammatory factors (increase risk of CVD)
- hypoactive prefrontal cortex, overactive anterior cingulate and subcortical structures
