10A, 11A : mood affective disorder

Question 1

Mood is a description of

Answer 1

one’s internal emotional state over long-term.

• Both external and internal stimuli can trigger moods, which may be labeled as sad, happy, angry, or irritable.
• It is normal to have a wide range of moods and to have a sense of control over one’s moods.

Question 2

Affect is a

Answer 2

short-term physical expression of an emotional state (caused by specific events).

Question 3

Mood disorders vs. mood episodes

Answer 3

• Mood episodes are distinct periods of time in which some abnormal mood is present; include
  *manic episode,
  *hypomanic episode, and *depressive episode.
• Mood disorders are defined by their patterns of mood episodes; often have chronic courses that are marked by
  relapses with relatively normal functioning between episodes. Include :
  *major depressive disorder (MDD),
  *bipolar I disorder,
  *bipolar II disorder,
  *persistent depressive disorder,
  *cyclothymic disorder

Question 4

DSM-5 diagnostic criteria for
Manic episode

Answer 4

A. Distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally
and persistently increased goal-directed activity or energy, lasting at least 1 week.
B. During the period of mood disturbance, 3 (or more) of the following symptoms are present to a
significant degree and represent a noticeable change from usual behavior:
1. Distractibility
2. Impulsivity/Indiscretion (seeks pleasure without regard to consequences)
3. Grandiosity (inflated self-esteem)
4. Flight of ideas (racing thoughts)
5. ↑ goal-directed Activity/psychomotor Agitation (purposeless non-goal-directed activity)
6. ↓ need for Sleep
7. Talkativeness or pressured speech (increased production, volume, and rate of speech)
8. Excessive involvement in pleasurable activities that have a high risk of negative consequences
(shopping, gambling, sex activities)
C. The mood disturbance is sufficiently severe to cause marked impairment in social or occupational
functioning, or to necessitate hospitalization to prevent harm to self/others, or there are psychotic
features.
D. The episode is not attributable to the physiologic effects of a substance or to another medical condition

Question 5

DSM 5 Hypomanic episode

Answer 5

A. Distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and
persistently increased activity or energy, lasting at least 4 consecutive days.
B. ≥ 3 criteria met (as for manic episode).
C. The episode is associated with an unequivocal change in functioning that is uncharacteristic of the
individual when not symptomatic.
D. The disturbance in mood and the change in functioning are observable by others.
E. The episode is not severe enough to cause marked impairment in social or occupational functioning or
to necessitate hospitalization. If there are psychotic features, the episode is, by definition, manic.
F. The episode is not attributable to the physiological effects of a substance.

Question 6

mania vs hypomania

Answer 6

Question 7

dsm5 diagnostic :
Major depressive episode

Answer 7

Question 8

DSM 5 :
Persistent Depressive Disorder (Dysthymia)

Answer 8

Milder form of major depressive disorder

Question 9

Bipolar I Disorder DSM5

Answer 9

• DSM-5 diagnostic criteria
  For a diagnosis of bipolar I disorder, it is necessary to meet the DSM-5 criteria for a manic episode (see above).
• Between manic episodes, there may be interspaced euthymia, major depressive episodes, or hypomanic episodes,
  but none of these are required for the diagnosis.

Question 10

TREATMENT OF BIPOLAR 1

Answer 10

II. Psychotherapy
III. ECT

Question 11

BIPOLAR 2

Answer 11

Bipolar II Disorder
History of one or more major depressive episodes and at least one hypomanic episode.

Question 12

If there has been a full manic episode (even in the past), or if the patient ever has a history of psychosis, then the
diagnosis is

Answer 12

bipolar I, not bipolar II disorder

Question 13

Cyclothymic Disorder

DSM5

Answer 13

Question 14

Major Depressive Disorder (MDD) TREATMENT

Answer 14

Combination therapy (pharmacotherapy + psychotherapy)
* selective serotonin reuptake inhibitor (SSRI; paroxetine, citalopram,
escitalopram, fluoxetine, sertraline)
* anxiolytic (clonazepam
* bupropion, SNRI, or other
atypical antidepressant.
*TCA’s (amitriptyline, nortriptyline, clomipramine)
* MAO-inhibitor (phenelzine, tranylcypromine)
*Serotonin-norepinephrine reuptake inhibitors (SNRIs; venlafaxine, desvenlafaxine, duloxetine) may be
particularly effective in severe or refractory cases of depressio
*2nd-gen’ antipsychotics (olanzapine) along with antidepressants are 1st-line treatment for patients with MDD
with psychotic features