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NOTES: Psych Review by Minnie > 111/112b - Depression and Bipolar Disorders I and II > Flashcards

111/112b - Depression and Bipolar Disorders I and II Flashcards

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1
Q

All of the following have been described in association with Major Depression Disorder except:

  1. Decreased activity in right prefrontal cortext
  2. Blunted TSH response to TRH
  3. Short allele of serotonin transport protein
  4. Volume reduction in hippocampus
  5. Decreased BDNF
A

a. Decreased activity in right prefrontal cortext

Decreased activity in the left prefrontal cortex is a biomarker of recurrent MDD

All other findings are associated with MDD

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2
Q

What defines major depressive disorder? (MDD)

A
  • Criteria for MDE have been met (have had at least 1 major depressive episode)
  • MDE not better explained by another psychiatric disorder
  • there has never been a manic or hypomanic episode
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3
Q

What is the lifetime prevalence of major depressive episodes in the US?

A

17%

21% females, 12% males

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4
Q

What is the lifeitme prevalence of Bipolar I disorder?

Bipolar II?

A

Both are ~1%

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5
Q

Tryptophan is a building block for which neurotransmitter?

A

Serotonin

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6
Q

What are the non-diagnostic but highly suggestive symptoms of a major depressive episode with mixed features?

A

Irritability, distractibility, and agitation in addtion to depressive symptoms

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7
Q

Which subtype of depression?

Mood reactivity, hypersomnia, leaden paralysis,

A

Depression with atypical features

  • Depression w/ Atypical Features DSM5 Criteria:
    • mood reactivity (mood brightens in response to positive events, but doesn’t hang on to the feeling for the rest of the day)
    • Two or more of the following: weight gain/increase in appetite, hypersomnia, leaden paralysis (heavy, leaden feelings in arms/legs), or long standing pattern of interpersonal rejection sensitivity
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8
Q

How long must the 5 or more symptoms of depression last for something to classify as a major depressive episode?

A

2 weeks or more

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9
Q

How are Bipolar I, Bipolar II, and cyclothymic disorder diffentiated?

A
  • Bipolar I
    • Requires history of manic episodes (at least 1)
  • Bipolar II
    • Requires history of hypomanic episodes
    • NO manic episodes
  • Cyclothymic disorder
    • More of a chronic state of ups and downs “undulating, cycling”
    • Recurrent mild depressive symptoms and hypomania lasting 2+ years
    • No fully syndromal major depressive episodes
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10
Q

Genetic factors are important in [early/late] onset depression

A

Genetic factors are important in early onset depression

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11
Q

What factors might increase the risk of recurrence of depression?

A
  • Positive family history
  • Incomplete treatment response
  • Neuroticism (personality trait)
  • Hypercortisolemia
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12
Q

What does the “with mixed features” specifier mean?

A

During a mood episode, at least 3 subthreshold symptoms from the opposing pole are present during a mood episode

Can occur in MDD, Bipolar I, Bipolar II

(In a major depressive episode of MDD, subthreshold symtoms means that the pt does not suddenly have Bipolar I or Bipolar II)

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13
Q

Which subtype of depression?

Pervasive anhedonia, weight loss, early morning awakenings

A

Depression with melancholic features

  • Depression w/ Melancholic Features DSM 5 Criteria:
    • criteria of MDE
    • loss of pleasure in all activities or lack of reactivity to pleasurable stimuli
    • 3 + of the following symptoms: depressed mood, depression regularly worse in the morning, early morning awakening, psychomotor changes, anorexia or weight loss, excessive guilt
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14
Q

What are the core features of depression with melancholic features?

A
  • Pervasive anhedonia
  • Lack of reactivity to usually pleasuralbe stimuli
  • Depressed mood
  • Early morning awakening
  • Excessive or inappropiate guilt
  • No interest in food -> weight loss, no appedite
  • Psychomotor changes (physical signs of distress)
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15
Q

List 4 biomarkers of recurrent MDD

A
  • Decreased immune functioning
  • Blunted TSH response to TRH
  • Volume reduction: basal ganglia, hippocampus, frontal cortex
  • Decreased activity in the left prefrontal cortex
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16
Q

Which of the following is a core symptom of atypical depression?

a) expansiveness
b) hypersomnolence
c) loss of appetite
d) anhedonia
e) thought racing

A

b) hypersomnolence (excessive sleepiness)

Other core symptoms:

  • Weight gain/increased appetite (hyperphagia)
  • Leaden paralysis
  • Longstanding pattern of interpersonal rejection sensitivity
17
Q

Which is not a symptom of hypomania:

  1. excessive sleeping
  2. increase in goal directed behaviors
  3. overactive thoughts
  4. irritable mood
  5. distractibility
A

a. excessive sleeping

All other symptoms can be seen in hypomania

Difference between hypomania and mania: Hypomania does not cause a marked impairment in functioning

18
Q

How does the risk of recurrence of depression change with each depressive episode?

A

Risk of recurrence increases with each episode

19
Q

What are the differences between mania and hypomania?

A
  • Mania causes marked impairment in fuctioning
    • Expansive, euphoric, grandiose, possibly irritable, hostile
    • Decreased need for sleep
    • Extravagant
    • Racing thoughts, distractable
    • Lasts >1 week
  • Hypomania does not cause marked impairment in functioning
    • Similar type of symptoms but much less noticible
    • Change is uncharacteristic for the person
    • May see increase in goal directed behavior, productivity
    • Lasts 4-7 days
20
Q

Which neurotransmitters are associated with bipolar disorder?

A

Dopamine and norepinephrine

2nd messengers are also implicated (remember that Li acts on second messengers)

21
Q

SIGECAPS mnemonic:

A
  • SIGECAPS mnemonic for depressive symptoms: sleep disturbances, interest reduced (anhedonia), guilt + worthlessness, energy loss and fatigue, concentration problems, appetite problem, psychomotor agitation or retardation, and suicidality
22
Q

Describe mood episodes w/ psychotic features:

A
  • Mood episodes w/ psychotic features:
    • delusions + hallucinations present at any time w/in a depressive, hypomanic, or manic episode
    • the psychotic features are labeled as mood-congruent or mood-incongruent (do their psychotic symptoms match w/ their mood episode or are they opposites?)
23
Q

Criteria for persistent Depressive disorder?

A
  • Persistent Depressive Disorders Criteria:
    • depressed mood most of the day on most days for > 2 years
    • presence of two or more of the following symptoms: poor appetite or overeating, insomnia or hypersomnia, fatigue, low self-esteem, poor concentration or difficulty making decisions, feeling of hopelessness
    • during the 2 years, never w/o symptoms for more than 2 months, and has never had manic/hypomanic episode

NOTES: Psych Review by Minnie (36 decks)

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