2. Mood disorders Flashcards
Mood disorders vs. mood episodes?
Mood disorders = PATTERNS of mood episodes (ex. MDD, BP1, BP2, dysthymic disorder, cyclothymic disorder); some may have psychotic features
Mood episodes = distinct PERIODS OF TIME in which some abnormal mood is present (ex. depression, mania, mixed-state, hypomania)
Symptoms of major depression
(SIGE CAPS)
- sleep (insomnia or hypersomnia)
- interest (anhedonia)
- guilt
- energy (loss of energy/fatigue)
- concentration (less)
- appetite (either up or down)
- psychomotor activity (agitation or reardation - restlessness or slowness)
- suicidal ideation
Major depressive episode criteria
at least 5 of symptoms (SIGE CAPS) and must include either depressed mood or anhedonia for AT LEAST 2 wk period
- must cause social/occupational impairment
Symptoms of mania
(DIG FAST)
- distractability
- insomnia/impulsive behavior
- grandiosity
- flight of ideas/racing thoughts
- activity/agitation
- speech (pressured)
- thoughtlessness
What is manic episode?
Period of abnormally and persistently elevated, expansive, irritable mood for AT LEAST 1 wk (or any duration if hospitalization is necessary)
- at least 3 of DIG FAST
What is mixed episode?
criteria met for both manic episode and major depressive episode; present nearly every day for at least 1 week
- this is psychiatric emergency! (like manic episode)
Difference b/w hypomanic episode and manic?
- hypomania lasts for at least 4 days (manic - 7 days)
- hypomania does not have marked impairment in social or occupational functioning
Mixed episode tx?
poorer response to lithium. anticonvulsants may help
medical causes of manic episode?
metabolic (hyperthyroidism), neurological disorders (temporal lobe seizures, multiple sclerosis), neoplasms, HIV infection
What are stroke pts at high risk of developing?
depression
Difference in prevalence of MDD in men and women
- twice as prevalent in women during reproductive years
- equal prevalence b/w men and women after menopause and before menses
What are some sleep problems associated w/ MDD?
- most common: initial and terminal insomnia (hard to fall asleep and early morning awakenings)
- multiple awakenings
- hypersomnia
- REM sleep shifted to earlier in night and stages 3 and 4 decreased
Some etiology (neurotransmitters) of depression
- decreased neurotransmitters (serotonin)
- high cortisol (hyperactivity of HPA axis)
- abnormal thyroid axis (thyroid disorders associated w/ depressive symptoms)
Genetic components of MDD?
- 1st deg relatives 2-3x more likely
- monozygotic twins = 50-70%
- dizygotic twins = 10-25%
What is the risk of a subsequent major depressive episode if left untreated?
50% within first 2 yrs after 1st episode
What % of patients respond to antidepressants?
50-60%
What are common side effects of ECT?
- retrograde and/or anterograde amnesia (usually goes away in 6 months)
- headache, nausea, muscle soreness (more transient)
Features of atypical depressive disorder?
- hypersomnia
- hyperphagia
- reactive mood
- leaden paralysis (heavy feeling in legs)
- hypersensitivity to interpersonal rejection
What is the Kubler-Ross model of grief? (5 stages)
- Denial
- Anger
- Bargaining
- Depression
- Acceptance
What can be given for normal grief?
- mild benzodiazepines for sleep
What is the definition of rapid cycling?
occurrence of 4 or more mood episodes in 1 yr (major depressive, manic, mixed, etc)
What is the requirement for the diagnosis of BP1 disorder?
- occurrence of 1 manic or mixed episode
- episode of major depression NOT required for the diagnosis
What is the likelihood of first-deg relative of a pt w/ BP disorder likely to get BP?
8-18times
Which major psychiatric disorder has the highest genetic link?
bipolar 1
What is the course and prognosis of untreated manic episode?
- untreated manic episode usually lasts about 3 months
- course is usually chronic w/ relapses
What % of individuals after 1 manic episode will have a repeat manic episode within 5 yrs?
90%
What can be given as prophylaxis b/w manic episodes to help decrease the risk of relapse?
lithium prophylaxis
What % of BP1 pts commit suicide vs. % for MDD?
25-50% with BP disorder; 15% with MDD
Symptoms of dysthymic disorder
CHASES
- poor Concentration or difficulty making decisions
- feelings of Hopelessness
- poor Appetite or overeating
- inSomnia or hypersomnia
- low Energy or fatigue
- low Self-esteem
Which is more prevalent - BP1 or BP2?
BP2
- but less studies on the tx of BP2
- so tx is the same as BP1 until further studies
What is dysthymic disorder?
Chronic mild depression most of the time w/ no discrete episodes
- at least 2 yrs
- 2 listed criteria (CHASES); but no major depressive episode
- never asymptomatic for >2months
- rarely need hospitalization
What is double depression?
Pts w/ MDD with dysthymic disorder during residual periods
What is the prognosis of dysthymic disorder?
- 20% will develop major depression
- 20% develop BP disorder
- > 25% have lifelong symptoms
What is cyclothymic disorder?
Alternating periods of HYPOMANIA and periods w/ mild-moderate depressive symptoms
- at least 2 yrs
- never symptom free for >2 months during the 2 yrs
- no hx of major depressive episode or manic episode
What is the triad for seasonal affective disorder?
- irritability
- carb craving
- hypersomnia
What is the difference b/w adjustment disorder and PTSD?
- Adjustment disorder: stressful event is not life threatening (ex. divorce, death of a loved one, loss of a job)
