Approach to Mood DOs

Question 1

Neurchemical imbalance in depression

Answer 1

Abnormal noradrenergic function, down regulation of B adrenergic receptors.
Decreased dopamine
Decreased 5-HT
Reduced GABA

Question 2

Etiology of mood DOs (inheritance & triggers)

Answer 2

50% of pts with Bipolar DO have a first degree relative with a mood DO.

10-25% of pts with a mood DO have a first-degree relative with a mood DO

Triggering life events and environmental stressors often proceed first mood episode

Question 3

Major depressive DO dx criteria

Answer 3

Pressence of one or more major depressive episodes and the absence of manic, hypomanic or mixed episodes

Question 4

Major Depressive episode criteria

Answer 4

At least 5 of the following for a 2-week period with either *

• • depressed mood
• • diminished interest/pleasure in activities
• Significant, unintentional, weight loss/gain
• Insomnia or hypersomnia
• Fatigue or loss of energy
• Feelings of worthlessness/excessive guilt
• Diminished ability to think or concentrate
• Recurrent thoughts of death or suicide

Question 5

Major depressive DO tx

Answer 5

Hospitalization
Meds
Electroconvulsive therapy or transcranial magnetic stim.

Question 6

Major depressive DO meds

Answer 6

Ketamine - Reduces suicidal thoughts

Spravato - resistant depression

Question 7

Persistent Depressive (dysthymia) DO

Answer 7

Depressed mood for most of the day but is not severe enough to be considered major depressive DO

Question 8

Different criteria for adults v children with persistent depressive DO

Answer 8

Adults are at least 2 years in duration and children 1 year.

*adults are not free of symptoms for greater than 2 mo at a time

Question 9

Two other forms periodic depression?

Answer 9

Depression with seasonal pattern

Premenstrual dysphoric disorder (PMDD)

Question 10

Criteria for a manic episode

Answer 10

Abnormal & persistently elevated or irritable mood lasting at least a week with at least 3 of the following:

• Inflated self-esteem or gradiosity
• Decreased need for sleep
• Talkative
• Racing thoughts
• Distractibility
• Incr Goal-oriented behavior
• Excessive involvement in pleasurable activities

Question 11

Difference between manic and hypomanic

Answer 11

Hypomanic is less severs and episodes are only 4 days

Question 12

Bipolar I v Bipolar II

Answer 12

1 - At least one manic/mixed episode

2 - Pts have at least one major depressive episode and one hypomanic episode

Question 13

Tx for bipolar disorders

Answer 13

Mood stabilizers are first line

• Li+
• valproic acid

Question 14

Cyclothymic DO & tx

Answer 14

Characterized by dysthymic DO with intermittent hypomanic periods.
>2yrs in duration for adults & 1 for children

Tx: mood stabilizing meds + psychotherapy

Question 15

Types of anxiety (7)

Answer 15

1. Separation anxiety
2. Panic DO
3. Agoraphobia
4. Generalized anxiety DO
5. Obsessive-compulsive DO
6. Specific/Social phobias
7. Posttraumatic Stress DO

Question 16

Panic DO criteria

Answer 16

1. Recurrent, unexpected attacks
2. At least one attack a month or more plus
   - persistent concern about add. attacks or
   - worry about implications of attack or
   - Sign. change in behavior related to the attacks

Question 17

Generalized Anxiety DO

Answer 17

Excessive anxiety and worry occurring most days then not, for most of the day, for at least 6 mo.

Question 18

Obsessive compulsive DO

Answer 18

Obsessions or compulsions a person has recognized to be unreasonable, time consuming and interfere with daily living.

Question 19

Difference between OCD and OCPD

Answer 19

OCPD people do not perceive they have a problem. They are not as debilitated

Question 20

Depression pneumonic (SIGECAPS)

Answer 20

Sleep deprivation
interest -> anhedonia
guilt
Energy loss
Concentration is obscured
Appetite change
Psychomotor decrease
suicidal ideations

Question 21

Manic pneumonic (DIG FAST)

Answer 21

Distractibility
Inflated self-esteem/Impulsive
Grandiosity
Fast/racing thoughts 
Agitation
Speech (very talkative)
Thoughlessness