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BMB Test 4 > B7.068 Mood Disorders in Psychiatry > Flashcards

B7.068 Mood Disorders in Psychiatry Flashcards

1
Q

definition of mood

A

conscious state of mind or predominant emotion
a feeling
prevailing attitude

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2
Q

affect

A

outward expression of emotion

may reflect presence of psych illness

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3
Q

effects of mood

A 
can be triggered by a stimulus
demonstrates the concept of valence (pos or neg)
transient and variable
helps direct cognitive processes
affects psychomotor activity
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4
Q

dysphoric mood

A

“bad” mood- sad, depressed, anxious, apprehensive, guilty

may be associated with depression and anxiety disorders

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5
Q

euthymic mood

A

moderately variable, appropriate to circumstance

no/little pathology

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6
Q

euphoric mood

A

elation, irritability, hilarity

may be associated with manic phase (BPD)

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7
Q

categories of mood disorders

A

bipolar

depressive

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8
Q

categories of bipolar disorders

A

BPD1
BPD2
cyclothymic disorder
bipolar NOS

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9
Q

categories of depressive disorders

A

major depression
dysthymic disorder
depression NOS

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10
Q

clinical features of depression

A

change in behavioral and psychological functioning that results in impairment in social, occupational, and personal functioning characterized by the following:

  • persistent sad or irritable mood
  • loss of interest in activities once enjoyed
  • significant change in appetite or body weight
  • difficulty sleeping or oversleeping
  • psychomotor agitation
  • loss of energy
  • feelings of worthlessness or inappropriate guilt
  • difficulty concentrating
  • recurrent thoughts of death or suicide
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11
Q

clinical impact of depression

A

associated with more disability than ischemic heart disease and cerebrovascular disease
2x mortality rate than the standard population

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12
Q

how to classify MDD

A

5 or more:
-persistent sad or irritable mood
-loss of interest in activities once enjoyed
-significant change in appetite or body weight
-difficulty sleeping or oversleeping
-psychomotor agitation
-loss of energy
-feelings of worthlessness or inappropriate guilt
-difficulty concentrating
-recurrent thoughts of death or suicide
2 week duration

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13
Q

additional specifiers of MDD

A 
single episode
recurrent
mild
moderate
severe
with or without psychosis
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14
Q

post partum depression

A

variable onset and course
with and without psychosis
occurs in 5-25%

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15
Q

seasonal affective disorder

A

seen in both MDD and BPD
onset and duration in winter months
related to light exposure and related neurochemistry
response to UV light therapy

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16
Q

persistent depressive disorder

A 
2 or more symptoms:
-poor appetite or overeating
-insomnia or hypersomnia
-low energy or fatigue
-low self esteem
-poor concentration or difficulty making decisions
-feelings of hopelessness
2 year duration (more chronic in course but less severe)
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17
Q

depressive disorder NOS

A

depressive symptoms are present but do not meet criteria for MDD or other psychiatric condition
can be made in context of comorbid psychiatric or medical condition

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18
Q

epidemiology of suicide

A 
#10 overall cause of death in USA
#2 cause of death on college campuses
#3 cause of death in 15-19 year olds
25,000 to 50,000 deaths per year
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19
Q

male suicide risk

A

attempts are less frequent than women, but more violent and successful

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20
Q

women suicide risk

A

more frequent than men

less successful

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21
Q

Caucasian suicide risk

A

rate increases with age
increased if unmarried/single/divorced
increased when depressed

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22
Q

African and native American suicide risk

A

peak at 25-35, then fall

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23
Q

other contributory factors to suicide

A 
alcohol
drugs
schizophrenia
panic disorder
BPD
loss of a parent
chronic illness
social isolation
previous attempts
fam history
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24
Q

function of hypothalamus in depression

A

hormone regulation
associated with reduced energy, fatigue, reduced appetite and weight regulation
contributes to sexual drive and sleep architecture
hypersecretion of cortisol

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25
detection of hypersecretion of cortisol
dexamethasone suppression test | failed decrease of cortisol (ACTH) following exogenous steroid
26
effect of hypersecretion of cortisol
atrophy of hippocampus | temporally associated with depression
27
relationship between stress and the HPA axis
1. amygdala detects stress and stimulates hypothalamus 2. hypothalamus releases corticotrophin releasing factor (CRF) 3. CRF stimulates the pituitary 4. pituitary releases adrenocorticotropic hormone (ACTH) 5. ACTH stimulates adrenal gland 6. adrenal gland releases glucocorticoids (cortisol)
28
shortened HPA axis
amygdala > hippocampus > CRF > pituitary > ACTH > adrenal gland > glucocorticoids
29
short term benefit of cortisol
increased energy and alertness
30
continual/ chronic cortisol release
impaired cognitive performance suppressed thyroid function blood sugar imbalances decreased bone density decrease in muscle tissue lowered immunity and inflamm response (slow wound healing) increased abdominal fat & risk for heart attack, stroke, high LDL
31
effect of cortisol release on the brain
increases excitatory neurotransmission - sympathetic nervous system - limbic system - frontal lobe
32
effect of cortisol release on sympathetic nervous system
contributes to arousal | exaggerated startle response
33
parts of limbic system affected by cortisol release
hippocampus (strongest site of binding)- memory formation and retrieval anterior cingulate-initial emotional regulation
34
parts of frontal lobe affected by cortisol release
prefrontal cortex and orbitofrontal cortex - involved in short term memory (organization) - problem solving - exec functioning - automatic and controlled emotional regulation
35
general diagnosis of bipolar mood disorders
diagnosed by the presence of manic and hypomanic episodes | can also experience depressive episodes
36
bipolar 1 mood disorder
``` a distinct period of abnormally and persistently elevated, expansive, or irritable mood, lasting 1 week 3 or more symptoms: -inflated self esteem/grandiosity -decreased need for sleep -more talkative/pressured speech -flights of ideas/ racing thoughts -distractibility -increased goal directed activity -increased engagement in pleasurable activities ```
37
bipolar 2 mood disorder
a distinct period of abnormally and persistently elevated, expansive, or irritable mood, lasting 4 days 3 or more symptoms met: -same as BPD1 -key difference is duration of episode and overall severity (less than BPD1...hypomanic more common than manic)
38
cyclothymic disorder
2 years of numerous hypomanic episodes and depressive episodes in children and adolescents, the duration is 1 year during the 1-2 year period, the person is not without the symptoms for more than 2 month at a time
39
severity of bipolar mood disorders
BP1 most severe- associated with disruption to function BPD2 less severe- associated with less dysfunction, can be more depressive overall cyclothymic least severe- least dysfunction overall, but chronically unstable mood
40
complications and consequences of bipolar disorder
suicide social and financial devastation relapse increases risk of recurrence catatonia- potentially lethal
41
neuroanatomy of BPD
hyperintensities in frontal-temporal networks in BP patients metabolic alterations in cortex, caudate, and frontal lobe neuronal phospholipid alterations in cell membranes
42
neurochemistry of BPS
elevation of NE (mania), or deficiency (depression) | elevation of glutamate (mania), excitatory neurotransmitter
43
endocrinology of BPD
HPA axis - transient activation = mania - chronic activation = depression - DST testing
44
signal transduction alterations seen in BPD
alterations seen in intracellular signaling processes: G protein couples subunits - thought to affect excitability of neurons - medications thought to stabilize alterations
45
components of mental status exam
presentation and behavior cognitive status emotional functioning thought processes and content
46
presentation and behavior
``` general appearance level of consciousness attitude toward examiner motor behavior eye contact ```
47
cognitive status
``` orientation attention concentration memory intelligence ```
48
emotional functioning: mood and affect
mood affect range of emotion/mood and affect congruence/ appropriateness of affect to mood
49
thought processes and content
``` speech stream and continuity of thought content of thought perceptual disturbances suicidal and homicidal ideation insight/judgment reliability of report ```
50
rapid assessment of depression
assessment of depressed mood and anhedonia is as sensitive as formal screening 1. over the past 2 weeks have you felt down, depressed, or hopeless? 2. over the past 2 weeks have you felt little interest or pleasure in doing things?
51
disorders in which antidepressants have therapeutic efficacy
``` MDD panic disorder OCD generalized anxiety social phobia ```
52
tricyclic antidepressant mode of action
block reuptake of NE, serotonin
53
MAOI mode of action
block degradation of NE, dopamine
54
SSRI mode of action
block reuptake of serotonin | most common med for depression
55
SNRI mode of action
block reuptake of NE primarily
56
adverse effects of SSRIs
``` CNS: -agitation and insomnia -restlessness and increased anxiety GI: -nausea -diarrhea -weight gain -sexual side effects ```
57
use of electroconvulsive therapy
``` >90% effective more rapid onset choice for: -patients with high comorbid medical risks -psychosis -high risk for suicide -catatonia ```
58
treatments for BPD
anticonvulsants mood stabilizers coupled with antipsychotic in the acute setting
59
characteristics of pharma treatment of BPD
``` shorten episodes reduce severity not prophylactic need to build steady state blood levels and monitor renal function adherence very important ```
60
typical agents used in BPD
lithium valproic acid carbamazepine lamotrigine
61
use of lithium in BPD
most effective overall mood altering medication prophylactic effect is most prominent -shortens bipolar mania and depression -prolongs remissions bipolar mania and depression known effect of lowering suicide potential in bipolar illness
62
problems with lithium usage
``` narrow therapeutic index need to monitor renal function can have antithyroid effects polyuria/polydipsia > DI weight gain tremor ```
63
use of valproic acid in BPD
``` may be the preferred drug in the: -elderly -patients with CNS damage -rapidly cycling BPD patients probably less effective in some patients than lithium more tolerable ```
64
side effects of valproic acid
``` GI weight gain tremor short half life > need ER monitor LFTs pancreatitis (rare) interactions with other drugs ```
65
use of carbamazepine in BPD
compares favorably to lithium teratogenic induces own metabolism/ interacts with other drugs
66
use of lamotrigine in BPD
antidepressant effects slow dose initiation risk of Stevens-Johnson syndrome reduces suicide risk in bipolar pts
67
psychological interventions for depression
multiple types can work | CBT, interpersonal, psychodynamic
68
psychological interventions for BPD
intervention difficult in acute phases (poor insight/ disorganized behavior / treatment resistance) emphasis on education to patient and family medication adherence sleep hygiene

BMB Test 4 (14 decks)

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