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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
Q

detection of hypersecretion of cortisol

A

dexamethasone suppression test

failed decrease of cortisol (ACTH) following exogenous steroid

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26
Q

effect of hypersecretion of cortisol

A

atrophy of hippocampus

temporally associated with depression

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27
Q

relationship between stress and the HPA axis

A
  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)
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28
Q

shortened HPA axis

A

amygdala > hippocampus > CRF > pituitary > ACTH > adrenal gland > glucocorticoids

29
Q

short term benefit of cortisol

A

increased energy and alertness

30
Q

continual/ chronic cortisol release

A

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
Q

effect of cortisol release on the brain

A

increases excitatory neurotransmission

  • sympathetic nervous system
  • limbic system
  • frontal lobe
32
Q

effect of cortisol release on sympathetic nervous system

A

contributes to arousal

exaggerated startle response

33
Q

parts of limbic system affected by cortisol release

A

hippocampus (strongest site of binding)- memory formation and retrieval
anterior cingulate-initial emotional regulation

34
Q

parts of frontal lobe affected by cortisol release

A

prefrontal cortex and orbitofrontal cortex

  • involved in short term memory (organization)
  • problem solving
  • exec functioning
  • automatic and controlled emotional regulation
35
Q

general diagnosis of bipolar mood disorders

A

diagnosed by the presence of manic and hypomanic episodes

can also experience depressive episodes

36
Q

bipolar 1 mood disorder

A 
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
Q

bipolar 2 mood disorder

A

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
Q

cyclothymic disorder

A

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
Q

severity of bipolar mood disorders

A

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
Q

complications and consequences of bipolar disorder

A

suicide
social and financial devastation
relapse increases risk of recurrence
catatonia- potentially lethal

41
Q

neuroanatomy of BPD

A

hyperintensities in frontal-temporal networks in BP patients
metabolic alterations in cortex, caudate, and frontal lobe
neuronal phospholipid alterations in cell membranes

42
Q

neurochemistry of BPS

A

elevation of NE (mania), or deficiency (depression)

elevation of glutamate (mania), excitatory neurotransmitter

43
Q

endocrinology of BPD

A

HPA axis

  • transient activation = mania
  • chronic activation = depression
  • DST testing
44
Q

signal transduction alterations seen in BPD

A

alterations seen in intracellular signaling processes: G protein couples subunits

  • thought to affect excitability of neurons
  • medications thought to stabilize alterations
45
Q

components of mental status exam

A

presentation and behavior
cognitive status
emotional functioning
thought processes and content

46
Q

presentation and behavior

A 
general appearance
level of consciousness
attitude toward examiner
motor behavior
eye contact
47
Q

cognitive status

A 
orientation
attention
concentration
memory
intelligence
48
Q

emotional functioning: mood and affect

A

mood
affect
range of emotion/mood and affect
congruence/ appropriateness of affect to mood

49
Q

thought processes and content

A 
speech
stream and continuity of thought
content of thought
perceptual disturbances
suicidal and homicidal ideation
insight/judgment
reliability of report
50
Q

rapid assessment of depression

A

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
Q

disorders in which antidepressants have therapeutic efficacy

A 
MDD
panic disorder
OCD
generalized anxiety
social phobia
52
Q

tricyclic antidepressant mode of action

A

block reuptake of NE, serotonin

53
Q

MAOI mode of action

A

block degradation of NE, dopamine

54
Q

SSRI mode of action

A

block reuptake of serotonin

most common med for depression

55
Q

SNRI mode of action

A

block reuptake of NE primarily

56
Q

adverse effects of SSRIs

A 
CNS:
-agitation and insomnia
-restlessness and increased anxiety
GI:
-nausea
-diarrhea
-weight gain
-sexual side effects
57
Q

use of electroconvulsive therapy

A 
>90% effective
more rapid onset
choice for:
-patients with high comorbid medical risks
-psychosis
-high risk for suicide
-catatonia
58
Q

treatments for BPD

A

anticonvulsants
mood stabilizers
coupled with antipsychotic in the acute setting

59
Q

characteristics of pharma treatment of BPD

A 
shorten episodes
reduce severity
not prophylactic
need to build steady state blood levels and monitor renal function
adherence very important
60
Q

typical agents used in BPD

A

lithium
valproic acid
carbamazepine
lamotrigine

61
Q

use of lithium in BPD

A

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
Q

problems with lithium usage

A 
narrow therapeutic index
need to monitor renal function
can have antithyroid effects
polyuria/polydipsia > DI
weight gain
tremor
63
Q

use of valproic acid in BPD

A 
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
Q

side effects of valproic acid

A 
GI
weight gain
tremor
short half life > need ER
monitor LFTs
pancreatitis (rare)
interactions with other drugs
65
Q

use of carbamazepine in BPD

A

compares favorably to lithium
teratogenic
induces own metabolism/ interacts with other drugs

66
Q

use of lamotrigine in BPD

A

antidepressant effects
slow dose initiation
risk of Stevens-Johnson syndrome
reduces suicide risk in bipolar pts

67
Q

psychological interventions for depression

A

multiple types can work

CBT, interpersonal, psychodynamic

68
Q

psychological interventions for BPD

A

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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