BM - Mood Disorders

Question 1

What is the criteria for major depressive disorder

Answer 1

either depressed mood or loss of interest/pleasure (anhedonia) for a two week period, most of the day nearly every day plus 4 of the SIG E CAPS symptoms

Question 2

What are the SIG E CAPS symptoms

Answer 2

1. S/I, thought of death/plan/attempt
2. Guilt/worthlessness
3. Energy loss/fatigue
4. Concentration/indecisiveness
5. Appetite/Weight change
6. Psychomotor agitation/retardation
7. Sleep change

Question 3

What is another requirement for MDD

Answer 3

Symptoms cause distress or impairment in areas of functioning; ex) not going to work

Question 4

What are some specifiers of MDD

Answer 4

Peripartum onset - within 4 weeks of delivery, normal to a certain extent but can worsen
Seasonal pattern - Seasonal affective disorder, can use light therapy

Question 5

“Depressed mood” can be:

Answer 5

“sad, hopeless, down”, somatic complaints/affect, loss of interest - “what kind of activities did you/do you do?”

Question 6

How does depression typically present in children

Answer 6

Irritability, school, acting out, weight changes

Question 7

How does depression typically present in the elderly

Answer 7

Somatic complaints, may deny depression, assess comorbid symptoms

Question 8

What is the pathophysiology of depression

Answer 8

1. Genetic/biological - neurotransmitters effected but not sure why
2. Environmental
3. Secondary to other diseases/conditions, inflammation, autoimmune, strokes, cancer, dimentia

Question 9

What is dysthymic disorder

Answer 9

Depressed mood for most of the day, more days than not, for at least 2 years, by subjective or objective account; in children mood can be irritable, duration for 1 year

Question 10

What are the symptoms of dysthymic disorder

Answer 10

1. Low energy/ fatigue
2. Poor concentration/ difficulty with decisions
3. Poor appetite/overeating
4. Insomnia/hypersomnia
5. Low self-esteem*
6. Hopelessness

Question 11

What is the difference between MDD and dysthymic disorder

Answer 11

Dysthymic - “always been this way”
MDD - Hitting and point and going downhill when life was fine before

Question 12

What is the criteria for a manic episode

Answer 12

distinct period of abnormally and persistently elevated, expansive, or irritable mood that lasts at least 1 week (or any duration if hospitalized); also need at least 3 symptoms

Question 13

What are the symptoms in which 3 or more are needed to meet criteria for a manic episode

Answer 13

1. Inflated self-esteem/grandiosity
2. More talkative/pressure to talk
3. Flight of ideas or racing thoughts
4. Decreased need to sleep
5. Distractibility
6. Increase in goal directed activity or psychomotor agitation
7. Excessive involvement in pleasurable activities that have a high potential for painful consequences (drinking, drugs, unprotected sex, spending sprees, etc.)

Question 14

What is the social challenge of a manic episode

Answer 14

Symptoms cause marked impairment in occupational or social functioning, or symptoms necessitate hospitalization, or there are psychotic features

Question 15

What is a criteria for bipolar disorder

Answer 15

Symptoms are not due to a substance or medical condition

Question 16

What is the average age of onset for MDD and bipolar disorder

Answer 16

early - mid 20s

Question 17

What do those with bipolar disorder believe

Answer 17

There is nothing wrong with them; poor insight

Question 18

How do most bipolar disorder patients act

Answer 18

non-compliant

Question 19

Compare the prognosis of MDD and bipolar disorder

Answer 19

Worse for those with bipolar disorder

Question 20

What is very important to ask about for a patient with bipolar disorder

Answer 20

Family history

Question 21

What are medical conditions that contribute to mood disorder

Answer 21

Parkinson’s disease, dementias, CVA, MS, Endocrine, lupus, RA, Cancer

Question 22

What are examples of substance induced mood disorders

Answer 22

Prescriptions or illicit substances, cardiac meds, steroids, sedatives, anti-inflammatory

Question 23

Describe the pharmacotherapy treatments for depressants

Answer 23

Antidepressants such as SSRIs (selective serotonin reuptake inhibitors) and SNRIs (serotonin norepinephrine reuptake inhibitors)

Question 24

How long does it take for antidepressant medications to work

Answer 24

Several weeks/months to show full effects

Question 25

What can be a dangerous drug interaction with antidepressants

Answer 25

St. John’s Wort

Question 26

Describe psychotherapy

Answer 26

Counseling, coping skills/techniques, help correct negative thoughts

Question 27

What are other treatments for MDD aside from pharmacotherapy and psychotherapy

Answer 27

exercise, limit ETOH/drugs, get sleep, less commonly are shock tx for severe/tx resistant, brain/vagus nerve stimulation

Question 28

What are the pharmacotherapy options for bipolar disorder

Answer 28

1. Mood stabilizers - bring them down from mania; anti-seizure medications
2. Anti-depressants - SSRI’s and SNRI’s
3. Antipsychotics - typically for schizophrenia but stabilizes mood as well

Question 29

What are other treatments for bipolar disorder

Answer 29

psychotherapy (more difficult during mania), hospitalization, limit/eliminate triggers such as disruption in sleep cycle and substances

Question 30

How should suicide risk be assessed?

Answer 30

Ask about thoughts, intent, plan, access, and what keeps patient from attempting; review many suicide questions

Question 31

What are the risk factors for suicide

Answer 31

Older age, male, single/widow/divorce, substance abuse, poor social supports, unemployed or retired, poor physical health, prior history, family history

Question 32

What is the correct response to suicidal ideation

Answer 32

Impatient treatment/hospitalization; be sure to document everything appropriately