Chapter 4: Mood Disorders Flashcards

Question

MDD course and prognosis

Answer 1

untreated- self-limiting 6-12 months. More frequently as disorder progresses. 60% respond to antidepressants

Answer 2

if at risk for suicide, homicide, or unable to care for self

Answer 3

safer and better tolerated than other antidepressants side effects: headache, GI, sex dysfunction, rebound anxiety SNRIs (venlafaxine and duloxetine), alpha2 adrenergic receptor antagonis mirtazapine dopamine-norepinephrine reuptake inhibitor: bupropion

Answer 4

Most lethal in overdose (cardiac arrhythmias side effects: sedation, weight gain, orthostatic hypotension, anticholinergic effects. Can aggravate prolonged QTc syndrome

Answer 5

Monoamine oxidase inhibitors older meds; occasionally used for refractory depression risk hypertensive crisis with sympathomimetics or tyramine-rich foods (wine, beer, aged cheeses, liver, smoked meats) risk of serotonin syndrome with SSRIs Most common side effect: hypotension

Answer 6

all antidepressant meds are equally effective but differ in side effect profiles. Meds usually take 4-6 weeks to fully work

Answer 7

atypical (2nd gen) antipsychotics with antidepressants are first-line treatment in pts iwith MDD with psychotic features. Also for resistant/ refractory MDD without psychotic features Triiodothyronine (T3), levothyroxine (T4) and lithium- some benefit when augmenting antidepressants in refractory MDD stimluants (methylphenidate) may be used in some (terminally ill, eg), but limited efficacy, small trials

Answer 8

autonomic instability, hyperthermia, hyperreflexia (including myoclonus), and seizures. Coma or death may result.

Answer 9

after multiple 1st-line treatment failures

Answer 10

Cognitive behavioral therapy, interpersonal psychotherapy, supportive therapy, psychodynamic psychotherapy, problem-solving therapy, and family/ couples therapy have all demonstrated some benefit in treating MDD (primarily CBT or interpersonal psychotherapy) May be used alone or in conjunction with pharmacotherapy

Answer 11

Electroconvulsive therapy - if unresponsive to drugs, cannot tolerate, or rapid reduction of symptoms is desired (e.g. immediate suicide risk, refusal to eat/ drink, catatonia) - extremely safe (primary risk is from anesthesia), may be used alone or with drugs - premedicate with atropine, followed by general anesthesia, administration of a muscle relaxant (typically succinylcholine). Generalized seizure is induced by passing a current of electricity across the brain (generally bilateral, less commonly unilateral); the seizure should last between 30 and 60 seconds, and no longer than 90 seconds - 6-12 (average of 7) treatments administered over a 2-3 week period; significant improvement sometimes after first treatment - retrograde and anterograde amnesia are common side effects, usually resolve within 6 months. - common but transient side effects: headache, nausea, muscle soreness

Answer 12

in 25-30% of patients more likely in severely ill inpatients anhedonia, early morning awakenings, depression worse in the morning, psychomotor disturbance, excessive guilt, anorexia

Answer 13

hypersomnia, hyperphagia, reactive mood, leaden aralysis, hypersensitivity to interpersonal rejection

Answer 14

manic/ hypomanic symptoms present during majority of days during MDE: elevated mood, grandiosity, talkativeness/ pressured speech, flight of ideas/ racing thoughts, increased energy/ goal-directed activity, excessive involvement in dangerous activities, decreased need for sleep

Answer 15

features inclue catalepsy (immobility), purposeless motor activity, extreme negativism or mutism, bizarre postures, and echolalia. Esp responsive to ECT

Answer 16

delusions/ hallucinations | 24-54% of older, hospitalized patients with MDD

Answer 17

feeling keyed up/ tense, restless, difficulty concntrating, fears of something bad happening, feelings of loss of control

Answer 18

occurs during pregnancy or 4 weeks following delivery

Answer 19

temporal relationship etween onset of MDD and particular time of the year (most commonly the winter but may occur in any season). SAD (seasonal affective disorder) often respond to light therapy.

Answer 20

= simple grief rxn to a major loss, usually of a loved one. not a mental illness. symptoms usually self-limited, several months. But if an individual meets creteria for a depressive episode, he/ she would be dxed with MDD. Normal bereavement should not include gross psychotic symptoms, disorganization or actve suicidality

Answer 21

combination of antidepressant and antipsychotic or ECT

Answer 22

episodes of mania and major depression | however, episodes of major depression are NOT required for the dx. Also known as manic-depression

Answer 23

only requirement is occurrence of a manic episode (5% of pts only experience manic episodes). Between manic episodes, there may be interspersed euthymia, major depressive episodes, or hypomanic episodes, but none of these are required for the dx

Answer 24

lifetime prevalence 1-2% women and men equally affected no ethnic differeces. high income 2x rate onset usually before age 30, mean age of first mood episode is 18 frequently misdiagnosed and thereby inappropriately or inadequately treated

Answer 25

biological, environmental, psychosocial, and genetic factors first-degree relatives of pts with bipolar disorder are 10x more likely to develop the illness highest genetic link of all major psychiatric disorders

Answer 26

untreated manic episodes generally last several months course is usually chronic with relapses; as disease progresses, episodes may occur more frequently 90% of individuals after one manic episode will have a repeat mood episode within 5 years Bipolar has poorer prognosis than MDD maintenance treatment with mood stabilizing meds between episodes helps reduce risk of relapse 25-50% of people with bipolar attempt suicide

Answer 27

Lithium- mood stabilizer -> partial reduction of mania. Reduces suicide risk. Acute overdose can be fatal (low therapeutic index) Anticonvulsants: carbamazepine, valproic acid- mood stabilizers. Particularly useful for rapid cycling bipolar disorder and those with mixed features. Atypical antipsychotics (risperidone, olanzapine, quetiapine, ziprasidone) are effective as both monotherapy and adjunct therapy for acute mania. In fact, many patients (especially with severe mania and/or with psychotic features) are treated with a combination of a mood stabilizer and antipsychotic; studies have shown a greater and faster response with combination therapy. Antidepressants are discouraged as monotherapy due to concerns of activating mania or hypomania. Occasionally used to treat depressive episodes when patients concurrently

Answer 28

works well in treatment of manic episodes some require more treatments (up to 20) than for depression esp. effective for refractory or life-threatening acutemania or depression

Answer 29

recurrent major depressive episodes with hypomania

Answer 30

History of one or more major depressive episodes and at least one HYPOMANIC episode. Rember: if there has been a full manic episode, even in the past, then the dx is bipolar I NOT bipolar II disorder.

Answer 31

``` Weight gain tremor GI fatigue Cardiac arrhythmias seizures goiter/ hypothyroidism leukocytosis (benign) coma (in toxic doses) polyuria (nephrogenic diabtes insipidus) polydipsia alopecia metallic taste ```

Answer 32

ECT | relatively safe in all 3 trimesters

Answer 33

lithium, valproic acid, carbamazepine (for rapid cyclers), or 2nd gen antipsychotics. Lithium remains the gold standard, particularly due to demonstrated reduction in suicide risk.

Answer 34

high risk of relapse with future deliveries treat with mood stabilizing agents as prophylaxis some meds may be contraindicated in breastfeeding

Answer 35

2 or more of CHASES ``` poor Concentration feelings of Hopelessness poor Appetite or overeating inSomnia or hypersomnia low Energy or fatigue low Self-esteem ```

Answer 36

MDD is episodic | persistent depressive disorder is pervasive

Answer 37

= dysthymia chronic depression most of the time discrete major depressive episodes

Answer 38

DD-2Ds 2 years of depression, 2 listed criteria never asymptomatic for >2 months

Answer 39

Depressed mood for the majority of time most days for at least 2 years (in children or adolescents for at least 1 year At least 2 of the following: poor concentration or difficulty making decisions, feelings of hopelessness, poor appetite or overeating, insomnia or hypersomnia, low energy or fatigue, low self-esteem During the 2 year period: the person has not been without the above symptoms for > 2 months at a time Never manic or hypomanic

Answer 40

early and insidious onset, with a chronic course. Depressive symptoms much less likely to resolve than in MDD

Answer 41

combo of psychotherapy and pharm most efficacious Cognitive therapy, interpersonal therapy, insight-oriented psychotherapy are most effective antidepressants include SSRIs, TCAs, and MAOIs

Answer 42

alternating periods of hypomania and periods with mild-to-moderate depressive symptoms

Answer 43

- numerous periods with hypomanic symptoms (but not a full hypomanic episode) and periods with depressive symptoms (but not full MDE) for at least 2 years - the person must never have been symptom free for >2 months during those 2 years - no history of major depressive episode, hypomania, or manic episode

Answer 44

chronic | most --> bipolar I/II

Answer 45

antimanic agents (mood stabilizers or 2nd generation antipsychotics) as used to treat bipolar disorder

Answer 46

mood lability, irritability, dysphoria, and anxiety that occur repeatedly during the prementrual phase of the cycle

Answer 47

In most cycles, at least 5 symptoms in final week before menses, improve within a few days after menses, minimal/ absent in the week postmenses (confirm by daily ratings for at least 2 cycles) - At least one of: affective lability, irritability/ anger, depressedmood, anxiety/ tension - at least one: anhedonia, problems concentrating, anergia, appetite changes/ food cravings, hypersomnia/ insomnia, feeling overwhelmed/ out of control, physical symptoms (e.g. breast tenderness/ swelling, joint/ muscle pain, bloating, weight gain) Symptoms cause distress/ impairment not exacerbation of another disorder not due to a substance or other med condition

Answer 48

symptoms may worsen prior to menopause but cease after menopause

Answer 49

SSRIs first-line: daily or luteal phase only (day 14, stop on menses or shortly thereafter) oral contraceptives may reduce symptoms GnRH agonists have also been used and, in rare cases, bilateral oophorectomy with hysterectomy will resolve symptoms

Answer 50

chronic, severe, persistent irritability occuring in childhood and adolescence

Answer 51

Severe recurrent verbal and/or physical outbursts out of proportion to situation more than 3 per week, inconsistent with deelopmental level between outbursts persistently angry/ irritable most of the day nearly every day, observed by others at least 1 year, no more than 3 months without symptoms in at least 2 settings start before age 10 but dx can be made from age 6-18 no episodes meeting full criteria for manic/ hypomanic episode lasting longer than 1 day do not occur during MDD and not better explained by another disorder (can't coexist with ODD, IED- intermittent explosive disorder, or bipolar) symptoms not due to a substance (medication or drug) or other conditions

Answer 52

New disorder; no consensus on evidence-based treatments. Psychotherapy, parent management training meds for comorbid disorders stimulants, SSRIs, mood stailizers, and 2nd gen antipsychotics have all been used to treat the primary symptoms of DMDD

Answer 53

Mood disorder due to another medical condition Substance/ Medication-induced mood disorder Specified depressive/ bipolar disorder (meets criteria for MDE or bipolar except shorter duration or too few symptoms) Unspecified depressive/ bipolar disorder