Clinical Approach to Mood Disorders

Question 1

What is the most common psychiatric illness?

Answer 1

Depression

Higher in females

Question 2

What happens to NE, Dopamine, 5-HT, and GABA in Major Depressive DO?

Answer 2

All decreased

Question 3

What is the diagnostic criteria for MDD?

Answer 3

5 of the following for 2 weeks without any manic, hypomanic, or mixed episodes:

1. Depressed mood
2. Decreased interest in normal activities
3. Weight Loss/Gain
4. Insomnia
5. Agitation/Retardation (slow throughout the day)
6. Fatigue
7. Worthlessness
8. Can’t concentrate
9. Thoughts of death and suicide

Question 4

Examples of treatment for MDD

Answer 4

TCAs
MAOi 
SSRI's 
Trazodone
Bupropion

Question 5

What is Electroconvulsive Therapy?

Answer 5

Used for treatment-resistant depression

Series of shocks to the brain induce seizures to help “reset” patient.

Question 6

Ketamine therapy for MDD

Answer 6

NMDA antagonist administered over a 45-60m infusion for treatment-resistant depression

Question 7

Persistent Depressive Disorder (Dysthymia)

Answer 7

Depressed mood for at least 2 years in adults (1y in children) that is not severe enough to be MDD.
Cannot have withdrawal of symptoms for >2m

Question 8

Depression with Seasonal Pattern (aka Seasonal Affective Disorder)

Answer 8

onset and remission of major depressive episodes that correspond with times of the year.
Symptoms of “Hibernation”- eating more and sleeping more
Tx: Light Therapy

Question 9

Premenstrual Dysphoric Disorder (PMDD)

Answer 9

Mood instability the week before menses (cough.. Allison)

Tx: Exercise, Diet, Relaxation

Question 10

What is defined as a manic episode?

Answer 10

Elevated, Expansive, or irritable mood for >1w and 3 of the following: 
Inflated Self-Esteem
Decreased need for sleep
Pressured Speech
Racing thoughts
Goal-oriented behavior
Excessive pleasurable activities (sex)

Question 11

Hypomanic Episode

Answer 11

Less severe and shorter time than a manic episode. Usually only 4 days and no psychotic features.
Not bad enough for mania, but bad enough for people to notice.

Question 12

Bipolar I Disorder

Answer 12

A single Severe manic episode can be diagnostic. Major depressive episode not required as in Type II, but can be present.

Question 13

Bipolar II Disorder

Answer 13

At least 1 depressive and 1 hypomanic episode. Tends to be more hypomania than full blown manic. More prevalent

Question 14

2 mood stabilizing treatments that are 1st line for Bipolar Disorder

Answer 14

Lithium

Valproic Acid

Question 15

Cyclothymic Disorder

Answer 15

Lesser form of Bipolar similar to Persistent Depressive Disorder. Patients have hypomanic and depressive periods over 2 years but do not meet criteria for BP.
Tx: Same as BP

Question 16

What is generalized anxiety?

Answer 16

Persistent worry about actual circumstances, events, or conflicts of a person’s life. Could be “realistic” worries, such as bills, relationships, etc.

Question 17

Separation Anxiety

Answer 17

Recurrent stress when anticipating or experiencing separation from an attachment.
Refusal to go out from home
Fear of being alone
May have physical symptoms

Question 18

Panic Disorder

Answer 18

1. Recurrent unexpected panic attacks AND
2. 1 attack followed by 1 month of: fear of another attack or significant change in behavior because of attack

May have agoraphobia

Question 19

How long to Panic attacks usually last?

Answer 19

<25m with peak at 10m

Symptoms: Palpitations, sweating, tremor, SOB, CP, Dizziness

Question 20

Agoraphobia

Answer 20

Anxiety about being in situations where a person can only focus on how to escape it.
Example: fear of sitting in a movie theater not near the exit

Question 21

Social Anxiety Disorder

Answer 21

Fear and/or avoidance of social settings lasting at lead 6 months due to fear of embarrassment or humiliation.

Question 22

Generalized Anxiety Disorder

Answer 22

excessive anxiety and worry for at least 6m with 3 of the following for most days: 
Restlessness
Fatigue
Irritability 
Muscle tension
Sleep disturbance

Question 23

OCD

Answer 23

Obsession- persistent thoughts and impulses to do something. (did i lock the door? am i sure? Should I check?)
Compulsion- Behavior or act a person must do to decrease distress or prevent some dreaded event. (I have to check or burglars will rob me)

Question 24

What is a major difference between OCD and OCPD?

Answer 24

A person with OCPD does not recognize their traits as a problem where as an OCD person knows their obsessions are unreasonable.
OCPD- CEO who is meticulous about branding
OCD- Guy who checks his stove 32 times before going to bed

Question 25

Examples of disorders related to OCD

Answer 25

Hoarding
Trichotillomania
Excoriation

Question 26

What is a phobia?

Answer 26

Intense fear of something that is excessive and unreasonable

Question 27

What is important to do before putting a mood disorder in your differential?

Answer 27

Rule out underlying substance, medication, or medical condition causing the problem.