Clinical Approach to Mood Disorders (Hill) Flashcards
10-25% of patients with a Mood Disorder and 50% of patients with Bipolar Disorder have what genetic link?
Have a first-degree relative with a mood disorder
What neurotransmitters are decreased with depression?
1) NE
2) Dopamine
3) 5-HT
4) GABA
What neurotransmitter is increased in mania?
Dopamine
A major depressive episode it characterized by five of the following symptoms for how long?
1) Depressed mood most of the day, nearly every day.
2) Markedly diminished interest or pleasure in all, or almost all, activities most of the day nearly every day
3) Significant weight loss or weight gain when not dieting
4) Insomnia or hypersomnia nearly every day.
5) Psychomotor agitation or retardation nearly every day.
6) Fatigue or loss of energy nearly every day.
7) Feelings of worthlessness or excessive guilt.
8) Diminished ability to think or concentrate.
9) Recurrent thoughts of death or suicide
2 weeks
Diagnosis of major depressive disorder requires?
The presence of one or more major depressive episodes and the absence of any manic, hypomanic, or mixed episodes
Normal grief (bereavement) is commonly seen following?
The loss of a loved one
What non-pharmacological treatments are available for major depressive disorder?
1) Electroconvulsive Therapy (ECT)
2) Transcranial Magnetic Stimulation
What NMDA antagonist produces a dissociative anesthesia effect and has an off label use for treatment-resistant depression?
Ketamine
What is characterized by a depressed mood for most of the day (at least 2 years in duration for adults and 1 year for kids) that has not been severe enough to meet criteria for major depressive episode?
Persistent Depressive Disorder (Dysthymia)
With the diagnosis of Persistent Depressive Disorder (Dysthymia), during those 2 years, they cannot be without symptoms for how long?
More than 2 months
Can Dysthymic Disorder and Major Depression occur simultaneously?
Yes
The onset and remission of Major Depressive Episodes at certain times of the year is characteristic of?
Depression with Seasonal Pattern
Most episodes of Depression with Seasonal Pattern begin at what time of the year?
They remit when?
1) Fall or winter
2) Summer
What is characterized by mood instability with anxiety, depression, irritability, and sleep disturbances a week before menses?
Premenstrual Dysphoric Disorder (PMDD)
What is characterized by abnormally and persistently elevated, expansive, or irritable mood with at least three of the following:
1) Inflated Self-Esteem or Grandiosity
2) Decreased Need for Sleep
3) More Talkative (pressured/push of speech)
4) Flight of Ideas / Racing Thoughts
5) Distractibility
6) Increased Goal-Oriented Behavior
7) Excessive Involvement in Pleasurable Activities
This must last for at least how long?
1) Manic Episode
2) At least 1 week
A Hypomanic Episode is similar to manic episode but is less severe and only needs to last?
4 days
At least one manic or mixed episode is diagnostic of?
Bipolar I Disorder
Is Major depressive episode required for diagnosis of Bipolar I Disorder?
No (But is usually in the episode that presents first)
What is Bipolar II disorder characterized by?
Patients have had at least one major depressive episode and one hypomanic episode in the absence of any manic or mixed episodes
Which Bipolar disorder is more prevalent?
Bipolar II disorder
What is the first line treatment of Bipolar Disorders?
Mood stabilizers such as lithium and Valproic Acid
What is characterized as dysthymic disorder with intermittent hypomanic periods over 2 years?
Cyclothymic Disorder
To fit the criteria of Cyclothymic Disorder what can the patient not have during the first two years?
1) Major depressive
2) Manic
3) Mixed episode
Under what circumstance can you not make a mood disorder diagnosis?
If patient is under the influence of substances
What are some Psychological symptoms associated with Anxiety Disorders?
What are some somatic (physical) symptoms?
What are some physical signs?
1) Sense of Doom, Hypervigilance
2) Headaches, Palpitations
3) Diaphoresis, tremor, fidgeting
What type of anxiety involves worry about actual circumstances, events, or conflicts?
Generalized anxiety
What is characterized by recurrent excessive stress when anticipating or experiencing detachment from major attachment figures or home?
Separation Anxiety Disorder
In order to diagnose Panic Disorder, recurrent unexpected panic attacks must occur along with at least one attack followed by 1 month or more of one of the following:?
1) Persistent concern about additional attacks
2) Worry about the implications of the attack (losing control, heart attack)
3) Significant change in behavior related to the attacks
Panic Attacks are a discrete period of intense fear or discomfort, in which four or more of symptoms below developed and reached peak within?
❖Palpitations ❖Sweating ❖Trembling / Shaking ❖Sensations of Shortness of Breath ❖Chest Pain or Discomfort ❖Feeling Dizzy / Unsteady / Lightheaded ❖Fear of Losing Control or Going Crazy or Dying ❖Paresthesia ❖Chills or Hot Flashes
How long do they usually last?
1) 10 minutes
2) Less than 25 minutes
Which sex are 2-3 times more likely to be affected by panic disorder?
Average age of presentation?
1) Women
2) 25
What is characterized by anxiety about being in situations from which escape might be difficult of embarrassing or for which help may not be available in the event of panic?
Agoraphobia (Being away from home, sitting in the middle row of theater seats, being in an elevator)
What is characterized by a persistent fear of situations in which the person is exposed to unfamiliar people or to possible scrutiny by others?
Social Phobia (Social Anxiety Disorder)
With Social Phobia the fear, anxiety, or avoidance is persistent, typically lasts?
6 months
Do people with social phobia recognize that the fear is unreasonable to excessive?
Yes
Generalized Anxiety Disorder is characterized by excessive anxiety and worry occurring more days than not for at least?
6 months
Recurrent and persistent thoughts, impulses, or images experienced as intrusive and inappropriate and causing marked anxiety or distress falls under what category of Obsessive-Compulsive Disorder?
Obsessions
Repetitive behaviors or mental acts that the person feels drive to perform falls under what category of Obsessive-Compulsive Disorder?
Compulsions
What is the difference between Obsessive-Compulsive Disorder and Obsessive-Compulsive Personality Disorder?
With OCPD they don’t perceive they have a problem while with OCD they know their compulsions and obsessions are not reasonable
Fear of germs (contamination), being responsible for a fire (safety/harm), and unwanted impulse to harm a loved one (unwanted acts of aggression) are types of?
Obsessions
Excessive cleaning, counting and repeating routine activities are types of?
Compulsions
Arachnophobia is the fear of?
Iatrophobia is the fear of?
Acrophobia is the fear of?
1) Spiders
2) Doctors
3) Heights
What are first line treatment options for major depressive disorder?
SSRIs such as bupropion, venlafaxine, and mirtazapine
