Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Psychiatry > Depression and Bipolar Related Disorders > Flashcards

Depression and Bipolar Related Disorders Flashcards

1
Q

What is the diagnostic criteria for major depressive disorder? Include amount of time and number of symptoms? READ ALL OF THESE

A

5 or more of the following symptoms over greater than 2 weeks:
At least one must be: Depressed mood or loss of interest / pleasure (anhedonia)

At least four must come from:
SIGECAPS (minus I which is interest)
Sleep -> increased or decreased
Guilt -> feeling excessively guilty or worthless
Energy -> decreased energy
Concentration -> impairment of concentration / decisionmaking
Appetite -> increased or decreased
Psychomotor retardation -> moving robotically or slowly, agitated in rare instances
Suicidality -> recurrent thoughts or attempted

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

For MDD, how often must these symptoms be present?

A

The criteria must be present EVERYDAY and represent a significant impairment in function (except for weight gain and suicidality)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What will the speech of a depressed person often be like?

A

Slow, monotonous, and delayed in production (sleep latency) -> thinking slow and have no emotion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is the typical thought process in MDD? What is the most dangerous thought content?

A

Typical -> poverty of ideation - slowed thinking and low or no thoughts, often with negative ruminations and hopelessness / helplessness

Most dangerous: psychotic depression with perceptual disturbances / command hallucinations = “you should kill your wife then yourself”

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

How do you distinguish between bereavement and depression? Think in respect to time course, thought content, suicidality, and self-esteem

A

Time course: in grief - you may still have positive emotions, and the sadness tends to come in waves, decreasing in intensity overtime

In depression - persistent depression / anhedonia

Thought content: Grief = thinking of the deceased. Depression = self-critical / pessimistic ruminations / guilt

Suicidality: possible in both, but grief tends to be more related to joining loved ones later

Self esteem: preserved in grief, though may express regret due to failing the deceased. Depression it is severely reduced.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What medical condition is depression a risk factor for?

A

Cardiac events / CAD in patients with pre-existing heart condition

  • > increased morbidity and mortality in co-occurring medical conditions
  • > same risk for MI as LV dysfunction
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

True or False, depression is responsible for over half of suicides.

A

True

-> 2/3 of patients will contemplate suicide, 15% will complete

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is the peak onset of depression, who is more affected with regards to sex, and ethnicity, and what is the biggest risk factor?

A

In the early 20s, women are more affected than men, native americans are most affected followed by caucasians, biggest risk factor is previous MDE.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is the logic with regards to keeping an MDD patient on longterm therapy?

A

Kind of like drug half lives to steady state:
1 previous episode: 50% chance of recurrence
2 previous episodes: 75% chance of recurrence
3 previous episodes: 90% chance

After 1 episode, can try weaning off. If a second episode occurs, depending on severity, can try to wean again. 3 episodes and it’s maintenance for life.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What sleep abnormalities are present in MDD?

A

Increased sleep latency

Decreased REM latency and greater proportion of REM sleep

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

How does the dexamethasone suppression test for MDD work?

A

Give dexamethasone

  • > in non-depressed people, coristol production is suppressed
  • > in depression, cortisol production is unchanged (increased cortisol levels in depression)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What does a positive dexamethasone test indicate?

A

That person with positive test + diagnosed depression is more likely to have melancholia, psychotic features, and at greater risk for suicide

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Is there any clinically useful test for diagnosis of depression?

A

NO - sleep abnormalities and dexamethasone suppression are not specific enough lab tests

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Why is Parkinson’s a risk factor for depression? How could this be treated?

A

By the monoamine hypothesis of depression, depletion of dopamine (a monoamine) will lead to increased depression risks
-> Bupropion (NDRI) and amphetamines could be used to treat this depresion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is the monoamine / receptor hypothesis of depression? Where in the brain does this affect?

A

Monoamine -> deficiency or malfunctioning in monoamines in the brain leads to depression

Receptor hypothesis -> upregulation of postsynaptic neurotransmitter receptors in the setting of deficiency leads to depression

-> both lack significant clinical evidence

This affects just about everywhere in the brain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are two hormonal axes changes that have been linked to depression?

A

Adrenal axis -> 50% have increased cortisol (think dexamethasone test)

Thyroid axis -> good percentage have hypothyroidism or decreased response to TRH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What are the nonspecific brain findings in MDD? With regards to size

A

Increased ventricle:brain ratio with smaller whole brain volume

Smaller hippocampal volume

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What are the nonspecific brain findings in MDD? With regards to activity

A

Reduced activity in dorsolateral prefrontal cortex -> seat of reasoning = associated cognitive decline

Increased activity in amygdala and ventromedial prefrontal cortex -> leads to depressed mood and anxiety

-> hypoactivity of the cortex overall on PET scan

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What psychological factor has the most compelling data that it causes depression? How?

A

Death of a parent prior to age 11

Stress alters neurotransmitters in brain, leads to neuronal loss / decrease in synapses

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is an important factor in early life which can lead to depression?

A

Maternal / parental neglect

-> animals deprived of attachment bonds have greater chance of depression + lifetime stress overactivity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What are two cognitive / thought patterns which predispose to depression?

A

Cognitive distortions -> how you interpret life events / personal significance to things. Can include giving an external locus of control -> feeling powerless to change things.

Learned helplessness -> helplessness and entrapment thoughts can seed depression -> nothing you do will make a difference -> i.e. infants in orphanages who stop crying

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What personality factors predispose to depression? How does this relate to chronicity of MDEs?

A

No single factor, but personality disorders can increase risk by changing stress response to favor depression

-> personality disorders and substance use increase likelihood of chronicity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Why are women thought to be more susceptible to depression?

A

Reproductive cycling influences hormones, and greater susceptibility to hypothyroidism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

How do genetic factors relate to treatment of depression?

A

Polymorphisms of 5-HT receptor expression associated with response to SSRIs, or NET blockade polymorphisms associated with response to tricyclic antidepressants

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Why do we treat to full remission and not just response?

A

For those who only achieve partial remission, there is a greater likelihood of developing additional depressive episodes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

How is full remission defined for MDD?

A

A return to patient’s baseline level of symptom severity and functioning, which correlates with a HAMD score of <7.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What is the criteria for an MDE to be a separate episode?

A

> 2 month separation between when MDD criteria are not met.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What is the acute phase of depression defined as? How often is the patient seen?

A

The time period from diagnosis until initial reduction of symptoms (typically 6-8 weeks)

  • > reduction in symptoms defined by >50% reduction in symptom severity, where patient no longer meets criteria for MDD
  • > better than 50% will respond to their first antidepressant, up to 20% will be intolerant and need a change

Patient should be seen twice a month in this period

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What are indications for hospitalization in the acute phase of depression and how long is the normal stay?

A

Suicide/homicide risk, lack of ability to care for self, rapid symptom progression, lack of social support system

5-7 days is usual

30
Q

How long should patient be treated in continuation phase? How often should patient be seen in continuation / maintenance phase?

A

6 months to a year on pharmacotherapy

  • > goal is to prevent relapse
  • > requires monthly visits (can go to quarterly in maintenance)
31
Q

What is recurrence vs relapse?

A

Recurrence -> new episode of MDD
Relapse -> same episode of MDD recovers, where there was remission but not full recovery (i.e. your HAMD score was <7 for only 1 month, and then you got depressed again)

32
Q

What is dysthymia now called and what are its diagnostic criteria? What is the time table?

A 
Persistent depressive disorder (PDD)
Depressed mood and 2+ of HCASES
H: Hopelessness
C: Concentration decrease
A: Appetite change
S: Sleep change
E: Energy decrease
S: Self esteem reduction

Must be for MOST days x2 years, never without symptoms for >2 months
Not enough symptoms for MDD

33
Q

When must symptoms be present for PMDD?

A

Premenstrual dysphoric disorder
-> in most menstrual cycles over the last year (>2 cycles), with at least 5+ symptoms during week before menses, with improvement within a few days of menses, and minimal / no symptoms a week post menses

34
Q

What are the AT LEAST 1 required symptoms of PMDD?

A

Affective lability (i.e. mood swings)
Irritability / anger / conflict
Depressed mood
Anxiety / tension

35
Q

What are the additional symptoms of PMDD?

A

Depression symptoms
Overwhelmed / out of control feeling
Physical symptoms - include breast tenderness, joint / muscle pain, bloating / weight gain

36
Q

What are the treatments for PMDD, regarding lifestyle, nutrition, and pharmacotherapy?

A

Lifestyle - increase exercise
Nutrition: B6, E, calcium, and magnesium supplements, with reduction in sodium and caffeine intake
Pharmacotherapy: SSRIs are first line, oddly enough Luteal (2nd half of ovarian cycle) SSRIs are equally effective

37
Q

What are the diagnostic criteria for a manic episode? Include time scale.

A

At least 1 week of:
Distinct period of abnormally / persistently elevated or irritable mood
AND
Persistently increased goal-directed activity or energy
PLUS 3+ of:
DIGFAST
Distractibility
Indiscretion - excessive pleasurable activities
Grandiosity
Flight of ideas / racing thoughts
Activity increase
Sleep deficit only (decreased need for sleep)
Talkativeness

38
Q

How does a hypomanic episode differ from a manic episode?

A

Identical to manic episode except:

  1. Lasts at least 4 days (instead of one week)
  2. Less significant impairment in functioning -> just noticeable and uncharacteristic change
  3. NO associated psychotic symptoms
39
Q

How is BPAD 1 (bipolar affective disorder) diagnosed?

A

At least one manic episode. Does NOT require depression for diagnosis

40
Q

How is BPAD 2 diagnosed?

A

At least one hypomanic episode AND a major depressive episode

  • > no history of full mania
  • > hypomania does not interfere with functioning significantly, but MDE does
41
Q

What is one thing that makes BPAD compliance to medication difficult?

A

Lack of insight into their own illness

-> don’t feel they need to be on meds

42
Q

Who does BPAD 1 vs BPAD 2 preferentially effect?

A

BPAD 1 = equal prevalence in men and women
BPAD 2 = more women than men (remember, that’s because depression affects women more than men), typically slightly later onset

43
Q

What is the nonspecific brain finding for BPD?

A

Enlarged third ventricles

44
Q

Is bipolar disorder or MDD more heritable? What disease typically co-occurs with this?

A

Bipolar disorder -> family history is a major risk factor

-> high risk of co-morbidity with schizophrenia since they share a similar origin

45
Q

How does BPAD1 typically first present and why is this dangerous?

A

Typically with depression -> dangerous because SSRIs can precipitate manic episode

46
Q

What behaviors tend to precipitate manic episodes?

A

Psychosocial stressors or sleep disturbances -> BPD patients should be sure to get enough sleep

47
Q

What is defined as rapid cycling?

A

BPAD 1 patients who experience 4+ distinct episodes a year

48
Q

What is the prognosis of BPD with respect to MDD? Suicidality?

A

Poorer prognosis -> many do not recover to baseline function during episodes and have significant social decline

Account for 25% of all completed suicides -> most often in depressed episodes

49
Q

What is the diagnostic criteria for cyclothymia?

A

It’s literally the BPD equivalent of PDD (dysthymia)

> 2 years, not >2 months without symptoms, hypomania and depressive symptoms which do not meet criteria for MDE

50
Q

How do you diagnose depressive or bipolar disorder due to another medical illness?

A
  1. Anhedonia or depressed mood
    OR
  2. Manic mood / increased energy

plus:
Evidence that cause is another medical condition (from history, labs, or physical exam
Not better explained by another psych disorder
Significant distress or decrease in function

51
Q

Other than obvious neurologic / endocrine causes (i.e. thyroid / parathyroid, adrenal), what are some infectious and cancer causes of depression or bipolar?

A

Infectious: Hepatitis and HIV
Cancer: Pancreatic

52
Q

How are substance induced depressive and bipolar disorders diagnosed?

A

Same criteria as medical-illness induced, except symptoms develop within 1 month of starting or withdrawing from a substance
+
evidence of association with intoxication or withdrawal and the diagnostic mood symptoms

53
Q

What features would suggest that the MDD or BPD are not medication-induced?

A

Symptoms last for >1 month after substance is stopped

History of recurrent mood episodes before substance use started

54
Q

What is one common medication known to induce depression?

A

Birth control pills

55
Q

What is one substance known to induce both depression and mania?

A

Steroids

56
Q

How are MDE criteria changed for children?

A

Depressed mood may be changed to include irritability

Weight loss may be replaced with growth retardation / lack of expected weight gains

57
Q

How is PDD criteria changed for children?

A

Needs to be persistent for 1 year rather than two, and irritability can replace depressed mood

58
Q

Are there changes in mania / hypomania / cyclothymia related to children?

A

Mania / hypomania = no changes

Cyclothymia = criteria reduced to 1 year (like PDD)

59
Q

What are specifiers to diagnoses like MDE and BPAD?

A

Specific features to add onto a particular diagnosis to make it more clear and show you extra risk factors.

60
Q

What are the criteria for the “anxious distress” modifier?

A 
2+ during majority of time patient is MDE or manic:
A. Keyed up or tense
B. Unusually restless
C. Concentration issues due to worry
D. Fear of something awful happening
E. Fear of losing control

tense, restless, fear of bad things / loss of control, concentration problems

61
Q

What does anxious depress put you at risk for?

A

Increased risk of suicide, longer illness, and treatment non-response

62
Q

What are the criteria for the “mixed features” modifier? What is this associated with?

A

A combination of symptoms of both mania / hypomania and a MDE simultaneously

If mixed features associated with MDD -> higher risk of future development of BPAD 1 or 2

63
Q

What are the criteria for the “seasonal pattern” modifier?

A

Association between onset of symptoms and time of year.

During past 2 years, 2+ episodes demonstrate a pattern, with NO nonseasonal episodes. Seasonable episodes outweigh non-seasonal episodes throughout the patient’s lifetime.

64
Q

What two modifiers can be applied to BPD 1 and MDE, but not BPD2?

A

Psychotic features, catatonic features

65
Q

What two modifiers can only be applied to MDE, and not BPD1/2?

A

Atypical features, melancholic features

66
Q

What are the diagnostic criteria for psychotic features? How do these present?

A

Delusions and hallucinations

These present in a mood-congruent fashion -> in depression: delusions of guilt / punishment. In mania: delusions of grandeur.

67
Q

What are the diagnostic criteria for catatonic features?

A

Immobility -> catalepsy and stupor
Excessive purposeless activity and extreme negativitism
Posturing, sterotypies, mannerisms / grimacing
Mutism
Echolalia / echopraxia

Basically looks like autism and negativity

68
Q

What are echolalia and echopraxia?

A

Echolalia - repeating of a word or phase or sound which was just spoken, sometimes as a means to process speech, other times just to fill in space

Echopraxia - imitating or repeating an action of someone else

69
Q

What are the diagnostic criteria for atypical features?

A 
MDE only:
High mood reactivity
Significant weight gain / increase of appetite with hypersomnia
Leaden paralysis - feeling stiff / heavy
Oversensitivity to rejection
70
Q

What are the diagnostic criteria for melancholic features?

A

Opposite of atypical: Low mood reactivity / complete anhedonia, significant anorexia / weight loss, early morning awakening / insomnia, worse in the morning.

Marked psychomotor abnormalities.

71
Q

What is the peripartum onset modifier?

A

MDE or BPD with symptoms starting during pregnancy or within 4 weeks of delivery

Psychiatry (23 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions