Depressive/Bipolar Disorders Flashcards
MDD Diagnostic Criteria
5+ for more than 2 wks
- One must be depressed mood or anhedonia
Others (4+):
- Significant weight change
- Sleeping change nearly every night
- Psychomotor changes
- Fatigue
- Feelings of worthlessness/excessive built
- Diminished concentration, ability to make decisions
- Recurrent thoughts of death, suicide, or suicide attempt
(Present every day w/ weight and sleeping exceptions)
SIGECAPS
Depression mnemonic for 4+ symptoms/anhedonia:
Sleep disturbance Interest Guilt Energy Concentration Appetite Psychomotor Suicide
MDD
One or more MDEs
MDD Delusions
“I am worthless” “I will be dying shortly”
MDD Perceptual Distubances
“You are worthless” “You should kill yourself”
Assc. Features of MDD
Somatic complaints, irritability, decreased libido, negative ruminations, hoplessness/helplessness, tend to smoke, less physically active, obesity
Sleep problems in depression
Prolonged/increased sleep latency, decreased REM latency, decreased nREM
PFC MDD Correlates
Concentration, interest , pleasure, psychomotor fatigue (mental), guilt, suicidality, worthlessness, mood
Amygdala MDD Correlates
Guilt, suicidality, worthlessness, mood
Hypothalamus MDD Correlates
Sleep, appetite
NA MDD Correlates
Pleasure, interests, fatigue/energy
Striatum MDD Correlates
Psychomotor fatigue (physical)
Cerebellum MDD Correlates
Psychomotor
Spinal cord MDD Correlates
Fatigue (physical)
MDD PET Scan
Hypoactivity of cortex compared to nondepressed
MDD Risk Factors for BPAD I
Onset of illness in adolescence, psychotic features, family history of BPAD
MDD factors assc w/ worse prognosis
Younger pt, personality disorders, symptom severity, psychotic features, prominent anxiety, current episode duration, multiple episodes
Remission
Return to pts baseline level of symptom severity and fxn (HAMD-17 <7)
Time between MDE to be considered separate?
2 months
Stages of tx for MDD
Acute, continuation, maintenance
Acute stage of tx of MDD
Time from diagnosis –> initial reductino of symptoms – response defined as >50% reduction in symptom severity; meet 2x q/mo; medication tx typically for 6-8wks
Indications for MDD Hospitalization
Suicide/homicide risk, inability to care for self, rapidly progressive symptoms, lack of social supports, need for diagnostic procedures
Continuation phase of MDD tx
After remission has been achieved, 6mo-1yr of pharmacotherapy (see pt q2wks or qmo); goal to prevent relapse and consolidate response –> remission
Maintenance phase of MDD tx
Primary goal to prevent relapse (reactivation of index episode)/recurrence (new episode of illness); meet qmo or q3mo
PDD Mnemonic
HCASES (Depressed mood and 2+ for most days x2yrs):
Hopelessness Concentration Appetite Sleep Energy Self esteem
PMDD Diagnostic Criteria
In week prior to most menstrual cycles over last yr (at least 2 cycles), 5+ of:
1+ MUST be present:
- Affective lability
-Irritability/anger/increased IP conflicts
- Depressed mood, hopelessness, self-deprecating thoughts
-Anxiety, tension
Other:
- Anhedonia, fatigue, inability to concentrate
- Change in appetite or sleep
- Overwhelmed/feel out of contorl
- Physical symptoms (breast tenderness/swelling, joint/muscle pain, sensation of “bloating” or wt gain)
Tx of PMDD
Lifestyle: exercise, nutrition (less Na and caffeine); supplements: B6, E, Ca2+, Mg2+; pharmacotherapy: SSRIs
Manic episode diagnostic criteria
At least 1 wk of distinct period of abnormally/persistently elevated, expansive, or irritable mood AND persistently increased goal-directed activity or energy, and 3+ of:
DIGFAST
Distractability Indiscretion Grandiosity Flight of ideas/racing thoughts Activity increase Sleep deficit (decreased need) Talkativeness (pressured speech)
Hypomanic diagnostic criteria
Same as manic but at least 4 days (not 1 wk), assc w/ change in fxn uncharacteristic for pt instead of significant impairment, can NOT have psychotic symptoms
BPAD I
At least 1 manic episode (can/cannot have MDE)
BPAD II
At least 1 hypomanic and 1 MDE
Triggers for manic episodes
Sleep disturbance, or psychosocial trigger
Rapid cycling
4+ BPAD I episodes in 1 yr
Manic episode BPAD I Pharmacotherapy
Li, Valproic Acid, antipsychotics (sedation w/ benzo or antipsychotic if severe)
Maintenance BPAD I tx
Li, Valproic Acid, antipsychotics, carbamazepine, lamotrigine (combo if severe)
Tx of BPAD I MDE
Li, lamotrigine, atypical antipsychogtics, antidepressants (MUST HAVE ADEQUATE MOOD STABILIZATION OR RISK RAPID CYCLING)
Tx of BPAD I Psychosis
Antipsychotic
Cyclothymia Diagnostic Criteria
For 2+ yrs, numerous episodes of hypomania and dysthmia (don’t meet MDE criteria); cannot be w/o symptoms for >2mos; clinically significant distress or impairment in social, occupations, or other fxning
Common assc medical illnesses to BPAD and MDD
Alzheimers, Huntingtons, Parkinsons, CVA, MS, TBI, thyroid/parathyroid/adrenal dysfxn, hepatitiis, HIV, pancreatic cancer
Substances assc w depression
Antidepressants, anticonvulsants, anti-migraine, antipsychotics, antivirals, cardiovascular, hormonal (steroids, OCP), interferon, retinoic acid derivatives, smoking cessation
Substances assc w mania
Antidepressants, amphetamines, L-dopa, steroids
Criteria differences for children with MDE or PDD
MDE: irritability can replace depression, inability to make weight gains instead of weight loss
PDD: one year instead of 2
Criteria differences for children with BPAD and cyclothymia
BPAD: NONE
Cyclothymia: one year instead of two
Anxious distress specifier (disorders and criteria)
Disorders: MDE, mania, hypomania Diagnostic criteria -- 2+ for majority of episode: - Keyed up or tense - Unusually restless - Difficulty concentrating due to worry - Fear that something awful will happen - Fear of losing control
Assc w increased suicide risk, longer duration illness, and great tx non-response
Mixed features specifier (disorders and criteria)
Disorders: MDE, mania, hypomania
Criteria: Combo of symptoms of mania/hypomania and MDE simultaneously
Assc w/ MDE increases risk of BPAD I or II
Seasonal pattern specifier (disorders and criteria)
Disorders: MDD, BPAD I and II
Cirteria:
- Regular assc between onset and time of year OR
- Full remission or change to mania/hypomania at a specific time of year
- During past 2 yrs, 2+ episodes demonstrate pattern and no-nonseasonal episodes have occurred (seasonal episode outweight non-seasonal in total)
Psychotic features specifier (disorders and criteria)
Disorders: MDE, mania
Criteria: delusions and hallucinations (usually mood congruent)
Catatonic features specifier (Disorders and criteria)
Disorders: MDE, mania Criteria: - Immobility: catalepsy or stupor - Excessive purposeless activity - Extreme negativism - Mutism - Posturing, stereotypies, prominent mannerisms or grimacing - Echolalia or echopraxia
Atypical features specifier (Disorders and criteria)
Disorder: MDE only Criteria: - Mood reactivity - Significant weight gain/increase in appetitie - Hypersomnia - Leaden paralysis - Long standing rejection sensitivity
Melancholic features (Disorders and criteria)
Disorder: MDE only
Criteria:
- Loss in pleasure in all/almost all activities
- Lack of mood reactivity
- Distinct quality of depressed mood (worse in AM, early morning awakening, marked psychomotor abnormalities/feels slowed down, significant anorexia/weight loss, excessive guilt)
Peripartum onset (Disorders and criteria)
Disorders: MDE, manic, hypomanic
Criteria: symptoms during pregnancy or w/in 4 wks of delivery
