Depressive Disorders

Question 1

MDD Criteria

Answer 1

A. 5 or more of the following have been present during the same 2 week period and represent a change in functioning, and at least 1 must be depressed mood or anhedonia
- depressed mood
- anhedonia
- significant weight loss or gain/similar with appetite
- insomnia/hypersomnia
- psychomotor agitation or retardation
- fatigue
- feelings if worthlessnesss/inappropriate guilt
- poor concentration or indecisiveness
- recurrent thoughts of death or suicide
B. Symptoms cause significant distress or impairment in functioning
C. Episode is not secondary to an exogenous substance or medical condition
D. Episode is not better explained by schizo spectrum/other psychotic disorder
E. No history of manía or hypomania

Question 2

Investigations for MDD

Answer 2

Biological: same as for schizo + EBV serology, iron, folate, B12, vit D
Psychological: DASS, PHQ-9, MSE

Question 3

Management of MDD

Answer 3

Biological:
- Antidepressants
- continue for 6-12 months after remission, 2 years of relapse
- if treatment resistant, augment with lithium, atypical antipsychotics, ECT
Psychological:
- psychoeducation, CBT, IPT
Social:
- academic and occupational achievement, peer support, healthy diet, exercise, cessation of substance abuse

*for mild-mod usually only need psychotherapy and psychosocial intervention

Question 4

Manic episode criteria

Answer 4

A. distinct period of abnormally and persistently elevated, expansive or irritable mood lasting at least one week/any duration of hospitalization
B. during period of mood disturbance, at least 3 (or 4 if mood only irritable) of the following:
- inflated self-esteem/grandiosity
- decreased need for sleep
- talkative/pressured speech
- flight of ideas/thoughts racing
- distractibility
- increase in goal-directed activity/psychomotor agitation
- excessive involvement in activities with high potential for painful consequences
C. Symptoms don’t meet criteria for mixed episode
D. mood disturbance severe enough to cause marked impairment in functioning/social activities/need hospitalization/psychotic features
E. not due to substance/general medical issue

Question 5

Bipolar disorder criteria

Answer 5

at least one manic episode

not better explained by schizophrenic/psychotic disorder

Question 6

Management of bipolar disorders

Answer 6

Biological: 
- mood stabilizers +/- SSRI 
- antipsychotics +/- SSRI 
- ECT 
Psychological 
- CBT, IPT
- restoration of sleep-wake cycle 
- reduce stimulating activities 
Social 
- like MDD

Question 7

Acute manic episode management

Answer 7

• admit to hospital
• cease antidepressants/stimulants
• acute sedation with BDZ/sedating AP
• investigate for organicity
• start mood stabilizers + AP and maybe BDZ
• may need ECT

Question 8

Tests for bipolar

Answer 8

Similar to MDD

MDQ, BDRS, MADRS