Depressive Disorders Flashcards by sarala Kal

What is the definition of Depressive Disorders?

Low moods without abnormally high moods

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What is Major Depressive Disorder (MDD)

What can they not have?

What is MDD knows as?

Person must experience one or more major depressive episodes

They can not have a history of mania or hypomania

MDD is known as a unipolar disorder

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What do these mean?
Euthymic
Dysthymic
MDE
Hypomanic
Manic

Euthymic: normal
Hypomanic/Dysthymic: Can still do normal functions
Manic/MDE: Cannot do normal functional tasks

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What is a major depressive episode (MDE)

A major depressive episode is 5 or more symptoms from three different categories for at least 2 weeks

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What are the three categories?

What are the conditions for MDE

What is the Pneumonic?

1/5 of the traits must be either:
Affective Symptoms
1. Depressed mood
2. Anhedonia (lack of pleasure/interest in anything that used to make you happy)
Neuro-vegetative Symptoms:

SIG E CAPS (Energy Capsules)

Sleep Change: Insomnia-they want to sleep, but are unable to
Interest loss
Guilt/worthlessness
Energy Problem: Loss of Energy
Decreased concentration
Appetite change: significant weight change due to loss of weight -LOSE weight
Cognitive:
Psychomotor changes-retardation-similar to watching lectures at 0.5 speed
Suicidal Ideation: thoughts of death about others

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Is there genetic vulnerability?

Yes

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Neurobiology behind MDD
Five structures: increase or decrease?

It is multifactorial

Increase in Amygdala activity
Increase in HPA Axis activity: high cortisol and high levels of cytokines-inflammatory response
Decrease in hippocampus volume
Decrease in volume/activity of dorsolateral prefrontal cortex-inability to inhibit overactivity of limbic regions
decrease neurotransmission of monoamines

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Treatment of MDD

How long do they take to work

Psychotherapy-CBT

2. Antidepressants (AD’s) to INCREASE monoamines (Serotonin and Norepi)-4-6 weeks to work

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What are the different types of AD’s and what are the side effects

SSRI’s-mild side effects-Prozac (Fluoxetine)
SNRI’S-Venlafaxine (Effexor)
TCA’s-less serotonin, more norepinephrine, many cardiac side effects-postural HTN, tachycardia
MAOi’s-not selective to serotonin-diet restrictions to avoid Tyramine: induce HTN,: avoid beer, wine, aged cheese

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Common theme for Bipolar Disorders?

High mood

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BP1 Criteria? There are 4.

Must experience 1 manic episode
symptoms last at least 1 or more weeks
Marked impairment in functioning
Can also express MDE’s (more common)

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What is a Manic Episode

What is the pneumonic and what are the symptoms

Abnormally elevated mood AND increased energy
“feel on top of the world”

Need 3 other symptoms:

DIG FAST

Distractibility
Irresponsibility: excessive involvement in “risky/pleasurable” activities
Grandiosity/inflated self esteem
Flight of ideas and/or racing thoughts
Increased goal-directed behavior or psychomotor agitation
Decreased need for sleep
Talkativeness/pressured speech

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Is BPI more or less controlled by genetics?

Manic episodes involve increase or decrease in MAO activity?

MORE-80%

INCREASE

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Treatment for BPI?

What are they and how do they work?

Mood Stabilizers: Drugs used to treat bipolar disorders especially manic phase

Treatment of Manic Episodes include: Lithium, Anticonvulsants, and Antipsychotics
Treatment of bipolar MDE’s are:
- Antidepressants not FDA approved due to risk of inducing mania
- Antipsychotics

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BPII

A person who experiences at least 1 MDE and at least 1 HYPOmanic episode

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What is a hypomanic episode?

Includes the same symptoms of mania but of different severity-does not cause impairment of functioning
Change in mood must be unequivocal and uncharacteristic of person
Must last four or more days

What is the most disruptive problem in BPII?

Treatment?

The depressed phase-this can affect the patient’s life while the hypomania phase does not

Same as BPI

What is Cyclothymic Disorder?

How is it different from BPI?

Treatment?

For 2 or more years, a person experiences periods of hypomanic symptoms that fluctuate with periods of depressive symptoms but criteria for an MDE or manic episode haven’t been met

-Mood shifts are not as extreme

Mood Stabilizers

What are specifiers for mood disorders?

There are 7. pneumonic?

Used for depressive and bipolar related disorders to provide further description of mood episodes
CRAMPPS
1. Catatonia
2. Rapid Cycling
3. Atypical Features
4. Melancholic features
5. Psychotic features
-Mood Congruent
-Mood Incongruent
6. Peripartum Onset
7. Seasonal Pattern

What is Catatonia?

Used for depressive/manic episodes with psychomotor symptoms such as:

Mutism
Immobility
Waxy flexibility
Stereotypes
Other odd posturing

What is Rapid Cycling?

When four or more mood episodes occur in a year

A mood episode can be mania, hypomania, or depression

What are Atypical Features

Weight gain
Sleep increase
Mood reactivity
Leaden Paralysis-feel that you’re made of lead, and lack energy

What are melancholic features?

Characterized by symptoms such as:

Severe anhedonia, lack of mood reactivity, profound despondency and guilt
When depression is worse in the morning
Wake up early in the morning
Significant loss in apetite

What are psychotic features?

Episodes characterized by hallucinations and/or delusions

Mood congruent: content is consistent with typical themes of that mood-sad when depressed, happy during mania

Mood INcongruent: hallucinations do not involve typical themes of that mood state

What is Peripartum Onset

Used for mood disorders in which mood episodes onset is during pregnancy or within 4 weeks of delivery

What is with seasonal pattern

when disorders show consistent temporal relationship between time of year and mood episode

What are the four brain stimulation therapies for Mood Disorders?

1. Electroconvulsive Therapy 2. Repetitive Transcranial Magnetic Stimulation 3. Vagus Nerve stimulation 4. Experimental - Magnetic Seizure therapy - Deep brain stimulation

1. What is Electroconvulsive Therapy? 2. What are the indications? 3. What is the mechanism of action 4. What are the contraindications? 5. What is the procedure?

1. Electrical Induction of a generalized seizure-patient is pre-treated with a muscle relaxant to prevent injury and an anesthetic to reduce consciousness 2. Treatment-resistant depression/mania or severe depression/mania 3. Multiple and indiscriminate CNS effects, but therapeutic mechanism has not been isolated 4. vascular disease because BP increases during a seizure 5. Place the electrode in the frontotemporal area or start unilateral, then progress to bilateral, which is more effective. Induce a generalized seizure for 30 seconds or more 3 times a week for for 2-4 weeks (6-12 treatments)

What are the long and short term effects of ECT? | What is the efficacy of ECT?

Initial: headaches, some memory loss for recent long-term memory and some consolidation difficulties surrounding ECT sessions Long term: no permanent memory system problems-memory abilities normalize few months post-treatment Efficacy: - Rapid clinical improvement of mood episode-complete remission within 3-4 weeks, generally considered safe and rapidly effective - Used to treat acute illness, but not as prophylaxis

What is Repetitive Transcranial Magnetic Stimulation? (rTMS) What are the side effects? How long are sessions? Who is it available to?

- Magnetic pulses are used to stimulate the prefrontal cortex - Minimal-scalp discomfort at stimulation site - 40 minutes 5x/week, takes 4-6 weeks of sessions before benefits are seen Available to patients who have failed at least 1 medication trial

What is vagus nerve stimulation?

- Intermittent electrical stimulation of vagus nerve - For treatment resistant depression - risks of surgery/implantation - Mild effecting of stimulation-coughing - effects take several months

What are 2 experimental brain stimulation therapies?

1. Magnetic Stimulation Therapy (MST) - similar to ECT except seizures are induced by rTMS, and focally induced. - The goal is to retain ECT effectiveness but reduce memory side effects 2. Deep Brain Stimulation (DBS) - For OCD - Target sites that have been experimented include: subcallosal cingluate white matter, reward pathway, ventral tegmental, nucleus accumbens to feel less Anhedonic

Persistent Depressive Disorder What two forms can it be in?

Chronic depressive mood for 2 or more years OR Dysthymia-chronic depressed mood plus 2 or more of the following symptoms: 1. poor appetite/overeating 2. insomnia/hypersomnia 3. low energy 4. low self-esteem 5. trouble concentrating or making decisions 6. feelings of hopelessness

What are PDD Specifiers? There are 3, when do you use them?

Use to describe nature of depression during 2 year interval 1. With persistent MDD: prolonged MDE 2. With pure Dysthymic episode: prolonged dysthmia, but no MDE 3. With intermittent MDEs: dysthymic episode AND MDE

Treatment for PDD?

- Severe MDE/Treatment resistant MDE: Brain stimulation therapies - Dysthymic MDE: Same psychotherapeutic and pharmacologic methods as MDD

What is PMDD (Premenstrual Dysphoric Disorder) When should symptoms present? What are the symptoms? What are the rules? Treatments?

- Symptoms must present in the week before menses and improve a few days after and minimize in the week post-menses - Symptoms include: mood lability, irritability, dysphoria, and anxiety symptoms, anhedonia, problems concentration, lethargy, appetite and sleep change, and physical symptoms such as breast tenderness and weight gain - Symptoms must cause clinically significant distress or functional impairment - SSRI's

Disruptive Mood Dysregulation Disorder (DMDD) What are the core features? Timelines? Why was this developed?

1. Severe temper outbursts at least 3 times a week 2. Sad irritable, or angry mood daily 3. Reaction is disproportionate to situation 4. Symptoms present in multiple settings Child must be at least 6 years old, symptoms must begin before the age of 10 and cannot be diagnosed after the age of 18 Developed so that a child's irritability would not be mislabeled as part of a bipolar disorder