Depressive Disorders Flashcards
What is the definition of Depressive Disorders?
Low moods without abnormally high moods
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
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
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
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
Is there genetic vulnerability?
Yes
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
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
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
Common theme for Bipolar Disorders?
High mood
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)
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
Is BPI more or less controlled by genetics?
Manic episodes involve increase or decrease in MAO activity?
MORE-80%
INCREASE
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
BPII
A person who experiences at least 1 MDE and at least 1 HYPOmanic episode
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?
- Electroconvulsive Therapy
- Repetitive Transcranial Magnetic Stimulation
- Vagus Nerve stimulation
- Experimental
- Magnetic Seizure therapy
- Deep brain stimulation
- What is Electroconvulsive Therapy?
- What are the indications?
- What is the mechanism of action
- What are the contraindications?
- What is the procedure?
- Electrical Induction of a generalized seizure-patient is pre-treated with a muscle relaxant to prevent injury and an anesthetic to reduce consciousness
- Treatment-resistant depression/mania or severe depression/mania
- Multiple and indiscriminate CNS effects, but therapeutic mechanism has not been isolated
- vascular disease because BP increases during a seizure
- 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?
- 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 - 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:
- poor appetite/overeating
- insomnia/hypersomnia
- low energy
- low self-esteem
- trouble concentrating or making decisions
- 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
- With persistent MDD: prolonged MDE
- With pure Dysthymic episode: prolonged dysthmia, but no MDE
- 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?
- Severe temper outbursts at least 3 times a week
- Sad irritable, or angry mood daily
- Reaction is disproportionate to situation
- 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
