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NB 2 Development > Depressive Disorders and Bipolar & Related Disorders II > Flashcards

Depressive Disorders and Bipolar & Related Disorders II Flashcards

1
Q

describe diagnostic criteria for persistent depressive disorder (PDD)

A
  • ​chronic depressed mood for ≥ 2 years
  • the depressed mood can be in the form of:
    • a long-lasting MDE
      • or
    • dysthymia: ≥ 2 of the following:
      • poor appetite or overeating
      • insomnia/hypersomnia
      • low energy
      • low self-esteem
      • trouble concentrating or making decision
      • feelings of hopelessness
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2
Q

describe the 3 PDD specifiers

A
  • PDD with pure dysthymic syndrome
    • depression is characterized by prolonged dysthymia but no MDE occurs
  • PDD with persistent MDE
    • depression is characterized by a prolonged MDE
  • PDD with intermittent MDEs
    • depression is characterized by dysthymic periods and MDEs
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3
Q

what is the diagnosis of this patient?

A
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4
Q

describe premenstrual dysphoric disorder (PMDD)

A
  • symptoms must:
    • present in the week before menses onset
    • improve a few days after menses onset
    • minimize in the week post-menses
  • symptoms include:
    • mood lability, irritability, dysphoria and anxiety symptoms
    • anhedonia, problems concentrating, lethagy, appetite and sleep change, physical symptoms (breast tenderness, weight gain)
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5
Q

describe treatment of PMDD

A
  • several SSRIs are approved for PMDD; they are taken either intermittently during a month (2 weeks per month) or continuously
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6
Q

describe disruptive mood dysregulation disorder (DMDD)

A

not diagnosed after age 18

  • diagnostic criteria:
    • severe temper outbursts at least 3 times/week
    • sad, irritable or angry mood almost daily
    • reaction is disproportioante to situation
    • symptoms are present in multiple settings
  • timelines
    • child must be at least 6 years old
    • symptoms must begin before age 10
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7
Q

describe the validity of a DMDD diagnosis

A
  • DMDD diagnosis was developed so that a child’s irritability would not be mislabeled as part of “bipolar” disorder
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8
Q

describe a manic episode

A
  • abnormally elevated mood (or irritability) PLUS increased energy
  • at least 3 additional symptoms are required:
    • inflated self-esteem/grandiosity
    • decreased need for sleep
    • pressured speech
    • flight of ideas (and/or racing thoughts)
    • distractibility
    • increased goal-directed activity or psychomotor agitation (purposeless activity)
    • excessive involvement in “risky” activities
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9
Q

describe a mnemonic for manic symptoms

A

abnormally elevated (or irritable) mood and increased energy PLUS ≥ 3 of the following (manics DIG FAST)

  • Distractibility
  • Irresponsibility (excessive involvement in pleasurable activites)
  • Grandiosity, inflated self-esteem
  • Flight of ideas, racing thoughts
  • increased goal-direct Activity/psychomotor agitation
  • decreased need for Sleep
  • talkativeness (pressured speech)
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10
Q

describe diagnostic specifiers of BPI (bipolar I)

A
  • BPI with “rapid cycling”
    • if a patient experiences ≥ 4 mood episodes/year
  • BPI with “psychotic features”
    • if delusions or hallucinations are present
      • specify if mood-congruent or mood-incongruent
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11
Q

describe the course of illness of BPI (bipolar I) and differentials

A
  • BPI often begins with MDEs before the first manic episode is experienced
  • mania usually occurs directly before/after an MDE and lasts on avg. approx. 3 months
  • differentials
    • rule out another medical condition (esp. if onset after age 40) and substance intoxication (esp. stimulant drugs)
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12
Q

do patients need to experience MDEs in order to diagnose BP1?

A

No, while most BPI patients also experience MDEs, MDEs are NOT necessary for a BPI diagnosis (despite the term “bipolar”)

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13
Q

describe the genetic risk of developing BPI

A

BPI is more genetically-controlled than MDD

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14
Q

manic episodes involve ____ monoaminergic activity

A

manic episodes involve increased monoaminergic activity

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15
Q

describe BPI treatment of manic episodes

A
  • mood stabilizers: drugs used to treat bipolar disorders, especially the manic phase
    • ~10 FDA-approved drugs
      • lithium
      • anticonvulsants
      • antipsychotics
    • problems with non-compliance
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16
Q

describe treatment of bipolar MDEs (bipolar depression)

A
  • antidepressants (ADs) are NOT FDA-approved for BP depression and are contraindicated due to risk of inducing mania
    • if ADs are used (off-label), a mood stabilizer is added
  • antipsychotics are the ONLY FDA-approved drugs for BP depression (different from those used to treat mania)
17
Q

describe the use of ECT for BPI treatment

A
  • ECT improves both manic and depressive states of BPI
    • the #1 use of ECT is for BPI disorder
18
Q

describe the use of psychotherapy for BPI treatment

A
  • psychotherapy is used for secondary issues (self-esteem, occupational/marital problems) but not to treat the primary symptoms
19
Q

what are diagnostic criteria for bipolar II disorder (BPII)

A
  • a person experiences at least 1 MDE AND at least 1 hypomanic episode
20
Q

contrast hypomanic vs manic

A
  • hypomania includes the same symptoms of mania but of different severity
    • mania causes “marked” impairment in functioning; hypomania does not
  • change in mood must be “unequivocal” and “uncharacteristic” of person
  • hypomania must last ≥ 4 days
21
Q

describe graphically the difference beteween BPI and BPII

A
22
Q

the more disruptive problem in BPII disorder is the ____ phase. By definition, ____ does not significantly affect the patient’s life

A

the more disruptive problem in BPII disorder is the depressed phase. By definition, hypomania does not significantly affect the patient’s life

23
Q

describe diagnostic criteria for cyclothymic disorder

A
  • for ≥ 2 years, a person experiences periods of hypomanic symptoms that fluctuate with periods of depressive symptoms
  • criteria for a MDE or a manic episode have never been met
24
Q

contrast bipolar vs unipolar MDEs

A
  • in BP disorders, a MDE may be the patient’s first mood episode (prior to a manic/hypomanic episode)
  • beause of treatment implication, it’s important to determine whether a MDE reflects MDD or a BP disorder
  • some factors suggesting a bipolar depression are:
    • family history of BPI
    • onset in adolescence
    • short MDEs (< 3 months)
    • psychotic features
25
Q

describe the chart showing BPI mood possibilities

A
26
Q

summarize the mood episodes found in BPI, BPII and cyclothymia

A

NB 2 Development (20 decks)

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