Depressive Disorders and Bipolar & Related Disorders II Flashcards
describe diagnostic criteria for persistent depressive disorder (PDD)
- 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
- a long-lasting MDE
describe the 3 PDD specifiers
-
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
what is the diagnosis of this patient?
describe premenstrual dysphoric disorder (PMDD)
- 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)
describe treatment of PMDD
- several SSRIs are approved for PMDD; they are taken either intermittently during a month (2 weeks per month) or continuously
describe disruptive mood dysregulation disorder (DMDD)
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
describe the validity of a DMDD diagnosis
- DMDD diagnosis was developed so that a child’s irritability would not be mislabeled as part of “bipolar” disorder
describe a manic episode
- 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
describe a mnemonic for manic symptoms
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)
describe diagnostic specifiers of BPI (bipolar I)
- 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
- if delusions or hallucinations are present
describe the course of illness of BPI (bipolar I) and differentials
- 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)
do patients need to experience MDEs in order to diagnose BP1?
No, while most BPI patients also experience MDEs, MDEs are NOT necessary for a BPI diagnosis (despite the term “bipolar”)
describe the genetic risk of developing BPI
BPI is more genetically-controlled than MDD
manic episodes involve ____ monoaminergic activity
manic episodes involve increased monoaminergic activity
describe BPI treatment of manic episodes
-
mood stabilizers: drugs used to treat bipolar disorders, especially the manic phase
- ~10 FDA-approved drugs
- lithium
- anticonvulsants
- antipsychotics
- problems with non-compliance
- ~10 FDA-approved drugs
describe treatment of bipolar MDEs (bipolar depression)
- 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)
describe the use of ECT for BPI treatment
- ECT improves both manic and depressive states of BPI
- the #1 use of ECT is for BPI disorder
describe the use of psychotherapy for BPI treatment
- psychotherapy is used for secondary issues (self-esteem, occupational/marital problems) but not to treat the primary symptoms
what are diagnostic criteria for bipolar II disorder (BPII)
- a person experiences at least 1 MDE AND at least 1 hypomanic episode
contrast hypomanic vs manic
- 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
describe graphically the difference beteween BPI and BPII
the more disruptive problem in BPII disorder is the ____ phase. By definition, ____ does not significantly affect the patient’s life
the more disruptive problem in BPII disorder is the depressed phase. By definition, hypomania does not significantly affect the patient’s life
describe diagnostic criteria for cyclothymic disorder
- 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
contrast bipolar vs unipolar MDEs
- 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
describe the chart showing BPI mood possibilities
summarize the mood episodes found in BPI, BPII and cyclothymia
