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Psych Clerkship > DSM Mood Disorders + Key fun facts > Flashcards

DSM Mood Disorders + Key fun facts Flashcards

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1
Q

What is a “mood disorder”?

A

when a person experiences abnormal range of moods and lose some level of control over them

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2
Q

What are examples of mood disorders?

A

defined by their patterns of mood episodes

  • Major Depressive Disorder
  • Bipolar I disorder
  • Bipolar II disorder
  • dysthymic disorder
  • cyclothymic disorder

*note… if a psychotic feature occurs during these moods… it becomes “bipolar with psychotic features”

If there are psychotic features in the ABSENCE of mood episodes/disorders… then start thinking about schizoaffective disorder

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3
Q

What are mood episodes? (4)

A

distinct period of time in which some abnormal mood is present. The 4 types are:

  • depressed
  • mania
  • hypomania
  • mixed
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4
Q

What are DSM criteria for a “Major Depressive Episode”?

Note that these can occur within major depressive disorder as well as within bipolar I/II disorder

A

*at least 5 of 9 + anhedonia/depressed mood (of the 5… one MUST BE from #1 and/or #2 required) for at least 2 weeks!

1) Depressed mood (self-described)
2) anhedonia

3) sleep changes
4) appetite changes
5) guilt/worthlessness
6) energy loss/ fatigue
7) concentration down
8) Psychomotor retardation/agitation
9) suicide/death… recurrent thoughts

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5
Q

DSM criteria for Manic Episode?

A

period of abnormally and persistently: elevated, expansive, or irritable mood last at least 1 week (or if hospitalized) and includes at least 3 of the following 7

1) distractibility
2) increase in goal-directed acitivity (social, work, sexual)
3) grandioisity
4) flight of ideas/racing thoughts
5) pressured/uninterruptible speech
6) sleep – decreased need for it
7) irresponsibility – excessive invovlement in high risk things (shopping sprees… going to unprotected sex partys)

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6
Q

What else should you look for in a manic patient? (big difference from hypomanic episode… in a manic episode there is severe impairment in social/work functioning + …)

A

75% of them have psychotic symptoms!!! it is a psychiatric emergency; severely impaired judgment! THESE ARE NOT present in hypomanic episode!

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7
Q

What is a mixed episode? (DSM criteria)

A

when both manic episode and major depressive episode criteria are met simultaneously… Must be present nearly every day for at least 1 week…

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8
Q

DSM criteria for hypomanic episode?

A

distinct period of elevated, expansive, or irritable mood that includes 3 symptoms listed for manic… essentially the SAME for manic episode EXCEPT…

hypomanic only need to be present for 4 days, NO marked impairment in social or occupational functioning, does NOT require hospitalization, NO psychotic features!

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9
Q

its important to remember that there may be medical causes for depression or manic episodes… name 1 super high yield medical condition that could cause each of these

A

Depressive episode - cerebrovascular disease (stroke, MI)… stroke patients are at a very high risk for developing depression!!!

Manic episode - hyperthyroidism!!

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10
Q

What are DSM criteria for Major Depressive Disorder?

A

At least one major depressive episode with NO history of manic or hypomanic episodes! (otherwise you’re looking at bipolar)

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11
Q

Name 4 important epi facts regarding MDD?

A

1) lifetime prevalence is 16.2%… prevalence in elderly is 25-50%
2) women 2X more likely than men during reproductive years… but prevalence is equal between men and women after menopause and before menses
3) MDD has the highest rate of suicide of any disorder
4) average age of onset is 40

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12
Q

What kind of sleep problems do people with MDD have?

A

multiple awakenings

initial and terminal insomnia (hard to fall asleep and early morning awakenings)

hypersomnia (excessive sleepiness… more in atypical)

REM sleep shifted to earlier in the night and overall decrease in stage 3/4 sleep (aka less deep sleep)

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13
Q

What is the leading pathophys hypothesis underlying depression?

A

decreased 5-HT! both in the brain and CSF… also decreased levels of 5-HIAA

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14
Q

What are some important medical conditions that can cause depression?

A

Obviously a stroke like mentioned earlier, but also:

high cortisol

abnormal thyroid

genetics (2-3X more likely to have MDD if 1st degree relative does)

pancreatic and colon cancers have a high association with depression.

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15
Q

What is the course/prognosis of depression?

A

typically self-limiting but lasts anywhere between 6 and 13 months… Risk of 2nd episode is 50% in first 2 years after first episode… about 15% eventually commit suicide.

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16
Q

How long should a person be on anti-depressants for after a single episode of MDD?

A

at least 6 months!!!`

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17
Q

Recall the 3 ‘big’ medication categories for depression and name a few high yield side effects for them

A

SSRIs - GI dist and sexual dysfunction

TCAs - most lethal in OD, sedation, wt gain, ortho hypotension (except for nortriptyline), can aggravate prolonged QT syndrome

MAOIs - HTN crisis risk w/ tyramine foods & 5-HT syndrome risk with combo SSRI usage… most useful for atypical depression!

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18
Q

How long does it take antidepressant meds to work on average?

A

4-8 weeks…

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19
Q

Should a post-partum patient (3 days PP for example) be given medication?

A

no… PP depression typically resolves without medication

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20
Q

What are some key signs of atypical depression?

A
  • mood reactivity (mood can brighten with positive events)
  • leaden paralysis (heaviness sensation in legs)
  • hypersomnia (increased amount of sleep)
  • hyperphagia
  • hypersensitive to interpersonal rejection

***Recall atypical depression is best treated typically with a MAOI (phenelzine, tranyl—, isocarb—)

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21
Q

What are “melancholic” features of depression?

A

characterized by anhedonia, early morning awakenings, excessive guilt, and anorexia

22
Q

What are the five stages of grief in order?

A
  • DABDA*
    1) denial
    2) anger
    3) bargaining
    4) depression
    5) acceptance
23
Q

What are NORMAL signs of bereavement (aka grief)

A

typically in reaction to a major loss: often lasts for 2 months and includes:

crying spells
problems sleeping
trouble concentrating at work

does NOT include gross disorganization or suicidality!

24
Q

What are some key ways to distinguish between normal grief and depression?

A

grief: illusions are common but suicidal thoughts are rare… symptoms last 2 months and tx with antidepressants

25
Q

DSM criteria for Bipolar I Disorder

A

ONLY requirement is occurence of one manic episode or mixed episode…

Between manic episodes their may be euthymia, or major depressive episodes, dysthymia, or hypomanic episodes but NONE are required for diagnosis!

26
Q

What are some key facts about Bipolar I (3)

A

1) lifetime prevalence 1%, men = women
2) onset usually before 30
3) HIGHEST genetic link of all major psychiatric disorders… 8-18X more likely to develop bipolar 1 if you have a 1st degree relative with the disorder…

27
Q

How long does a manic episode last usually and what is the prognosis or Bipolar I?

A

untreated manic episodes last ~3 months

90% of people will have a 2nd manic episode within 5 years

it has a worse prognosis than MDD

25-50% of people w/ bipolar 1 attempt suicide, and 15% die by suicide, which is higher than MDD

28
Q

how effective is Li in treating bipolar?

A

70% reduction in mania and long-term reduction of suicide risk.

29
Q

When would you use carbamazepine or valproic acid over lithium in treating bipolar?

A

they are better for rapid cycling bipolar and mixed episodes although they are associated with a higher risk of suicide!

*rapid cycling is defined by 4+ mood episodes in 1 year

30
Q

What is the role of antipsychotics in bipolar?

A

they are effective both as monotherapy and adjunct for acute mania

31
Q

what should you screen for before prescribing an antidepressant?

A

be sure to ask about DIGFAST to look for a history of mania… they could be one of those patients with major depressive episodes in between manic episodes… IF given an antidepressant, a bipolar pt can actually be sent into a manic/hypomanic episode!

32
Q

What is the sequence typically tried for a manic patient?

A

1) lithium
2) valproate
3) ECT

ECT works well in treatment of manic episodes.. and is the BEST for a manic women who is pregnant!

33
Q

What are some side effects of lithium?

A

1) wt gain
2) tremor
3) cardiac arrhythmias
4) seizures
5) goiter/hypothyroidism
6) leukocytosis (benign)
7) polyuria (nephrogenic Diabetes insipidus)
8) alopecia
9) metalic taste

34
Q

What is bipolar 1 previously known as?

A

“manic depression”… however now depression is not required for diagnosis

35
Q

What are the DSM criteria for bipolar 2?

A

history of at least 1 major depressive episode and AT LEAST one hypomanic episode…

If there has been a full manic episode even in the past… then the dx is bipolar I NOT bipolar II…

36
Q

What are 4 key facts about bipolar 2?

A

1) more prevalent than bipolar 1
2) Onset usually before age 30 (just like Bp 1)
3) slightly more common in women
4) frequently misdiagnosed as unipolar depression!!! and therefore mistreated with antidepressants and sent into a hypomanic episode!

37
Q

How is bipolar 2 treated?

A

the same way as bipolar 1…

38
Q

DSM for dysthymic disorder?

A

(chronic mild depression most of the time with no discrete episodes)
1) depressed mood majority of time for at least 2 years

and at least 2 of the following:

  • poor concentration/difficulty making decisions
  • feeling of hopelessness
  • poor appetite or overeating
  • insomnia or hypersomnia
  • low energy or fatigue
  • low self-esteem

AND

*during the 2 year period:
person has not been without about symptoms for >2 months at a time
NO major depressive episodes (recall 5 of 9 for 2 weeks)
NEVER a hx of manic or hypomanic episodes… otherwise the diagnosis would be bipolar or cyclothymic disorders respectively)

39
Q

What is a key way to think about dysthymic disorder?

A

2D’s

2 years of not quite major depressive episodes
2 listed criteria
(all while never asymptomatic for >2months)

*never has psychotic features either…

40
Q

What are some key epi facts about dysthymic?

A

1) lifetime prevalence is 6%
2) 2-3X more common in women
3) onset before age 25 in 50% of patients

41
Q

what is most effective at treating dysthymic disorder?

A

cognitive therapy… antidepressants are useful when used concurrently with psychotherapy.

42
Q

DSM for cyclothymia?

A

(alternating periodsd of hypomania with mild to moderate depressive symptoms)

Numerous periods of hypomania and periods of mild to moderate depression symptoms for at least 2 years

Person must have never been symptom free for >2 months during those 2 years

No history of major depressive episode or manic episode

(essentially the dysthymic disorder + bipolar II mixed… oa combo of not quite major depressive episode + not quite mania for a long time and alternating)

43
Q

What is the epidemiology facts (3) of cyclothymia

A

1)

44
Q

what is the prognosis?

A

1/3 are eventually diagnosed with bipolar… aka the depression becomes full (bipolar 2…) or the mania becomes full (bipolar 1)

45
Q

What is the difference between minor depressive disorder and dysthymic disorder?

A

Key to look for whether or not there are euthymic periods are also seen… these are present in minor depressive disorder but NOT in dysthymic disorder… 18% with minor DD may fall into major depressive disorder within 1 year

46
Q

How do you diagnose seasonal affective disorder?

A

at least 2 consecutive years of 2 major depressive episodes during the same season (usually in winter but not required).

47
Q

What is the “triad” for Seasonal affective disorder?

A

1) hypersomnia
2) carbohydrate cravings
3) irritability

48
Q

DSM for adjustment disorder?

A

(maladaptive behavior or emotional symptoms develop after a stressful life event).

symptoms begin within 3 months after the event, end within 6 months of the event and cause significant impairment in faily functioning

DSM:

1) emotional or behavioral symptoms within 3 months after a stressful life event. these symptoms produce either:
- severe distress in excess of what would be expected after such an event
- significant impairment in daily functioning

2) symptoms are NOT those of bereavement (DABDA,

49
Q

What is important about the “stressor” in adjustment disorder?

A

It cannot be a life threatening event… otherwise you might be looking at a PTSD… the stressors for adjustmenet disorder are things like: death of a loved one, divorce, job loss

50
Q

When are adjustment disorders typically diagnosed?

A

They are typically diagnosed during teenage years (more vulnerable) BUT can be diagnosed at any time (more common in females)… overall adjustment disorders are VERY common

51
Q

How is adjustment disorder best treated?

A

supportive psychotherapy (most effective)
group therapy
pharmacotherapy only for associated symptoms (insomnia, anxiety, depression)

Psych Clerkship (6 decks)

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