Exam 2 Mood disorders Flashcards
What are the various mood disorders
- Depression: Major Depressive Disorder (MDD); Dysthymia
- Bipolar disorder: Type 1, Type 2, Cyclothymia
- Adjustment Disorder:
- with depressed mood
- with anxiety
- with mixed anxiety and depressed mood
- with disturbance in conduct
- with mixed disturbance of emotion and conduct
- unspecified
S/sx of MDD
- persistent low mood, depressed mood, anhedonia
- loss of interest and enjoyment
- neurovegetative disturbance (slowed down)
- Reduced energy, poor concentration
- social and occupational dysfunction
- weight, libido and sleep changes
- Psychomotor problems
- excessive guild, suicidal ideation
DSM criteria for MDD… LONG LONG LONG
[A]. Presence of Major depressive episode (single or recurrent)
1) Sx present of at least TWO WEEKS. at least one of the sx is either DEPRESSED mood OR LOSS OF INTEREST or pleasure:
- (a) depressed mood most of the day, nearly every day. Children/adolescent can be irritable mood
- (b) markedly diminished interest or pleasure in all or almost all activities most of the day nearly every day
- (c) sig wt loss/gain or increase or decrease in appetite
- (d) Insomnia or hypersomnia nearly every d
- (e) psychomotor agitation or retardation
- (f) fatigue or loss of energy nearly every d
- (g) feelings of worthlessness or excessive or inappropriate guilt
- (h) Diminished ability to think or concentrate or indecisiveness
- (I) recurrent thought of death (not just fear of dying), recurrent suicidal ideation w/o a specific plan or a suicide attempt or a specific plan for committing suicide
2) Not mixed episode
3) Clinically sig impairment
4) not due to drug or GMC
5) NOT BEREAVEMENT
[B] not attributed to schizoaffective disorder or superimposed on other psychotic disorder
[C] no hx of manic, mixed or hypomanic episodes
ways to remember MDD sx ( remember, must have been present at least 2 wks everyday and one being depressed mood or loss of interest/pleasure )
SIG E CAPs
Sleep, Interest, Guilt, Energy, Concentration, Appetite, Psychomotor changes, Suicide
*write for (SIG) some Energy (E) Capsules (CAPs)
MDD specifiers re. psychotic features
Mild, moderate, severe with or Severe without psychotic features
MDD specifiers re. time/chronic
*chronic: >2yr continuous
MDD specifiers re. catatonic features
*with CATATONIC features: immobility, echolalia, echopraxia
MDD specifiers re. melancholic features
with MELANCHOLIC features (anhedonia, or no rxn to pleasure, worse in AM, early AM awakening, marked psych changes, sig wt loss, guilt) (usually older pt)
MDD specifiers re. atypical features
MOOD REACTIVITY, wt gain, hypersomnia, LEADEN PARALYSIS, interpersonal rejection sensitivity leading to sox/oxx impairment (usually younger pt)
MDD specifiers re. postpartum/preg features
With postpartum onset (within 4 weeks)
MDD specifiers re. seasonality
With seasonal pattern (ie winter depression)
*think seattle and maine
What ways can you screen for MDD/depression
PRIME-MD (primary care evaluation of mental disorders)
Patient Health Questionnaire (PHQ-9)
Edinburg Depression Score for Postpartum Depressions
Based off the Patient health questionnaire (PHQ-9), what criteria qualify for MDD
Checked #s 1 or 2 at level of “nearly every day” AND:
- 5 items from #s 3-9 checked at level of “for more than half” or “nearly every day”
- SI (suicidal ideation?) always counted if + response regardless of severity
*Cannot make MDD dx until it is confirmed that pt is w/o hx of hypomanic or manic episode, underlying med condition or drug causing sx and situation of “normal bereavement”
Score of 15-19 = moderately severe, initiate psychopharmacotherapy and/or refer for psychotherapy
Interpreting PHQ-9 results (MDD)
0-4 = none/minimal depression –> no tx
5-9 = mild depression –> watch/wait/reevaluate
10-14 = moderate –> consider referral for psych meds and/or therapy
15-19 = moderate/severe –> initiate pscyh meds and/or refer for therapy
20-27 = severe –> initiate psych meds, may expedite therapy referral
DSM dx criteria for dysthymia
A) depressed mood for most of the day for more days than not as indicated by self or others for at least TWO YEARS
B) Presence while depressed, of TWO OR MORE:
(1) poor appetite or overeating
(2) insomnia or hypersomnia
(3) Low energy or fatigue
(4) Low self-esteem
(5) poor concentration or difficulty making decisions
(6) feelings of hopelessness
{{Eat, sleep, energy, esteem, concentration/decisions, hopelessness}}
[C] during the TWO YEAR PEROID (ONE if child/adoles), the person has never been without the sx in Criteria A and B for >2mth at a time
[D] No MD episode during first 2 yr disturbance
[E] never a manic episode
[F] does not occur during course of psychotic disorder
[G} not due to GMC or substance
[H} sx cause clinically sig distress or impairment
Tx of mild/moderate dysthymia//MDD
Antidepressants (SSRI/SNRI)
Psychotherapy (CBT, IPT)
*IPT = interpersonal threapy
Tx of severe dysthymia/MDD
Antidepressants: SSRI/SNRI, mirtazapine (alpha 2 antagonist, good for older bc wt gain), TCA (cardiotoxic)
Psychotherapy: CBT
Reasonable Alt: ECT
Citalopram, escitalopram, fluoxetine, fluvoxamine CR, Paroxetine CR, Sertraline… class
SSRI
venlaxafine, duloxetine, milnacipran … class of med
SNRI
Atypical anti depressants
Bupropion, Mirtazapine
