First Aid CH4 Mood Disorders Flashcards
define mood
description of one’s internal emotions influenced by internal and external stimuli, normal to have a sense of control over moods
define mood disorder
abnormal range of moods and loss of some control over them
does hypomania have psychotic features?
no
mood episode vs mood disorder
episode: distinct period of time (depression, mania, hypomania)
disorder: repeating mood episodes (MDD, bipolar I and II, persistent depressive disorder, cyclothymic disorder)
what should always be explored before making a primary psychiatric diagnosis?
medical or substance-induced causes
what is a manic episode?
a psychiatric emergency, impaired judgement can make a patient dangerous to self and others
tx for mixed features
anticonvulsants > lithium
stroke patients are at an increased risk for developing
depression
anhedonia
inability to experience pleasure, common in depression
lifetime prevalence of depression
12% worldwide
depression onset
peaks in 20s
sleep problems associated w/ MDD
multiple awakenings, insomnia (hard to fall asleep, early morning awakenings), hypersomnia (excessive sleeping), greater REM
MDD etiology
specifics unknown, dec CSF levels of 5-HIAA (metabolite of serotonin), high cortisol, abnormal thyroid axis, psychosocial trauma, genetics
MDD prognosis
untreated episodes self-limiting and can last 6-12 months, recurrence 50-60%, 2-12% eventually commit suicide, 60% show dramatic improvement w/ tx (antidepressants + psychotherapy)
what’s used to measure severity of depression?
Hamilton Depression Rating Scale, PHQ-9
what type of CA commonly causes depression?
pancreatic CA
how long does it take for anti-depressants to begin working?
4-6 weeks
TCA risk
cardiac failure d/t arrhythmias
MAOi risk
hypertensive crisis w/ tyramine-rich foods (wine, beer, aged cheeses, liver, smoked meats), serotonin syndrome when used w/ other SSRIs, hypotension
tx of MDD
anti-depressants, psychotherapy (CBT), ECT (if unresponsive to pharm)
serotonin syndrome sxs
autonomic instability, hyperthermia, hyperreflexia, seizures
triad for seasonal affective disorder
irritability
carbohydrate craving
hypersomnia
tx: light/photo-therapy
simple grief also called? features
bereavement
- self-limited, lasts several months
mixed features vs MDD w/ psychotic features
mixed: manic/hypomanic sxs present during major depressive episodes
MDD w/ psychotic features: MDD + delusions and/or hallucinations
tx for MDD w/ psychotic features
anti-depressant + antipsychotic or ECT
what’s the only requirement for bipolar I diagnosis?
manic episodes
can bipolar I include psychotic features?
yes, delusions or hallucinations
rapid cycling
occurrence of four or more mood episodes in 1 year (major depressive, manic, hypomanic)
how many people with bipolar attempt suicide?
25-50%
bipolar I treatment
mood stabilizer + atypical + psychotherapy
- lithium, depakote, carbamazepine
- olanzapine, quetiapine, risperidone, ziprasidone
ECT for tx-resistant bipolar I
- first-line is pt is pregnant
bipolar II
hypomania + MDD
if there’s been a manic episode, can it be bipolar II?
no, only hypomanic episodes qualify for bipolar II
what is lithium known for far as tx benefits?
reduces suicide risk
dysthymia
persistent depressive disorder, depression most of the time
tx for cyclothymic disorder
mood stabilizers or atypicals, similar to bipolar tx
does premenstrual dysphoric disorder ever end?
typically after menopause
PDD (premenstrual dysphoric disorder) tx
SSRIs + OCs
DMDD stands for?
disruptive mood dysregulation disorder
when must DMDD sxs show by?
10 yo
DMDD tx?
psychotherapy + pharm (SSRIs, mood stabilizers, atypicals), meds for comorbid disorders
