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PSYCH ROTATION > FIrst Aid: Mood Disorders > Flashcards

FIrst Aid: Mood Disorders Flashcards

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1
Q

What is another term for mood disorders?

A

affective disorders

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2
Q

Distinct period of time in which some abnormal mood is present.

A

Mood episode

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3
Q

List the 4 types of mood episodes.

A
  • Major depressive episode
  • Manic episode
  • Mixed episode
  • Hypomanic episode
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4
Q

When are 2 times you can see a major depressive episode?

A
  • MDD

- Bipolar I/II disorder

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5
Q

Name the DSM IV criteria for a major depressive episode.

A
  • Must have at least 5 of the 9 s/s of depression for at least a 2 week period and must include either depressed mood or anhedonia.
  • Symptoms must cause social or occupational impairment.
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6
Q

Name the 9 s/s of depression.

A
  • Depressed mood*

- SIGECAPS

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7
Q

List SIG E CAPS

A 
Sleep disturbances (insomnia or hypersomnia)
Interest (anhedonia--lose interest in pleasurable activities)
Guilty or worthless feelings
Energy loss or fatigue
Concentration is diminished
Appetite or body weight changes
Psychomotor agitation or retardation
Suicidal thoughts (recurrent)
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8
Q

What is the likelihood for suicide in a pt who has been previously hospitalized for a major depressive episode?

A

15%

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9
Q

What is the DSM IV criteria for a manic episode?

A
  • Period of abnormally and persistently elevated, expansive or irritable mood, lasting for at lease 1 week and including at least 3 of the s/s (4 if mood is irritable)
  • Symptoms must cause social or occupational impairment
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10
Q

List the 7 s/s of mania.

A

DIGFAST

  • Distractibility
  • Insomnia (decreased need for sleep)
  • Grandiosity (inflated self-esteem)
  • Flight of ideas (racing thoughts)
  • Activity is increased and goal directed (socially, at work, or sexually)
  • Speech is pressured (rapid and uninterruptible) and pt is more talkative
  • Thoughtlessness (excessive involvement in pleasurable activities that have high risk for negative consequences)
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11
Q

What percentage of manic patients have psychotic symptoms?

A

75%

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12
Q

What is the criteria for a mixed episode?

A
  • Criteria met for both manic and major depressive episode

- Criteria must be present nearly every day for at least 1 week

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13
Q

What is the predominant mood state in mixed episodes?

A

Irritability

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14
Q

What are the treatment options for mixed episodes?

A
  • Poor response to lithium

- Anticonvulsants may help

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15
Q

What is the criteria for a hypomanic episode?

A
  • Distinct period of elevated, expansive or irritable mood that includes at least 3 of the sympoms of mania (4 if mood is irritable)
  • Does NOT caused marked impairment in social or occupational functioning
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16
Q

What is the time difference between diagnosing a manic v. hypomanic episode?

A

Mania- at least 7 days

Hypomania- at least 4 days

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17
Q

Which type of episode may have psychotic features, mania or hypomania?

A

mania (psychiatric emergency)

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18
Q

What are some medical causes of a manic episode?

A
  • Hyperthyroidism
  • MS
  • Temporal lobe seizures
  • Neoplasms
  • HIV
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19
Q

What is the DSM-IV criteria for MDD?

A
  • At least 1 major depressive episode

- No history of mania or hypomania

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20
Q

What is the subtype of MDD only present during winter months (fewer daylight hours)?

A

SAD (seasonal affective disorder)

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21
Q

How do you treat SAD?

A

Light Therapy

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22
Q

What are the triad of symptoms for SAD?

A

Irritability
Carbohydrate drawing
Hypersomnia

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23
Q

What is the lifetime prevalence of MDD?

A

15%

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24
Q

When is the average age of onset for MDD?

A

40 yo

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25
Q

Is MDD more common in women or men?

A

women 2X more common

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26
Q

What is the prevalence of MDD in the elderly?

A

25-50%

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27
Q

Name the 4 sleep problems associated with MDD.

A
  • Multiple awakenings
  • Initial and terminal insomnia (problems falling asleep and early AM wakening)
  • Hypersomnia
  • REM sleep shifted to earlier in night; stages 3 & 4 decreased
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28
Q

Low CSF levels of what chemicals are found in depressed patients?

A
  • Serotonin

- 5-HIAA

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29
Q

Abnormal regulation of what receptors are seen in depressed patients?

A

Beta-adrenergic

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30
Q

What do drugs that alleviate symptoms of depression do?

A

Increase availability of serotonin, NE, and dopamine

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31
Q

What are cortisol levels like in depressed patients?

A
  • High levels due to hyperactive HPA axis

- Fail to suppress cortisol levels in dexamethasone supression test

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32
Q

What sort of thyroid disorders do depressed patients get?

A

1/3 of MDD patients have blunted TSH response to TRH infusion

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33
Q

True or false: losing a parent before age 11 is associated with later development of MDD

A

true

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34
Q

True or false: stable family and social functioning have no implication on prognosis for MDD patients

A

FALSE- have good prognostic indication

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35
Q

If you have a first degree relative with MDD, what increased risk are you for also developing MDD?

A

2-3X more likely

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36
Q

How many depressed patients contemplate suicide?

A

around 2/3

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37
Q

How many depressed patients commit suicide?

A

10-15%

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38
Q

How long do untreated episodes of MDD last?

A

6-13 months (self limited)

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39
Q

True or false: the episodes of major depression in MDD patients occur more frequently as the disorder progresses

A

True

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40
Q

What is the risk of another major depressive episode within the first 2 years after having one?

A

50%

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41
Q

What percentage of MDD patients receive treatment?

A

50%

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42
Q

What percentage of MDD patients see success with medical therapy (antidepressants)?

A

75%

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43
Q

When do you admit a patient with MDD?

A
  • SI
  • HI
  • Inability to care for self
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44
Q

How long do antidepressants take to work?

A

4-8 weeks

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45
Q

What are the safest and best tolerated class of antidepressants?

A

SSRIs

46
Q

What are the major side effects of SSRIs?

A
  • HA
  • Gastrointestinal disturbance
  • Sexual dysfunction
  • Rebound anxiety
47
Q

Which antidepressants are most lethal in overdose?

A

TCAs

48
Q

What are the major side effects of TCAs?

A
  • Sedation
  • Weight gain
  • Orthostatic hypotension
  • Anticholinergic effects
  • Aggrivation of prolonged QTC syndrome
49
Q

Which antidepressant class are useful for refractory depression or “atypical depression”?

A

MAOIs

50
Q

What is the major concern with MAOIs?

A

Hypertensive crisis with tyramine-rich roods (wine, beer, aged cheeses, liver, smoked meats) or sympathomimetics

51
Q

What is tyramine?

A

Intermediate in conversion of tyrosine to NE

52
Q

What is the most common side effect of MAOIs?

A

Orthostatic hypotension

53
Q

Why do you not combine SSRIs and MAOIs?

A

Serotonin syndrome (autonomic instability, hyperthermia and seizures)

54
Q

When would you use stimulants in MDD?

A
  • Rarely (terminally ill or refractory depression)

- Potential for dependence limits use

55
Q

What drugs help to convert antidepressant non-responders to responders?

A
  • Liothyronine (T3)
  • Levothyroxine (T4)
  • Lithium
  • L-tryptophan
56
Q

What is L-tryptophan?

A

serotonin precursor

57
Q

Which patients may not be able to tolerate antidepressant SEs?

A

elderly

pregnant women

58
Q

When do you use ECT in MDD?

A
  • Unresponsive to pharmacotherapy
  • Cannot tolerate pharmacotherapy
  • Rapid reduction of symptoms is desired (suicide risk)
59
Q

How do you prepare a patient for ECT?

A
  • Atropine
  • General anesthesia
  • Muscle relaxant
60
Q

How are ECT seizures induced?

A

Passing current of electricity across the brain

61
Q

How long do ECT seizures last?

A

less than 1 minute

62
Q

What is the optimal treatment timeline with ECT?

A
  • Around 8 treatments over a 2-3 week period

- Usually see improvement after 1 week

63
Q

What is the most common SE of ECT?

A

retrograde amnesia (usually disappears within 6 months)

64
Q

What percent of hospitalized patients with major depression are melancholic?

A

40-60%

65
Q

List some features of melancholy.

A
  • Anhedonia
  • Early AM wakening
  • Psychomotor disturbance
  • Excessive guilt
  • Anorexia
66
Q

What type of depression has hypersomnia, hyperphagia, reactive mood, leaden paralysis and hypersensitivity to interpersonal rejection?

A

atypical

67
Q

What type of depression (or bipolar) has immobility, purposeless motor activity, extreme negativism or mutism, bizarre postures, and echolalia?

A

catatonic

68
Q

What percentage of hospitalized depressed patients have delusions or hallucinations (psychotic features)?

A

10-25%

69
Q

How do you treat catatonic major depression?

A

antidepressants and antipsychotics concurrently

70
Q

What is the DSM-IV criteria for Bipolar I Disorder?

A

Occurrence of one manic or mixed episode

71
Q

What is another name for Bipolar I Disorder?

A

manic depression

72
Q

Does a patient have to have episodes of major depression to be diagnosed with Bipolar I?

A

No

73
Q

In bipolar I disorder, what commonly occurs between manic episodes?

A
  • Euthymia
  • Major depressive episodes
  • Dysthymia
  • Hypomanic episodes
74
Q

What is the lifetime prevalence of bipolar I?

A

1%

75
Q

When does bipolar I usually get diagnosed?

A

before age 30

76
Q

If you have a 1st degree relative with bipolar I, how much more likely are you to develop it?

A

8 to 18X

77
Q

How long do untreated manic episodes usually last?

A

around 3 months

78
Q

What percentage of patients DO NOT have recurrence of symptoms after the 1st episode of mania in bipolar I?

A

7%

79
Q

Which has a worse prognosis, MDD or bipolar?

A

bipolar

80
Q

What percentage of lithium treated patients show significant improvement in bipolar I symptoms?

A

50-60%

81
Q

What is “rapid cycling”?

A

occurence of 4 or more episodes of major depression, mania or mixed in 1 year

82
Q

How do you treat bipolar I?

A
  • Lithium (mood stabilizer)
  • Anticonvulsants (carbamazepine or valproate)
  • Olanzapine (atypical antipsychotic)
83
Q

What are anticonvulsants especially good for in bipolar I?

A

rapid cycling and mixed episodes

84
Q

What role does ECT play in bipolar I?

A
  • Treatment of manic episodes

- Requires more treatments than for depression

85
Q

List some side effects of lithium.

A
  • Weight gain
  • Tremor
  • GI disturbances
  • Fatigue
  • Arrhythmias
  • Seizures
  • Goiter/hypothyroidism
  • Leukocytosis (benign)
  • Coma
  • Polyuria
  • Polydipsia
  • Alopecia
  • Metallic taste
86
Q

What is another name for bipolar II?

A

recurrent major depressive episodes with hypomania

87
Q

What is the DSM-IV criteria for bipolar II?

A
  • 1 or more major depressive episode and at least 1 hypomanic episode
  • NO h/o full manic episodes (this would be bipolar I)
88
Q

What is the lifetime prevalence of bipolar II?

A

0.5%

89
Q

What gender more commonly gets bipolar (I and II)?

A

I- equal

II- women slightly more

90
Q

When is bipolar II usually diagnosed?

A

usually before age 30

91
Q

What is the prognosis for bipolar II?

A

chronic, requires long term treatment

92
Q

How do you treat bipolar II?

A

same as bipolar I

93
Q

What is the DSM-IV criteria for diagnosing dysthymic disorder?

A
  • Depressed mood for majority of time of most days for at least 2 years (in children for at least 1 year)
  • At least 2 of the s/s
  • During the 2 year period no major depressive epsiodes and no absence of s/s for >2 months at a time
  • NO h/o manic or hypomanic episodes
  • NO psychotic features
94
Q

What are the S/S of dysthymic disorder?

A

CHASES

  • poor Concentration or difficulty making decisions
  • Hopelessness
  • Appetite is poor or overeating
  • Sleep disturbed (insomnia or hypersomnia)
  • Energy is low (fatigue)
  • Self-esteem is low
95
Q

What are the “2 D’s” of dysthymic disorder?

A
  • 2 years of depression
  • 2 listed criteria
  • Never asymptomatic for >2 months
96
Q

What is the lifetime prevalence of dysthymic disorder?

A

6%

97
Q

What gender more commonly gets dysthymia?

A

women 2-3X more common

98
Q

What age do most people present with dysthymia?

A

50% before age 25

99
Q

What is a major difference between dysthymic disorder and MDD?

A

dysthymic disorder is persistent (chronic mild depression with no discrete episodes) usually and MDD is episodic

100
Q

What is the prognosis for dysthymic disroder?

A
  • 20% get major depression
  • 20% get bipolar disorder
  • > 25% have life-long symptoms
101
Q

What is the most effective treatment for dysthymia?

A
  • Cognitive therapy and insight oriented psychotherapy

- Antidepressants when used concurrently

102
Q

What is cyclothymic disorder?

A

alternating periods of hypomania and periods with mild to moderate depressive symptoms

103
Q

What is the DSM-IV criteria for cyclothymic disorder?

A
  • Numerous periods with hypomania symptoms and periods with depressive symptoms for at least 2 years
  • Person must never have been symptom free for >2 months in those 2 years
  • No h/o major depressive episode or manic episode
104
Q

What is the lifetime prevalence of cyclothymic disorder?

A

less than 1%

105
Q

What personality disorder may exist with cyclothymic disorder?

A

Borderline Personality disorder

106
Q

What is the average age of onset for cyclothymic disorder?

A

15-25

107
Q

What is the prognosis for cyclothymic disorder?

A

-1/3 eventually diagnosed with bipolar disorder

108
Q

How do you treat cyclothymic disorder?

A

Antimanic agents used to treat bipolar disorder

109
Q

What is minor depressive disorder?

A

Episodes of depressive symptoms that do not meet criteria for MDD

110
Q

How do minor depressive disorder and dysthymic disorder differ?

A

Minor depressive disorder has periods of euthymia

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