FIrst Aid: Mood Disorders Flashcards
1
Q
What is another term for mood disorders?
A
affective disorders
2
Q
Distinct period of time in which some abnormal mood is present.
A
Mood episode
3
Q
List the 4 types of mood episodes.
A
- Major depressive episode
- Manic episode
- Mixed episode
- Hypomanic episode
4
Q
When are 2 times you can see a major depressive episode?
A
- MDD
- Bipolar I/II disorder
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.
6
Q
Name the 9 s/s of depression.
A
- Depressed mood*
- SIGECAPS
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)
8
Q
What is the likelihood for suicide in a pt who has been previously hospitalized for a major depressive episode?
A
15%
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
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)
11
Q
What percentage of manic patients have psychotic symptoms?
A
75%
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
13
Q
What is the predominant mood state in mixed episodes?
A
Irritability
14
Q
What are the treatment options for mixed episodes?
A
- Poor response to lithium
- Anticonvulsants may help
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
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
17
Q
Which type of episode may have psychotic features, mania or hypomania?
A
mania (psychiatric emergency)
18
Q
What are some medical causes of a manic episode?
A
- Hyperthyroidism
- MS
- Temporal lobe seizures
- Neoplasms
- HIV
19
Q
What is the DSM-IV criteria for MDD?
A
- At least 1 major depressive episode
- No history of mania or hypomania
20
Q
What is the subtype of MDD only present during winter months (fewer daylight hours)?
A
SAD (seasonal affective disorder)
21
Q
How do you treat SAD?
A
Light Therapy
22
Q
What are the triad of symptoms for SAD?
A
Irritability
Carbohydrate drawing
Hypersomnia
23
Q
What is the lifetime prevalence of MDD?
A
15%
24
Q
When is the average age of onset for MDD?
A
40 yo
25
Is MDD more common in women or men?
women 2X more common
26
What is the prevalence of MDD in the elderly?
25-50%
27
Name the 4 sleep problems associated with MDD.
- 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
28
Low CSF levels of what chemicals are found in depressed patients?
- Serotonin
| - 5-HIAA
29
Abnormal regulation of what receptors are seen in depressed patients?
Beta-adrenergic
30
What do drugs that alleviate symptoms of depression do?
Increase availability of serotonin, NE, and dopamine
31
What are cortisol levels like in depressed patients?
- High levels due to hyperactive HPA axis
| - Fail to suppress cortisol levels in dexamethasone supression test
32
What sort of thyroid disorders do depressed patients get?
1/3 of MDD patients have blunted TSH response to TRH infusion
33
True or false: losing a parent before age 11 is associated with later development of MDD
true
34
True or false: stable family and social functioning have no implication on prognosis for MDD patients
FALSE- have good prognostic indication
35
If you have a first degree relative with MDD, what increased risk are you for also developing MDD?
2-3X more likely
36
How many depressed patients contemplate suicide?
around 2/3
37
How many depressed patients commit suicide?
10-15%
38
How long do untreated episodes of MDD last?
6-13 months (self limited)
39
True or false: the episodes of major depression in MDD patients occur more frequently as the disorder progresses
True
40
What is the risk of another major depressive episode within the first 2 years after having one?
50%
41
What percentage of MDD patients receive treatment?
50%
42
What percentage of MDD patients see success with medical therapy (antidepressants)?
75%
43
When do you admit a patient with MDD?
- SI
- HI
- Inability to care for self
44
How long do antidepressants take to work?
4-8 weeks
45
What are the safest and best tolerated class of antidepressants?
SSRIs
46
What are the major side effects of SSRIs?
- HA
- Gastrointestinal disturbance
- Sexual dysfunction
- Rebound anxiety
47
Which antidepressants are most lethal in overdose?
TCAs
48
What are the major side effects of TCAs?
- Sedation
- Weight gain
- Orthostatic hypotension
- Anticholinergic effects
- Aggrivation of prolonged QTC syndrome
49
Which antidepressant class are useful for refractory depression or "atypical depression"?
MAOIs
50
What is the major concern with MAOIs?
Hypertensive crisis with tyramine-rich roods (wine, beer, aged cheeses, liver, smoked meats) or sympathomimetics
51
What is tyramine?
Intermediate in conversion of tyrosine to NE
52
What is the most common side effect of MAOIs?
Orthostatic hypotension
53
Why do you not combine SSRIs and MAOIs?
Serotonin syndrome (autonomic instability, hyperthermia and seizures)
54
When would you use stimulants in MDD?
- Rarely (terminally ill or refractory depression)
| - Potential for dependence limits use
55
What drugs help to convert antidepressant non-responders to responders?
- Liothyronine (T3)
- Levothyroxine (T4)
- Lithium
- L-tryptophan
56
What is L-tryptophan?
serotonin precursor
57
Which patients may not be able to tolerate antidepressant SEs?
elderly
| pregnant women
58
When do you use ECT in MDD?
- Unresponsive to pharmacotherapy
- Cannot tolerate pharmacotherapy
- Rapid reduction of symptoms is desired (suicide risk)
59
How do you prepare a patient for ECT?
- Atropine
- General anesthesia
- Muscle relaxant
60
How are ECT seizures induced?
Passing current of electricity across the brain
61
How long do ECT seizures last?
less than 1 minute
62
What is the optimal treatment timeline with ECT?
- Around 8 treatments over a 2-3 week period
| - Usually see improvement after 1 week
63
What is the most common SE of ECT?
retrograde amnesia (usually disappears within 6 months)
64
What percent of hospitalized patients with major depression are melancholic?
40-60%
65
List some features of melancholy.
- Anhedonia
- Early AM wakening
- Psychomotor disturbance
- Excessive guilt
- Anorexia
66
What type of depression has hypersomnia, hyperphagia, reactive mood, leaden paralysis and hypersensitivity to interpersonal rejection?
atypical
67
What type of depression (or bipolar) has immobility, purposeless motor activity, extreme negativism or mutism, bizarre postures, and echolalia?
catatonic
68
What percentage of hospitalized depressed patients have delusions or hallucinations (psychotic features)?
10-25%
69
How do you treat catatonic major depression?
antidepressants and antipsychotics concurrently
70
What is the DSM-IV criteria for Bipolar I Disorder?
Occurrence of one manic or mixed episode
71
What is another name for Bipolar I Disorder?
manic depression
72
Does a patient have to have episodes of major depression to be diagnosed with Bipolar I?
No
73
In bipolar I disorder, what commonly occurs between manic episodes?
- Euthymia
- Major depressive episodes
- Dysthymia
- Hypomanic episodes
74
What is the lifetime prevalence of bipolar I?
1%
75
When does bipolar I usually get diagnosed?
before age 30
76
If you have a 1st degree relative with bipolar I, how much more likely are you to develop it?
8 to 18X
77
How long do untreated manic episodes usually last?
around 3 months
78
What percentage of patients DO NOT have recurrence of symptoms after the 1st episode of mania in bipolar I?
7%
79
Which has a worse prognosis, MDD or bipolar?
bipolar
80
What percentage of lithium treated patients show significant improvement in bipolar I symptoms?
50-60%
81
What is "rapid cycling"?
occurence of 4 or more episodes of major depression, mania or mixed in 1 year
82
How do you treat bipolar I?
- Lithium (mood stabilizer)
- Anticonvulsants (carbamazepine or valproate)
- Olanzapine (atypical antipsychotic)
83
What are anticonvulsants especially good for in bipolar I?
rapid cycling and mixed episodes
84
What role does ECT play in bipolar I?
- Treatment of manic episodes
| - Requires more treatments than for depression
85
List some side effects of lithium.
- Weight gain
- Tremor
- GI disturbances
- Fatigue
- Arrhythmias
- Seizures
- Goiter/hypothyroidism
- Leukocytosis (benign)
- Coma
- Polyuria
- Polydipsia
- Alopecia
- Metallic taste
86
What is another name for bipolar II?
recurrent major depressive episodes with hypomania
87
What is the DSM-IV criteria for bipolar II?
- 1 or more major depressive episode and at least 1 hypomanic episode
- NO h/o full manic episodes (this would be bipolar I)
88
What is the lifetime prevalence of bipolar II?
0.5%
89
What gender more commonly gets bipolar (I and II)?
I- equal
| II- women slightly more
90
When is bipolar II usually diagnosed?
usually before age 30
91
What is the prognosis for bipolar II?
chronic, requires long term treatment
92
How do you treat bipolar II?
same as bipolar I
93
What is the DSM-IV criteria for diagnosing dysthymic disorder?
- 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
What are the S/S of dysthymic disorder?
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
What are the "2 D's" of dysthymic disorder?
- 2 years of depression
- 2 listed criteria
- Never asymptomatic for >2 months
96
What is the lifetime prevalence of dysthymic disorder?
6%
97
What gender more commonly gets dysthymia?
women 2-3X more common
98
What age do most people present with dysthymia?
50% before age 25
99
What is a major difference between dysthymic disorder and MDD?
dysthymic disorder is persistent (chronic mild depression with no discrete episodes) usually and MDD is episodic
100
What is the prognosis for dysthymic disroder?
- 20% get major depression
- 20% get bipolar disorder
- >25% have life-long symptoms
101
What is the most effective treatment for dysthymia?
- Cognitive therapy and insight oriented psychotherapy
| - Antidepressants when used concurrently
102
What is cyclothymic disorder?
alternating periods of hypomania and periods with mild to moderate depressive symptoms
103
What is the DSM-IV criteria for cyclothymic disorder?
- 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
What is the lifetime prevalence of cyclothymic disorder?
less than 1%
105
What personality disorder may exist with cyclothymic disorder?
Borderline Personality disorder
106
What is the average age of onset for cyclothymic disorder?
15-25
107
What is the prognosis for cyclothymic disorder?
-1/3 eventually diagnosed with bipolar disorder
108
How do you treat cyclothymic disorder?
Antimanic agents used to treat bipolar disorder
109
What is minor depressive disorder?
Episodes of depressive symptoms that do not meet criteria for MDD
110
How do minor depressive disorder and dysthymic disorder differ?
Minor depressive disorder has periods of euthymia
