Jacobs: Mood Disorders Flashcards by Megan Foggia

Most common psychiatric illness you are likely to see as a physician

depression

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Co-morbidities of depression?

substance abuse disorders
pathological gambling
personality disorders
anxiety

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Women are (blank) more likely than men to experience depression during their lifetime.

70%

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Lifetime prevalence of depression?

16.5%

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What age group has the highest rate of depression? What nationality?

40-59;

non-hispanic black

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T/F: Medical students are more prone to depression than nonmedical peers

True

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(blank) is a disproportionally high cause of death among physicians

suicide

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Total annual cost of depression?

$83 billion

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When diagnosing depression, what are some things to consider?

bereavement
normal reaction to stress or loss
adjustment disorder
cultural factors

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Things included in major depressive episode diagnostic criteria?

2+ weeks of symptoms
5+ of 9 possible symptoms (depressed mood or loss of interests must be one symptom, weight/appetite changes, sleep changes, fatigue, etc)
marked distress of functional impairment
rule out medical and substance etiologies

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Use SIGECAPS to screen for depression. What does it stand for?

Sleep disturbance
Interest reduced
Guilt and self-blame
Energy loss and fatigue
Concentration probs
Appetite changes
Psychomotor changes
Suicidal thoughts

**need depressed mood or loss of interest

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Depression = depressed mood or loss of interest most of the day nearly every day plus at least (blank) of the symptoms for at least 2 weeks.

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What are these?

sleep disturbance
appetite problems
loss of energy
decreased libido
psychomotor retardation

neuro vegetative symptoms

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What are some “somatic symptoms” that might accompany depression?

nausea
constipation
headaches
back pain
SOB
chest pain

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When do 50% of major depressive orders begin? When is the peak incidence? What is the median age of onset? Can it occur in children/elderly?

ages 20-50;
peak incidence in 20’s;
onset age 32;
yes!

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How long does a single episode of major depressive disorder last?

6-13 months untreated

1-3 months treated

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Are relapsing depressive episodes common?

yes; 70% can have a recurrence

**15% suicide

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2 years of low mood (1 year for children/adolescents)
Milder, more fluctuating symptoms
Presence 2 additional symptoms
appetite, sleep, fatigue, self esteem, concentration, hopelessness
Distress or impaired functioning

Persistent depressive disorder

**milder, longer lasting form of depression - low mood for two years

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What is double depression?

low level of chronic persistent depressive disorder complexed with a shorter more severe spout of depression

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Used to be “Depression NOS” in DSM-IV
A. In the majority of menstrual cycles, > 5 symptoms present during the week before menses, improving within a few days of onset of menses, and becoming minimal/absent in the week after menses
B. > 1 symptoms: affective lability, irritability/anger/conflict, depressed mood, anxiety
C. > 1 symptoms: anhedonia, difficulty concentrating, lethargy, change in appetite, hypersomnia/insomnia, overwhelmed/out of control, physical symptoms (bloating, pain, weight gain, etc)
***D. CSD or interference with functioning

premenstrual dysphoric disorder

**focus on D, because lots of women have bad menses, but women who meet criteria have it so bad that it causes clinically significant distress or interferes w functioning

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A patient can have a prominent and persistent disturbance in mood that is judged to be the direct pathophysiological consequence of another medical disease. Give an example.

neurologic: parkinson’s, huntington’s
metabolic: renal failure

GI: IBS, chronic pancreatitis

endocrine: hypothyroidism
cardiovascular: cardiomyopathy, MI
pulmonary: OSA

etc etc..

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A prominent and persistent disturbance in mood that is judged to be due to the physiological effect of a substance or medication

substance-induced depressive disorder

Some drugs known to cause substance-induced depressive disorder

alcohol, benzos, opioids
hallucinogens
withdrawal from stimulants
oral contraceptives
steroids
antihypertensives (reserpine, beta blockers)

T/F: There are clinically significant depressive syndromes that do not meet criteria for established categories of depression

True

How is bereavement different from depression?

bereavement should not induce a major depressive episode **it used to be that grief should clear in 2 months... not an exclusion in DSM V

T/F: Children of depressed parents who are adopted out are at increased risk for depression

True

T/F: There is a strong familial pattern with depression

True * *first degree relatives are 2-5x more likely to depressed * *monozygotic twins at greater risk

6 pertinent biogenic amines

``` dopamine epinephrine ACh norepi histamine serotonin ```

4 theories on etiology of depression

``` learned helplessness model (exposure to uncontrollable negative events) cognitive theory (depression is a result of cognitive errors) genetics biology (dopamine, epi, etc) ```

What is this? the hypothalamus hypersecrets CRF in depression, resulting in elevated ACTH, which then triggers the adrenal cortex to release extra cortisol; unipolar and bipolar depressed patients oft have elevated cortisol that cannot be suppressed with dexamethasone; ketoconazole lowers cortisol levels and can be efficacious in treatment-resistant depression

neuroendocrine model of depression

What is this? the Borna virus and other infectious agents can cause depression; the antiviral amantadine can be helpful

infectious model

elevated mood + increase in goal-directed activity or energy for a week or more 3 or more additional symptoms inc self-esteem/ grandiosity decr need for sleep more talkative racing thoughts/ FOI distractible incr activity (school, work, sex, social) activities with neg. consequences (shopping sprees, business investments, gambling)

manic episode

The disorder is characterized by severe recurrent TEMPER outbursts in response to common stressors. A. The temper outbursts are manifest verbally and/or behaviorally, such as in the form of verbal rages, or physical aggression towards people or property.  The reaction is grossly out of proportion in intensity or duration to the situation or provocation.  B. The responses are inconsistent with developmental level. C. Frequency: The temper outbursts occur, on average, three or more times per week. D. Mood between temper outbursts: 1. Nearly every day, the mood between temper outbursts is persistently negative (irritable, angry, and/or sad). 2. The negative mood is observable by others (e.g., parents, teachers, peers).

Disruptive mood dysregulation disorder

What are these? ``` Single manic episode Most recent episode hypomanic Most recent episode manic Most recent episode depressed Most recent episode unspecified ```

bipolar types

What is the avg age of onset of bipolar disorder?

20's-30's

How long do manic episodes last?

weeks to months **not transient mood swings

Is rapid cycling common in bipolar disease? Ex: 4+ episodes in a year

no, less common

T/F: 60% of people with bipolar disease have a family history of mood disorder

True

T/F: Bipolar disorder is likely a mixture of genetic and environmental factors

True

T/F: Bipolar disorder can be secondary to another medical condition

True

If there is head trauma to the right frontal lobe, what is the result?

mania

If there is head trauma to the left frontal lobe, what is the result?

depression

If there is head trauma to the medial frontal lobe, what is the result?

apathy

If there is head trauma to the orbitofrontal lobe, what is the result?

profanity irritability irresponsibility

Which drugs can cause substance-induced bipolar disorder?

``` LSD stimulants (meth) PCP steroids L dopa thyroxine captopril **drug withdrawal of clonidine ```

At least 4 days of elevated mood + increase in goal-directed activity or mood 3 or more other symptoms (4 if mood is just irritable) Change in functioning Not severe enough to severely impair functioning or necessitate hospitalization No psychosis

hypomanic episode

Hypomanic episode + Major depressive episode | Never a history of manic episodes

Bipolar type II

So how is a hypomanic episode different from a manic episode?

1. hypomanic episodes are usually not severe enough to impair functioning, but cause a change in functioning 2. hypomanic episodes have no psychotic symptoms 3. manic episode lasts at least 1 week; hypomanic episode lasts at least 4 days

Involves the occurrence of one or more manic episodes with or without a history of one or more major depressive episodes Lifetime prevalence = .4-1.6% Equally common in males and females

Bipolar I

Involves at least one major depressive episode and one hypomanic episode with no history of manic episodes Lifetime prevalence = .5% More common in females

Bipolar II

Combining aspects of two different disorders Schizophrenia symptoms (psychosis, negative symptoms) Prominent affective (mood) symptoms Psychotic symptoms present even when mood symptoms absent

Schizoaffective

What two types of symptoms are present in schizoaffective disorders. Which symptoms are always present?

schizophrenia symptoms (psychosis, negative symptoms) prominent mood symptoms; Psychotic symptoms present even when mood symptoms absent

Chronic mood disturbance (over 2 years) Hypomanic symptoms that don’t meet criteria for a hypomanic episode (hypomania) Depressive symptoms that don’t meet criteria for a major depressive episode (mild depression) No history of depressive, manic or hypomanic episodes Clinically significant distress or functional impairment

Cyclothymic disorder