Lecture 2: Major Disorders Flashcards
Psychiatric Disorders (3)
- Mood disorders
- Anxiety disorders
- Psychotic disorders
Disorder
disruption in normal functioning of a body part or system
Disease
pathophysiological response to external or internal factors
Mood Disorder (3)
- change in mood that is persistent
- accomp. by physical, emotional, and functional deficits
- may be intrinsic or related other factors like stressors, illness, or substance abuse
Quality of Mood
- exists on spectrum
- evaluated in discrete episodes that usually represent a clear departure from “normal”
Mania > euthymia (cheerfullness/tranquility) > depression
Major Depressive Episode overview
depresses, irritable on most days
anhedonia= lack of pleasure in previously pleasureable activities
anhedonia
lack of pleasure in previously pleasurable activities
Major depressive episode signs
- significant appetite disturbance or weight change
- sleep disturbance
- psychomotor agitation or retardation
- loss of energy/fatigue
- feelings of worthlessness
- decreased concentration or cognitive abilities
- recurrent thoughts of death or suicide
- self-rejection/better off dead
Dx major depresive disorder (6)
- symptoms of MDE for at least 2 weeks
- symptoms cause significant social, occupational, or interpersonal functioning
- exclude drug use, bereavement, or other primary mental disorders
- rate severity-mild, moderate, severe
- note psychotic features: hallucinations, negativisitc delusions, or paranoia
- note peri-partum onset (post partum depression)
Persistent Depressive Disorder (3)
- chronic depression without complete remission for 2 years or more
- Dysthymia/ melancholia
- includes episodes of major depression with incomplete remission between episodes
Adjustment disorder
- mood change in reaction to a stressor (job loss, illness, etc. )
with mild functional impairment - Symptoms are brief in duration, less than criteria for full disorders
- Generally do not require pharmacology except for symptomatic approach
- brief psychotherapy if beneficial
Manic Episode (11)
- elated, euphoric, giddy
- inflated sense of self-esteem or grandiosity
- though process races but goal-directed although tengentiality is common
- thought can be excessively focused on religion, business, sexuality, specialness, or persecution.
- speech pressured, difficult to interrupt
- lacks need for sleep
- excessive goal-directed activity with high risk behaviors (spending, sec, business or financial misadventures, chaotic relationships)
- impulsive, easily angered, can lash out physically
- mood lasts for 7 days, may be dx earlier if hospitalized
- may be triggered by medication, stress, drug use-or spontaneous
- significant functional impairment, causes chaos in family and workplace
Hypomanic episode
- similar to symptoms of manic episode but os less intensity and duration
- minimal functional impairment
Mixed specifier
- during either depressive or manic episode, at least 3 diagnostic criteria for the opposite mood episode are also present
- increase complexity of correct diagnosis and treatment
Bipolar I disorder (4)
- at least one documented manic episode
- major depressive episodes not common but not required
- dx may be difficult or delayed
- tx for depression may result in “flip” to mania
Bipolar (II) Disorder (2)
- at least one major depressive episode and at least one episode of hypomania
- no hx full manic episodes
Bipolar Disorders, DX tips (5)
- r/o substance induced origin
- r/o origin due to medical conditions
- r/o other mental disorders
- note psychotic freatures spcifier
- note anxious distress specifier
Mood Disorder Tx steps (4)
- diagnosis, include severity
- discuss tx modes with patient
- choose specific tx
- follow up and monitor
Treating Depression
1st line
2nd line
3rd line
- 1st line treatments: SSRI, SNRI w/ therapy
- 2nd line: atypical antidepressants, TCAs, mood stabilizer, augmentation, TMS
- 3rd line: MAOIs, ECT
Antidepressant pharmacology
SSRIs: fluoxetine, citalopram, sertraline, paroxetine, fluvoxamine, escitalopram, vilazodone, vortioxetine
SNRIs: venlafaxine, duloxtine, levomilnacipran
SGAs: ariprazole, quetiapine, lurasidone
Mood Stabilizers: lithium carbonate, divalproex, cabamezepine
SSRI (4)
Selective, Serotonin reuptake inibitor
- 1st line tx for depression
- ease of dosing, minimal toxicity in OD
- generally well tolerated
- patient preferences, past responses, or family responses considered in selection
SNRI
Serotonin and Norepinephrine Reuptake Inhibitor
- tx option that come clinicians consider first line with SSRIs
- NE receptor binding can help treat anxious distress of concentration issues assoc. with depression
- Duloxetine also indicated for anxiety and neuropathic pain disorders, increasing utility in patients with comorbid issuea
TCAs
tricyclic antidepressants
older class of ad.= impiramine, amitryptyline, doxepin
MAOIs
momamine oxidase inhibitors
react with high amnt. of tyramine to create potentially dangeroud hypertension
req. carefully controlled diet
Atypical antidepressants (4)
bupropion, mirizapine, nefazodone, trazodone
TMS
transcranial magnetic stimulation
stimulates ares of left frontal cortex assoc. with mood.