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psycopathology > Lecture 8(block 2) Mood Disorders And Suicide Managenent 1 > Flashcards

Lecture 8(block 2) Mood Disorders And Suicide Managenent 1 Flashcards

1
Q

What are depressive disorders?

A

Disorders that share in common low mood without abnormally high mood periods

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2
Q

Give examples of depressive disorders

A
  • Major depressive disorder
  • Persistent depressive disorder
  • Premenstrual dysphoric disorder
  • Disruptive Mood Dysregulation Disorder
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3
Q

What are the requirements of a diagnosis of Major Depressive disorder?

A

A person must experience atleast major depressive disorder

Person cannot have a history of mania or hypomania

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4
Q

Major depressive disorder is a ….

A

Unipolar depression

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5
Q

Describe a Major Depressive Episode

A

Atleast 2 weeks of 5 or more of the following, one or more must be depressed mood or anhedonia:

Affective- depressed mood, anhedonia

Neurovegetative- significant weight change, insomnia/hypersonia, loss of energy

Cognitive - psychomotor changes, feeling guilty/worthliness, decreased concentration, thoughts of death/ suicidal ideation

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6
Q

What are major depressive disorder specifiers?

A

Used to provide further description of the depressive episode

-A patient may have more than 1 specifier(or none)

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7
Q

What are Major depressive disorder specifier with melancholic features used for ?

A

Used for depressive episodes characterized by symptoms such as:

  • Severe anhedonia, lack of mood reactivity, profound despondency and guilt
  • Depression worse in the morning
  • Early-morning awakenings
  • Significant appetite loss
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8
Q

What is the purpose of for major depressive disorder specifier with atypical features?

A

Used for depressive episodes characterized by symptoms such as:

  • Weight increase
  • Sleep increase
  • Mood reactivity
  • Leaden paralysis
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9
Q

What is the purpose of Major depressive disorder specifier with psychotic features?

A

Used for depressive episodes characterized by hallucinations and/or delusions

  • With mood-congruent psychotic features: the content of delusions/hallucinations is consistent with typical depressive themes
  • With mood-incongruent psychotic features: the content of delusions/hallucinations
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10
Q

What is the purpose of Major depressive disorder specifier with catatonia?

A

Used for depressive episodes characterized by psychomotor symptoms such as:

  • Mutism
  • Immobility
  • Waxy flexibility
  • Stereotypes
  • Other odd posturing
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11
Q

Describe Major depressive disorder specifier with Peri-Partum Onset

A

Used for depressive disorders in which the mood episodes begin during pregnancy or within 4 weeks post-delivery

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12
Q

Describe Major depressive disorder with Seasonal Pattern

A

Used for depressive disorders that show a consistent temporal relationship between time of the year and the mood episode

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13
Q

What is the general course of Major Depressive disorder?

A
  • Usually starts up in in 20s and lasts 6-12 months in duration if left untreated
  • Major Depressive Episodes are usually recurrent
  • 5-10% of patients develop mania after several MDEs (diagnosis will then change)
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14
Q

Give the associated features of Major Depressive Disorder

A

-high psychiatric co-morbidity (e.g. substance dependence)

  • Increased mortality and morbidity
    - Approximately 15% commit suicide
    - Presence of MDD worsens medical condition
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15
Q

Give the common findings neurobiological theory of depression

A
  • A genetic predisposition for depression
  • HPA axis overactivation resulting in chronic cortisol release and Immune system activation
  • underactivity of monoamines( norepinephrine , serotonin, dopamine)
  • Underactivity of prefrontal cortex (prefrontal cortex not inhibiting overactive HPA axis
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16
Q

What can be used to treat Major Depressive Disorder?

A
  • Cognitive Behavioral therapy
  • Antidepressant drugs
  • Electroconvulsive therapy
  • Vagus Nerve Stimulation
  • rTMS
  • Antidepressants
  • Esketamine
  • Phototherapy
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17
Q

How is phototherapy used for MDD treatment ?

A
  • Exposure to bright artificial light

- Used for seasonal pattern of MDD( seasonal affective disorder)

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18
Q

How is Esketamine used for MDD treatment ?

A

A nasal spray

  • Recently approved for treatment -resistant depression
  • Rapid Antidepressant effects
  • NMDA receptor blocker
19
Q

How does Esketamine help in the treatment of MDD?

A

Works as a NMDA receptor blockade

20
Q

How does ECT work in the treatment of MDD?

A
  • Induction of seizures

- Potential fast-acting reversal of mood episode

21
Q

How does VNS in MDD treatment?

A

Stimulates vagus nerve

22
Q

How does rTMS work in MDD treatment ?

A

Stimulates prefrontal cortex

23
Q

How does CBT work in treating MDD?

A

Correct biases in thinking (cognitive) and encourage behaviors associated with good mood( behavioral)

24
Q

What MDD treatment options take 4-6 weeks for effect?

A
  • CBT
  • Antidepressants
  • VNS
  • rTMS
25
Q

What is the “Black Box Warning” of antidepressants?

A

Warning of antidepressants about the increased risk of suicide in people 24 years old or younger when taking them for depression or other psychiatric disorders

26
Q

What are the diagnostic criteria of Persistent Depressive Disorder?

A
  • Chronic depressed mood for 2 or more years

- the depressed mood could be in the form of a long-lasting MDE or dysthymia

27
Q

What is the dysthymia?

A

Chronic depressed Mood and 2 or more of the following symptoms:

  • Poor appetite or overeating
  • Insomnia/hypersomnia
  • Low energy
  • Low self esteem
  • Trouble concentrating or making decisions
  • Feelings of Hopelessness
28
Q

What is the purpose of PDD specifiers?

A

To describe the nature of their depression during the 2 year interval

29
Q

Describe the specifier- PDD with persistent MDE

A

-Depression is characterized by a prolonged MDE

30
Q

Describe the specifier -PDD with pure dysthymia syndrome

A

-Depression is characterized by prolonged dysthymia but no MDE occurs

31
Q

Describe the specifier- PDD with intermittent MDEs

A

-Depression is characterized by dysthymia periods and MDEs

32
Q

How to treat PDD with dysthymia subtype?

A

-CBT and/or antidepressant medications

33
Q

How should PDD be treated with MDE subtypes(either intermittent or persistent )?

A
  • CBT and/or antidepressants

- Depending of severity and treatment-resistance of MDE, more invasive techniques are used (e.g. ECT)

34
Q

What symptoms MUST BE INCLUDED in Premenstrual Dysphoric Disorder?

A
  • Present in the week before menses onset
  • Improve a few days after menses onset
  • Minimizes in the week post-menses
35
Q

What symptoms MAY BE included in Premenstrual Dysphoric Disorder (PMDD)?

A
  • Mood lability, irritability, dysphoria and anxiety symptoms
  • Anhedonia, problem concentrating, lethargy, appetite and sleep change, physical symptoms (e.g. breast tenderness, weight gain)
36
Q

How is clinical significance relevant in PMDD diagnosis ?

A

Symptoms must cause clinically significant distress or functional impairment

- Symptoms are more than just “pre-menstrual syndrome”
- Validated clinical scales are used to confirm the diagnosis
37
Q

How can PMDD be treated ?

A

Several SSRIs are approved for PMDD

38
Q

What are the core features of Disruptive Mood Dysregulation Disorder(DMDD)?

A
  • Severe temper outbursts 3 times a week
  • Sad, irritable or angry mood almost every day
  • Reaction is disproportionate to the situation
  • Symptoms are present in multiple settings
39
Q

Explain the timelines of Disruptive Mood Dysregulation Disorder (DMDD)

A
  • Child must be atleast 6 years old
  • Symptoms must begin before age 10
  • Not diagnosed after age 18
40
Q

Why is DMDD argued to not be a valid diagnostic entity?

A
  • DMDD diagnosis was developed for DSM-5 so a child’s irritability won’t be mislabeled as a part of bipolar disorder
  • Some argue DMDD behaviors are that of Opposition Defiant disorder
  • mislabeling DNDD children with depression would be just as inaccurate and lead to ineffective treatment
  • Etiology, course, management are unknown
41
Q

What is the Mnemonic for the MDE?

A

SIG: Energy CAPSules

S: sleep change
I: interest loss
G: guilt

E: energy problem

C: concentration is poor
A: appetite change
P: psychomotor changes
S: suicidal ideation

42
Q

What are the clusters into which MDE symptoms can be categorized?

A

Affective

Neurovegetative

Cognitive

43
Q

Give examples of MDD with psychotic features

A

Psychotic content : paranoid delusion “people want me dead”

Diagnosis MDD with mood congruent psychotic features

Ex 2

Psychotic content: grandiose delusion “I am the queen of England”

Diagnosis: MDD with mood incongruent psychotic features

44
Q

What is the warning about antidepressant drugs?

A

There is a “black box” warning on antidepressants about the increased risk of suicide in people aged under or equal to 24 years old when taking these drugs

psycopathology (23 decks)

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