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Behavioral Dynamics Exam 2 > Mood/affect disorders > Flashcards

Mood/affect disorders Flashcards

1
Q

A persistent and sustained “feeling
tone” or emotion, endured internally, and which impacts aspects of a person’s thoughts and behavior

A

Mood

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2
Q

APA Definition of Mood

A

“a disposition to respond emotionally in a particular way that may last for hours, days, or even weeks,
perhaps at a low level and without the person knowing what
prompted the state. Moods differ from emotions in lacking
an object

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3
Q

A _____ is defined by marked disruptions in emotions. These can be severe lows called depression, or
highs called hypomania or mania

A

Mood Disorder

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4
Q

Mood Disorders Screenings

A

● The Patient Health Questionnaire for depression (PHQ-9)
● PHQ-2
● Mood Disorder Questionnaire

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5
Q

Epidemiology of major depressive disorder

A

About 7% annually, highest incidence in ages 18-30
● Onset: Anywhere from pubitery to late life. Peak in the 20s

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6
Q

Pathophysiology of MDD

A

Not completely known
● Hypothalamic-pituitary-adrenal axis
● Various brain regions: amygdala, hippocampus, basal ganglia
● Genetic variations
● Neurotransmitters: Serotonin, tryptophan, dopamine, Noradrenaline
● Inflammation and Oxidative stress

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7
Q

Risk factors of MDD

A

● Family History of any mental health condition
● Female gender (1.5 to 3 times higher rates)
● Adverse childhood events (ACEs)
● Substance use (also increases severity)
● Sleep conditions (Apnea, insomnia, nocturia)

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8
Q

What are some of the disorders that coexist with unipolar depression?

A

● Dysthymia
● Generalized anxiety disorder
● Obsessive compulsive disorder
● Panic disorder
● Post traumatic stress disorder
● Agoraphobia
● Substance abuse

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9
Q

Over ___% of patients with MDD have at least one other comorbid psychiatric condition.

A

50

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10
Q

A true major depressive episode must last at least _____.

A

2 weeks

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11
Q

Physical Exam findings for MDD

A

● Blunted or depressed affect
● Psychomotor agitation (pacing, hand-wringing, fidgeting…) or retardation (slowed
speech, thinking, or movement, low volume speaking…)
● Decreased concentration

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12
Q

You should Always screen for a history of ____ in MDD

A

mania

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13
Q

Specify whether the MDD is “Mild”, “Moderate”, or “Severe” based on ____

A

number of symptoms,
intensity, and impairment

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14
Q

“with peripartum onset” refers to

A

Postpartum Depression
○ Onset during pregnancy or within 12 months of giving birth`

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15
Q

Depressive Disorders - Lifestyle Treatment

A

● Exercise: resistance or aerobic, 3-5 times a week, 45-60 minutes per
session.
● Improved sleep
● Relaxation Activities or meditation
● Generally improving diet can be helpful in some patients
● Peer support
● Avoiding drugs and alcohol

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16
Q

Depressive Disorders - Psychotherapy Treatment

A

● Most effective is Cognitive behavioral therapy (CBT)
● Interpersonal psychotherapy
● Behavioral activation
● Psychodynamic psychotherapy
● Provider guided programs - if available, not as helpful
● Motivational Interviewing

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17
Q

Depressive Disorders - Pyarmagotherapy first line option

A

General first option: Selective Serotonin Reuptake Inhibitor (SSRIs)
Other options are SNRIs, Wellbutrin, TCAs and MAOIs

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18
Q

Best outcomes in Depressive disorders involve

A

Lifestyle + Therapy + Medications

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19
Q

Common Side effects of medications for Depressive disorders

A

Diarrhea, nausea, somnolence, low libido, weight gain

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20
Q

How long to wait before saying a medication isn’t working?

A

○ If not improvement after 4-6 weeks, likely won’t have much improvement.
○ Give it up to 6-12 week to see max improvement

21
Q

Which medication do I choose first for a Depressive disorder?

A

● Utilize the side effect profile/other indications for a medication to assist you
For example:
○ Are they also try to quit smoking? Try Bupropion
● Balance efficacy (“Does it work?”) and acceptability (“Does it cause them side
effects?” and “What does it cost them?”)

22
Q

Serotonin syndrome symptoms

A

● Typically occurs with coadministration of multiple serotonergic drugs
● Symptoms: anxiety, agitation, confusion, delirium, hyperreflexia, muscle rigidity,
myoclonus, tachycardia, tachypnea, and tremor.
○ Severe cases: hyperthermia

23
Q

Serotonin syndrome Mechanism, onset and risk factors?

A

● Mechanism: overstimulation of serotonin receptors, generally dose-related
● Onset: Usually rapid; in the majority of cases (74%), onset occurred within 24 hours of
treatment initiation, overdose, or change in dose.
● Risk factors: Concomitant use of drugs that increase serotonin synthesis, block
serotonin reuptake, and/or impair serotonin metabolism. Can include non-psych drugs
like ondansetron

24
Q

Other Treatment Options for resistent depression:

A

● Transcranial magnetic stimulation (TMS)
○ Efficacious for acute, moderate treatment-resistant depression
● Ketamine Infusion or intranasal Esketamine
○ Becoming first-line for severe treatment-resistant depression
● Electroconvulsive therapy (ECT)
○ Can be difficult to get access to, can cause severe memory impairment
● Antipsychotic Medications
● Psilocybin? Nitrous oxide (laughing gas)? Neuromodulation?

25
Q

Persistent depressive disorder (dysthymia) criteria

A

● Depressed Mood
● Hopelessness
● High or low appetite or sleep
● Poor energy, concentration, or self esteem
● Continuous - No lapse in symptoms longer than 2 month in 2 years
○ Most of the day, more days than not

26
Q

Clinical presentation of Persistent Depressive Disorder (Dysthymia)

A

Early in life and insidious onset. Chronically depressed
(Length of time differentiates this from major depressive disorder)

27
Q

Persistent Depressive Disorder (Dysthymia) treatment

A

Similar to Major Depression: Lifestyle + Therapy + Medications = Best outcome
● Psychotherapy: Cognitive behavioral therapy or interpersonal psychotherapy
● Pharmacotherapy: Usually SSRIs

28
Q

Adjustment Disorder

A

● Emotional or behavioral changes within first 3 months after known
stressor
● Distress out of proportion to stressor or impairment in functioning
● Stops by 6 months after end of stressor

29
Q

Assessment and Diagnosis for adjustment disorder

A

● Screen patients with stressful life events for this
● Common in primary care

30
Q

Adjustment Disorder - Treatment

A

● Brief Therapy
● Reassurance
● Screening for Suicide
● Treat insomnia, anxiety, or panic attacks as needed (Ex.
Hydroxyzine)
● FMLA or short term disability if helpful

31
Q

Normal Grief Reaction- Treatment

A

No medications are usually indicated
Help them understand normal grieving
Therapy can be helpful, especially to prevent complicated grieving
Encourage peer support
Make sure to treat any short term anxiety and sleep appropriately and screen
for suicidality

32
Q

No medications are usually indicated for

A

Normal Grief Reaction

33
Q

Prolonged Grief Disorder

A

Prolonged grief disorder is defined as intense yearning or longing for the
deceased (often with intense sorrow and emotional pain), and preoccupation
with thoughts or memories of the deceased (in children and adolescents, this
preoccupation may focus on the circumstances of the death).

34
Q

Clinical presentation - Prolonged Grief Disorder

A
  • Death of close relationship, at least 12 months have to have passed
35
Q

Symptoms of Prolonged Grief Disorder

A

Persistent yearning, intense sorrow, preoccupation, distress,
bitterness, maladaptation, aloneness, without purpose, desire to die

36
Q

Prolonged Grief Disorder treatment

A

● Education
● CBT adapted for grief
● Eye movement desensitization and reprocessing (EMDR)
● Yoga or mindfulness
● Treat anxiety, depression, or PTSD if occurring as part of or separate from
this

37
Q

Bipolar Disorder risk factors

A

● More common in high income countries
● Advanced paternal age
● Genetics: Family history of Bipolar disorder (and less so schizophrenia) is
the strongest risk factor - 10-fold increase

38
Q

Mean age of onset is 18-20 years old for

A

bipolar disorder
but may present much later in life

39
Q

Bipolar Disorder prognosis

A

Moderately poor
○ Increased cognitive impairment and decreased social cognition
○ Increased risk of perpetrating and being the victim of violence
○ 30% show impairment in work functioning
○ 10-15% of bipolar patients die of suicide

40
Q

Mania Criteria

A

● Elevated, expansive, or irritable mood
● Increased activity or energy
● Lasting at least 1 week
● At least 3 of the following
○ Increased self-esteem or grandiosity
○ Decreased need for sleep
○ More talkative
○ Thoughts racing
○ Distractible
○ Increased goal-directed activity
○ High risk activities
● Marked impairment in functioning

41
Q

Hypomania Criteria

A

● Elevated, expansive, or irritable mood
● Increased activity or energy
● Lasting at least 4 consecutive days
● At least 3 of the following
○ Increased self-esteem or grandiosity
○ Decreased need for sleep
○ More talkative
○ Thoughts racing
○ Distractible
○ Increased goal-directed activity
○ High risk activities
● No marked or severe impairment in functioning, no psychosis present

42
Q

Bipolar Disorder - Types I and II

A

● Bipolar I Disorder:
○ Must meet criteria for at least one Manic Episode
○ May or may not have ever had a depressive episode, although usually
they usually have
● Bipolar II Disorder:
○ Must meet criteria for at least one current or past hypomanic episode
and depressive episode, but no manic episode

43
Q

Bipolar Disorder - Types: Cyclothymic disorder

A

○ Numerous periods of hypomanic
symptoms and periods of depressive symptoms
○ No diagnosable hypomanic or
depressive episodes

44
Q

Treating Mania/Hypomania

A

● Lithium
● Anti Seizure Medications
○ Valproate, Carbamazepine
● Antipsychotics
○ Haloperidol, Abilify, Olanzapine,
Quetiapine, Risperidone, Paliperidone

45
Q

Treating Bipolar Depression

A

● Mood Stabilizers
○ Lamotrigine, Lithium, Valproate
(Depakote)
● Antipsychotics
○ Lurasidone (Latuda), Quetiapine
(Seroquel), Olanzapine (Zyprexa)
● Olanzapine plus fluoxetine (SSRI)
● Antimanic drug plus SSRI or
Wellbutrin
● ECT

46
Q

Premenstrual Dysphoric Disorder (PMDD)

A

Final week before
onset of menses
○ Mood swings, irritability, depressed mood.

47
Q

Disruptive Mood Dysregulation Disorder

A

Onset before age 10
○ Irritable or angry mood

48
Q

Schizoaffective Disorder

A

○ Schizophrenia with episodes of depression or mania
■ Important to note, psychotic symptoms are always
present, and mood symptoms come and go.

49
Q

What do I need to rule out, before I diagnose any of these mental health conditions?

A

● Drug or Medication use (IE physiological effect of a substance):
● Other Medical conditions:

Behavioral Dynamics Exam 2 (5 decks)

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