Mood and Other Disorders Flashcards
Adjustment Disorder diagnostic criteria ?
Emotional or behavioral issues in response to identifiable stressors (such as the death of a loved one) within 3 months of the event
like start of PA school
Adjustment Disorder: Clinically significant as follows ?
Displays marked stress
- Anxiety, low mood, insomnia, worry, poor concentration
Significant social, occupational or other impairment
No not represent normal bereavement
IF YOU SEE SOMEONE DIE IT IS MORE LIKE ACUTE STRESS INJURY
Once stressors end this should resolve in ~ 6 months – if not consider other comorbidities
Adjustment Disorder sub-classifications
Depressed mood
Anxiety
Disturbance of conduct
Mixed emotions
Adjustment Disorder prevalence ?
~12% of the U.S. population
Adjustment Disorder etiology and risk factors ?
The most frequent confirmed diagnoses associated with adjustment disorder were personality disorders, organic mental disorders (something wrong in the brain like dementia), and psychoactive substance abuse disorders
Adjustment Disorder genetics ?
unclear
Adjustment Disorder DDx ?
Depression
Posttraumatic Stress
Disorder
Acute Stress Disorder
Personality Disorders
Adjustment Disorder prognosis ?
Very good
Adjustment Disorder medications ?
SSRIs
Benzodiazepines - mainly used for alcohol withdrawal to prevent siezures or for anxiety
Adjustment Disorder procedures / therapy /surgery ?
Counseling (i.e. CBT)
Major Depressive Disorder diagnostic criteria ?
-Five or more during the same 2 week period and represent a change in previous functioning:
Depressed mood
Markedly diminished interest or pleasure
Significant weight loss/gain
Insomnia/hypersomnia
Psychomotor agitation or retardation - very amped up or very amped up
Feelings of worthlessness / guilt - big ones
Diminished ability to concentrate
Recurrent thoughts of death/suicide
- Do not meet mixed episode
- Cause significant distress
- Not due to drugs or metabolic
- Not better explained by other disorder (i.e. death of a loved one)
what can help document and is an assessment to give to patients for Major Depressive Disorder
PHQ-9
PHQ-9 (Patient History Questionnaire): The nine items of the PHQ-9 are based directly on the nine diagnostic criteria for major depressive disorder in the DSM-IV (Diagnostic and Statistical Manual Fourth Edition). This can help track a patients overall depression severity as well as the specific symptoms that are improving or not with treatment.
Major Depressive Disorder prevalence ?
3.6-6.7%
Major Depressive Disorder etiology and risk factors ?
Life events and Personality (worried type)
Major Depressive Disorder genetics ?
Familial but not well understood
Major Depressive Disorder DDx ?
Medical / Neuro / Infectious /
Medications
Substance Abuse
Neoplasms (Pancreas, bronchogenic, CNS tumors…)
Metabolic (hypothyroidism…many others)
Collagen-Vascular (i.e. SLE)
Postpartum
Major Depressive Disorder prognosis ?
Many recover but ~15% commit suicide
Major Depressive Disorder medications ?
SSRI (typically 9 months to lifetime)
MAOI’s (many side effects)
Major Depressive Disorder procedures / therapy / surgery ?
CBT
ECT (electroconvulsive therapy)
Interpersonal
Couples / Marriage
Persistent Depressive Disorder (Dysthymia) diagnostic criteria ?
Think: Low-grade persistent depression
Depressed mood most of day for more days than not for at least 2 years
2 or more:
Poor appetite / overeating ( not as bad as weight loss or weight gain)
Insomnia or hypersomnia
Low energy or fatigue
Low self esteem
Poor concentration
Feeling hopeless
no thought of suicide or passive death wish
During 2 yrs never more than 2 months without symptoms
Never a manic or hypomanic episode or cyclothymic disorder ( this is bipolar)
Not another disorder (i.e. schizoaffective, etc)
Cause significant distress or impairment
Not attributable to drugs or metabolic causes
Persistent Depressive Disorder (Dysthymia) prevalence ?
~3.2% of U.S and women more than men ( less than major depression)
Persistent Depressive Disorder (Dysthymia) etiology and risk factors ?
Life events
Personality (worried type)
Persistent Depressive Disorder (Dysthymia) genetics ?
Familial but not well understood
Persistent Depressive Disorder (Dysthymia) DDx ? ?
Massive list…
Medical /Neuro / Infectious /
Medications
Substance Abuse
Neoplasms (Pancreas, bronchogenic, CNS tumors…)
Metabolic (hypothyroidism…many others)
Collagen-Vascular (i.e. SLE)
Postpartum
Persistent Depressive Disorder (Dysthymia) prognosis ?
~40% recover in 2 yrs and 30% in 5 years ( not that great)
its pretty resistant to treatment
**Major depression can remit or go away this one tends to stick around for a while **
Persistent Depressive Disorder (Dysthymia) medications ?
SSRI (typically 9 months to lifetime)
MAOI’s (many side effects)
Persistent Depressive Disorder (Dysthymia) procedures / therapy / surgery ?
CBT
Couples / Marriage Counseling
Bipolar I is recurrent _____ with ______ episodes
Recurrent Major Depressive Episodes with MANIC Episodes
Bipolar I diagnostic criteria ?
Abnormal and persistent elevated, expansive, or irritable mood lasting at least 1 wk
During this period 3 or more present to a significant degree:
Grandiosity - impressive appearance
Decrease need for sleep (i.e. <3 hrs)
Talkative / pressure to keep talking
Flight of ideas / racing thoughts that come out through speaking
Distractibility
Increase in goal-directed activity -
Excessive involvement in pleasurable activities (i.e. spending, sex)
Not due to direct causes (i.e. drugs)
SEVERE enough to caused marked impairment
MAY INCLUDE psychotic features
If a manic episode triggered by antidepressants consider BP activation ( bipolar)
**super talkative, racing thoughts, these people are really smart sometimes CEOs of companies **
Bipolar I prevalence ?
0.6-1.1% men=women, women typically worse + rapid-cycling
Bipolar I etiology and risk factors ?
Generally <50 yo – if older consider medical cause
Generally upper socioeconomic class
Can be misdiagnosed as ADHD - cause of the mania
Bipolar I genetics ?
Strong association – about 66% have family Hx
80% concordance with monozygotic twins
very strongly genetic
Bipolar I DDx and Organic causes of mania and hypomania ?
Medications (i.e. isoniazid, anticonvulsants)
Neuro (i.e. MS, Post stroke) /Neoplasms
knock out inhibition in the brian
Schizophrenia / Schizoaffective Disorder
Major Depressive Disorder (and irritability)
Substance Abuse
Bipolar I prognosis ?
Variable (the earlier the onset the worse the prognosis)
variable cause they like the high
mania is energy to the point where it is not useable (cant harness it)
Bipolar I medications ?
Mood stabilizers (i.e. Lithium),
Anticonvulsants (i.e. valproic acid),
2nd generation antipsychotics (i.e. quetiapine) - fewer side effects and more tolerable then 1st generations,
1st generation antipsychotics (i.e. haloperidol)
Bipolar I procedures /therapy / surgery?
Behavioral, cognitive, interpersonal, social rhythm therapy
Bipolar I Rapid cycling ?
increased risk of suicide (cycles up up and down )
Bipolar I slow cycling ?
may not have a manic episode for years
Lithium carbonate (Lithobid) ?
is considered a first-line agent for long-term prophylaxis in bipolar illness, especially for classic bipolar disorder with euphoric mania. It also can be used to treat acute mania, although it cannot be titrated up to an effective level as quickly as valproate can. Evidence suggests that lithium, unlike any other mood stabilizer, may have a specific anti suicide effect
What is critical to do when taking Lithium carbonate (Lithobid) ?
Monitoring blood levels is critical with this medication.
Serum levels should be determined twice weekly during the acute phase, and until the serum level and clinical condition of the patient has been stabilized.
Indications for Quetiapine (Seroquel, Seroquel XR): (2nd generation antipsychotic) ?
is indicated for acute treatment of manic (immediate release and extended release [XR]) or mixed (XR) episodes that are associated with bipolar I disorder. It can be used as monotherapy or adjunctively with agents such as lithium or divalproex.
Aripiprazole (Abilify, Abilify Discmelt) (2nd generation antipsychotic) indications ?
is indicated for the acute and maintenance treatment of manic or mixed episodes associated with bipolar I disorder. It can be used alone or in combination with lithium or valproate.
Haloperidol (Haldol) (1st generation antipsychotic) uses?
is used for the acute treatment of mania or mixed episodes in patients with bipolar disorder. It can be used alone or in combination with lithium or valproate in an adult patient. Haloperidol blocks postsynaptic dopamine receptors (D2) in the mesolimbic system and increases dopamine turnover by blockade of the D2 somatodendritic autoreceptor
Bipolar II is recurrent major depressive episodes with what ?
HYPOMANIC or MANIC Episodes
**bipolar II is hypomanic sxs. **
Bipolar II diagnostic criteria ?
Abnormal and persistent elevated, expansive, or irritable mood lasting at least 1 wk
During this period 3 or more present to a significant degree: Grandiosity Decrease need for sleep (i.e. <3 hrs) Talkative / pressure to keep talking Flight of ideas / racing thoughts Distractibility Increase in goal-directed activity Excessive involvement in pleasurable activities (i.e. spending, sex)
NOT severe enough to caused marked impairment
NO psychotic features otherwise it is BP Type I
Not due to direct causes (i.e. drugs)
**this one cannot have any psychotic features at all **
Bipolar II prevalence ?
0.6-1.1% men=women, women typically worse
Bipolar II etiology and risk factors ?
Generally <50 yo – if older consider medical cause
Generally upper socioeconomic class
Can be misdiagnosed as ADHD