mood disorder

Question 1

Criteria of MDD

Answer 1

• For at LEAST 2 WEEKS, Five or MORE of these SYMPTOMS, at least one of which is DEPRESSED MOOD or LOSS of INTEREST/PLEASURE
  
  • depressed mood most of the time, most days
  • loss of interest or pleasure in activites, most of the time, most days
  • significant change in appetite or weight
  • significant cahgne in sleeping habits
  • psychomotor agitation or retardation
  • fatigue or loss of energy, most of the time, most days
  • feeling of worthlessness or excessive guild
  • diminished ability to conc or make decisions
  • recurrent thoughts of death and suicide

Question 2

Course of illness of MDD

Answer 2

• Women twice as likely to experience a depressive episode
• Average age of onset mid-20’s, but may begin at any age
• TEND TO BE EPISODIC
  
  • Untreated episodes typically last at least four months, but will typically eventually remit spontaneously

Question 3

what to do before begining treatment

Answer 3

• Rule out medical causes for mood disturbances
• establish a diagnosis
• assess substances use
• assess for manic and psychotic symptoms
• determine patient preference and past treatment outcomes
• assess suicidality

Question 4

MAOI

Answer 4

• phenelzine and selegiline
• Not a first-line treatment due to signifcant risk with drug-food or drug-drug interations
  
  • goods containing tyramine cause HTN crisis

Question 5

Tricyclic antidepressants

Answer 5

• imipramine, amitriptyline
• side effects: dry mouth, constipation, weight gain, orthostatic hypotensions, sexual dysfunction
• rarely used now for depression; too lethal in event of overdose (cardiac arrhythmias and seizures)
• still used for chronic pain

Question 6

SSRI

Answer 6

Most common FIRST-LINE TX

• citalopram, escitalopram, fluoxetine, fluvoxamine, paraxetine, sertraline
• less sedating, less likely to cause weight gain than tricyclics but equally likely to cause sexual dysfunction, GI upset, headache, sleep distrubance
• NON-lethal overdose
• require 2-7 weeks for patient to notice a response

Question 7

SNRI

Answer 7

• first-line treatment
• venlafaxine, desvenlafaxine, duloxetine, levomilnocipran
• side effects = elevated blood pressure and heart rate, weight gain, sexual dysfunction

Question 8

Bupropion

Answer 8

anti-depressant

• norepinephrine and dopamine reuptake inhibitor
• activating, increases energy, does not help with anxiety, unlike SSRI and SNRI
• Does NOT cause sexual dysfunction, or weight gain
• can be used for smoking cessation

Question 9

Mirtazopine

Answer 9

anti-depressants

• significant sedating and wieght gain effects; useful in patients where insomnia an dloss of appetite and prominent

Question 10

Bipolar disorder

Answer 10

• less prevalence (1%)
• highly recurrent course (90%)
• diagnosis requires the presence of a manic or mixed episodes; no depressive episode is required
• elevated risk of suicide

Question 11

manic episodes

Answer 11

• distinct period of abnormally elevated, expansive, or irritbale mood and abnormally and persistently increased goal-directed activity or energy lasting at least one week
• at least three of the following symptoms:
  
  • inflated self-esteem or grandiosity
  • decreased need for sleep
  • increased talkativity or pressure to talk
  • flight of ideas or racing thoughts
  • distractivility
    
    • increase in goal-diret acitivity

Question 12

hypomanic episode

Answer 12

• some symptoms as manic episode, but less severe, 4 days or more
• symptoms are a definite change from baseline, but do not markedly impair functioning

Question 13

TX of bipolar disorder

Answer 13

• MOOD STABILIZERS
  
  • Lithium
    
    • higher effect but difficult to tolerate
    • narrow therapeutic window, can cause a variety of toxicities; requires ongoing close monitoring
  • anti-convulsants (lamotrigine, divalproex)
    
    • can also cause serious adverse evetns and require careful monitoring
• GOOD SLEEP HABITS are particularly important

Question 14

MDD

Answer 14

ONE or more major depressive episodes WITHOUT any manic, hypomanic, or mixed episodes

Question 15

Persistent depressive disorder

Answer 15

chronic, low-level depressed mood most days for at least 2 years

Question 16

Bipolar I disorder

Answer 16

one or more manic or mixed episodes (no MDE required)

–> hypomanic and depressive episodes may also be present

Question 17

bipolar II disorder

Answer 17

at least one hypomanic and at least one depressive episode without any manic or mixed episodes

Question 18

Cyclothymia

Answer 18

• 2 yrs of fluctuating periods of hypomanic and depressive symptoms that don’t meet full criteria for a hypomanic or major depressive episodes
  
  • must include clinically significant distress or impairment and neer symptom free for mroe than 2 months