Mood Disorder Conditions Flashcards
Etiology, Signs & Symptoms, Assessment. Topics: MDD, Schizo, Bipolar mania, Anxiety
State the biological etiology of MDD
1) Monoamine hypothesis: ↓ neurotransmitters in brain (NE, 5HT, DA)
2) Increase cortisol secretion (major stress hormone)
State how genetics play a role in the etiology of MDD
1) First degree relatives of pt with depression - 1.5-3x more likely to develop depression vs controls
2) Polymorphism in 5HTT gene (S allele of SERT gene more vulnerable to derpressive effects of early life stress). S/S vulnerable to depression. L/L immune to depressive effects of early life trauma
State at least 4 secondary medical conditions that can cause MDD
1) Endocrine: HyPOthyroidism, Cushing syndrome, T2DM (bidirectional association bw depression & T2DM in women)
2) CVD: CAD, CHF, MI (MI pts 2x more likely to be depressed)
3) Deficiency states: Anemia, Wernicke’s encephalopathy
4) Infections: CNS infxn, STD, HIV, TB
5) Metabolic disorders: Electrolyte imbalance ↓K+, Na+, hepatic encephalopathy
6) Neurological: Alzheimer’s, parkinson’s,epilepsy, pain, Post-Stroke
7) Malignancy
List 4 psychiatric secondary causes of MDD
1) Alcoholism
2) Anxiety disorder
3) Eating disorders
4) Schizophrenia
List at least 4 drugs/substances that can induce MDD
ACBPII
1) Withdrawal from alcohol, stimulants
Associated drugs:
2) Systemic Corticosteroids
3) Lipid soluble beta blockers
4) Psychotropics: CNS depressants (benzodiazepienes, opioids, barbiturates, anticonvulsants, tetrabenazine)
5) Isotretinoin
6) Interferon b-1a (hepatitis tx)
List the Signs & Symptoms of MDD
IN. SADCAGES
(1) In terest: Decreased interest and pleasure in normal activities (anhedonia)
(2) S leep: Insomnia or hypersomnia
(3) A ppetite: Decreased appetite, weight loss
(4) D epressed: Depressed mood (adults)
(5) **C **oncentration: Impaired concentration and decision making
(6) **A **ctivity: Psychomotor retardation or agitation
(7) G uilt: Feelings of guilt or worthlessness
(8) **E **nergy: Decreased energy or fatigue
(9) **S **uicidal thoughts or attempts
When diagnosing depression, what are the 2 key symptoms required for an MDD diagnosis?
- Depressed mood and/or
- Loss of interest (anhedonia)
State the DSM-5 diagnostic criteria for MDD
1) ≥ 5 of 9 symptoms (In.SAD.CAGES) FOR 2 WEEKS, including depressed mood or loss of interest
2) Symptoms cause significant distress or impairment in social, occupational, or other important areas of functioning.
3) Symptoms are not caused by an underlying medical condition or substance.
State at least 3 differential diagnosis of MDD
- Adjustment Disorder (Sx w/in 3mths onset of stressor, but no sx when stressor terminated)
- Acute stress disorder (Sx w/in 1mth of traumatic event and lasts 3d-1mth. Sx eg. Fear, helplessness, horror, increased arousal)
- Bipolar affective disorder - depressive episode
- Seasonal Affective Disorder
- Substance induced mood disorder
Before initating anti-depressants for depression, what other mood disorder must be ruled out first?
History of manic/hypomanic episodes
(starting antidepressant may acuse “manic switch” in pts with underlying bipolar disorder
What is the Gold-Standard, Clinician rated psychiatric rating scale used to diagnose MDD? What is the desired target score?
Hamilton Rating Scale for Depression.
Desired Score </=7, indicates remission
(This is a clinician-rated scale)
State 2 Self-Rated Psychiatric Rating Scales used for MDD
Screening tool: PHQ-2
Assessment tool: PHQ-9
Using the PHQ-9 assessment tool, a score of __ warrants antidepressant therapy.
Score of** >/= 10 indicates MODERATE severity, **which suggests antideppressamt therapy.
1-4: minimal symptoms (in remission)
5-9: mild depression
10-14: moderate depression
15-19: moderate-severe depression
20>/=: severe depression
True or False? When using self-rated scales, the PHQ-2 scale should be used first. If there is a positive response to either questions, then the PHQ-9 scale can be considered.
True
State the 2 questions asked in the PHQ-2 screening instrument for Depression
- Little interest or pleasure in doing things (Anhedonia)
- Feeling down, depressed or hopeless (depresesd moods)
Clinical Presentation of Schizophrenia
Positive Sx
1) Delusions (Fixated beliefs despite evidence of contrary)
2) Hallucinations (perception of auditory/visual/ tactile/olfactory in the absence of stimuli)
3) Disorganised speech
4) Grossly disorganised or catatonic behaviour
*3&4 = disorganised thoughts
Negative Sx
1) Affective flatttening (blunting of expression)
2) Avolition (lack of motivation)
State the DSM-5 Criteria for Schizophrenia
1) Two or more symptoms for ≥1mth period, (DHDGN)
- Delusions
- Hallucinations (perception of auditory/visual/ tactile/olfactory in the absence of stimuli)
- Disorganised speech
- Grossly disorganised or catatonic behaviour
- Negative symptoms (affective flatttening, avolition - lack of motivation)
**2) Social/occupational dysfunction **
Major areas of functioning eg. work, interpersonal relations, self care are below level prior to onset
3) Duration
Continuous signs of disorder for at least 6mths, which includes at least 1mth of sx of criteria A (Unless successfully treated)
This 6mths may include prodromal or residual symptoms
4) Schizoaffective or mood disorder has been EXCLUDED
5) Disorder is NOT due to a medical disorder (eg. hyperthyroidism) or substance use
6) If a hx of pervasive neurodevelopmental disorder is present, there must be sx of hallucinations or delusions present for at least 1mth
Describe the main neurochemical etiology of schizophrenia
Dysregulation of dopaminergic, serotonergic and glutaminergic pathways
List 3 factors that contributes to schizophrenia
1. Predisposing
- genetics
- Neurodevelopmental effects
- Environmentin utero
- Personality
- Physical, psychological & social factors in infancy & early childhood
2. Precipitating
- Drugs/substance induced psychosis eg. alcohol, benzodiazepines, CNS stimulants (amphetamines), dopamine agonist (levodopa)
3. Perpetuating
- Poor adherence with antipsychotics
- Social withdrawal
- Lack of support/poor SES
True or False?
In bipolar disorder, the depression is more severe than MDD and they are likely to commit suicide more
True (higher suicide rates could be due to impulsiveness from irritable mood)
State at least 4 etiologies of bipolar disorder
- Genetics: 80-90% pts have biological relative with mood disorder
-
Induced by treatment
* Antidepressant induced mania typically in initial few days-weeks (incr NA & DA)
* ECT - **Induced by general medical conditions **
- History of trauma: perinatal, head trauma, physical abuse
- Physical stressors
- Seasonal changes
List at least 4 medications or drugs that induce mania
Antidepressants(MAOis, TCAs, 5HT &/or NE &/or DA reuptake inhibitors, 5HT antagonist
DA-augmenting agents (CNS stimulants: Amphetamines, cocaine, DA agonist: levodopa)
Steroids (corticosteroids)
Thyroid preparations (T3/4)
** Drug withdrawal: alcohol, a2 agonist, antidepressants, barbiturates, benzodiazepine, opioids **
* Drugs of abuse: alcohol intoxicationl hallucinogens
* Xanthines (caffeine, theophylline)
* Pseudoephedrine
* St John’s Wort
List at least 2 medical conditions that induce mania
- CNS disorders (strokes, head injuries, brain tumor, multiple sclerosis)
- Endocrine (Cushing’s disease, hyperthyroidism- mania, hyPOthyroidism-depression, menstrual/pregnancy/perimenopausal mood disorders)
- CNS infections (encephalitis, sepsis, HIV, neuropsyphillis)
- Vitamins and nutritional deficiencies
State the duration for mania and hypomania episodes
Abnormal &persistently elevated /expansive/irritable mood.
≥7 days = mania
≤4 days = hypomania
