Mood Disorders Flashcards
DMDD cannot coexist with which other diagnoses? 3
Oppositional defiant
Intermittent explosive
Bipolar
DMDD diagnostic criteria symptoms
Recurrent temper outburst manifested verbally and or behaviorally grossly out of proportion in intensity or duration to the situation or provocation
Inconsistent with developmental level
Mood between temper outbursts is persistently irritable or angry most of the day, nearly every day, observable by others
At least 2 settings, severe in at least 1
Symptoms do not occur exclusively during an episode of MDD
DMDD age of diagnosis limits
No initial diagnosis prior to age 6 or after age 18
Age of onset prior to 10 years of age
DMDD timing/length of symptoms
Temper outbursts 3 or more times per week
Irritable or angry mood most of the day nearly every day observable by others
At least 12 months
No period of 3 or more consecutive months without all of the symptoms
No period longer than 1 day meeting full criteria for manic or hypomanic episode
DMDD 1 Core feature with 2 manifestations
Chronic, severe persistent irritability
- Frequent severe temper outbursts
- Chronic, persistently irritable or angry mood between outbursts. Mood is Characteristic of the child
Difference of irritable mood in DMDD versus bipolar
Bipolar is episodic
DMDD irritability is chronic
Expensive mood and grandiosity common in mania, not in DMDD
DMDD conversion
Common
Uncommon
Very low conversion to bipolar
Increased risk for unipolar depression and anxiety disorders in adulthood
DMDD vs Bipolar gender prevalence
Bipolar is gender equal
DNDD predominately male
DMDD versus pediatric bipolar functional consequences. Different or equal?
Levels of dysfunction are generally comparable
For both disorders in children dangerous behavior, suicidal ideation or suicide attempts, severe aggression and psychiatric hospitalizations are common
DMDD common psych Comorbidities
ODD most common
ADHD, anxiety disorders, autism
If a child needs the diagnostic criteria for DMDD & ODD, which diagnosis should be made?
DMDD
Is it more common for a child with ODD to also meet criteria for DMDD or for a child with DMDD to meet the criteria of ODD as well?
It is more common for a child with DMDD to also meet criteria for ODD. Only the diagnosis of DMDD should be made. Most children with ODD do not additionally meet the criteria for DMDD
2 Key differences between DMDD and IED
- DMDD requires persistent disruption in mood between outbursts, IED does not
- IED symptoms at least 3 months
DMDD at least 12 months
MDD: episode considered recurrent when there is a period of how many consecutive months between separate episodes in which criteria are not met for MDD
2 months
Symptoms of MDD must be present nearly every day with the exception of which two symptoms?
Weight change
Suicidal ideation
Define MDD remission
2 or more months with no symptoms or only one or two symptoms to no more than a mild degree
2 in 5 individuals with MDD Begin recovery within 3 months of onset, 4 in 5 within 1 year
During what decade does incidence of MDD peak?
How much higher are the rates of depression in females vs males?
2 symptoms more common in younger individuals
Symptom more common in elderly
20’s
1.5-3x, begins in adolescence
No clear differences by gender in phenomenology, course or treatment response in depression
Hypersomnia, hyperphagia
Melancholic features (psychomotor disturbances)
What temperament is one of the most established risk factor for depression?
What percent of depression cases are considered to be caused by genetics, especially a specific personality trait?
Neuroticism
40%, again neuroticism
Risk factors for increased risk for completed suicide
Most consistently described risk factors for suicide?
What personality disorder markedly increases risk for future suicide attempts?
Male sex, being single or living alone, persistent feelings of hopelessness
Past history of suicide attempts or threats
Borderline
In the United States and cross culturally what complaint is the most uniformly reported in MDD and is a major reason why patients present for care?
Insomnia, loss of energy
To meet a diagnosis for MDD symptoms must cause functional impairment (e.g., social, occupational) OR
Clinically significant distress
In MDD, can psychomotor agitation or retardation be subjective, observable by others, or both?
Must be observable by others, Subjective reports do not count
Diagnosis of persistent depressive disorder PDD (dysthymia)
Name Essential feature with associated symptoms
Which 3 MDD symptoms are not included in PDD?
Depressed mood
- Poor appetite or over eating
- Insomnia or hypersomnia
- Low energy or fatigue
- Low self-esteem
- Poor concentration or difficulty making decisions
- Feelings of hopelessness
Anhedonia, Psychomotor agitation or retardation, suicidality
Number and Timing of PDD symptoms
2
Depressed mood, or irritable mood in children, PLUS
2 symptoms
2 years (1 in peds)
symptom-free for no more than 2 months
Major childhood risk factors for PDD
Parental loss or separation
Define response in MDD treatment
At least 50% reduction of symptoms
Define MDD recovery
What is the return of symptoms called during recovery?
Symptom-free for at least 6 months and beyond
Recurrence
Define MDD partial and full remission
What is the return of symptoms called during remission?
Partial remission: less than 2 months without any MDD symptoms OR symptoms are present without meeting full criteria
Full remission: ZERO MDD s/s for 2-6 months (6 months and beyond is recovery)
Relapse
Dysfunction in which neurotransmitter may cause a reduction in positive affect (depressed mood, anhedonia)?
Dopamine
Dysfunction in which neurotransmitter may cause an increase in negative affect (anxiety, irritability)?
Serotonin
Dysfunction of which neurotransmitter is implicated in both decreased positive affect and increased negative affect?
Norepinephrine
True or false
Higher concentrations of several inflammatory markers including TNF alpha, interleukin six and interleukin one, and CRP may be found in patients with depression. Both cytokines and cytokine inducers can cause symptoms of depression.
True
Estrogen fluctuations cause the Vasomotor symptoms of Perimenopause. Estrogen fluctuations lead to dysregulation of which two neurotransmitter systems that are thought to mediate both vasomotor symptoms and depression?
Which class of antidepressants addresses both depression and vasomotor symptoms?
SE & NE
SNRI
Antagonism of which 2 receptors is thought to contribute to weight gain
5HT-2C
H1
Tyramine, A breakdown product of the amino acid tyrosine, should be avoided while taking MAOI anti-depressants with the exception of?
List foods with high tyramine content
Trans dermal and low-dose selegiline
(MAOI B)
Dried, aged, smoked, fermented or spoiled meat, poultry and fish
Broad bean pods
Aged cheeses
Tap and unpasteurized beer
Marmite
Soy products, tofu
Sauerkraut, kimchee
Banana peel and overripe banana
Tricyclic antidepressants block VSSC in both brain and the heart. In OD This can lead to?
Cardiac arrhythmia, cardiac arrest, seizure, coma
Which SGAs are approved as adjuncts to SSRIs and SNRIs in treating MDD?
Aripiprazole, brexpiprazole (Rexulti), quetiapine XR, olanzapine in combination with fluoxetine
Which three drugs are approved for major depression and bipolar disorder
Olanzapine with fluoxetine, lurasidone, Quetiapine
What is the most common manic/hypo manic symptom exhibited during a major depressive episode with mixed features?
Psychomotor agitation
What manic symptoms are most rarely seen in patients With mixed features during a major depressive episode?
Decreased need for sleep, inflated self-esteem, elevated mood, and high-risk behavior
The two most useful factors for determining if a current depressive episode is indicative of unipolar or bipolar depression are?
Family history and input from someone close to the patient
Name an STD that can cause depressive symptoms and name the screening and confirmatory tests
Syphilis. Cause is treponema pallidum
RPR and VDRL screen for syphilis
A specific treponemal Test is required for diagnosis
