mood disorders Flashcards
name two of the most common mood disorders in the world?
major depressive disorder
bipolar disorder
the term depressive disorders is used to describe a group of mood disorders in which patients have ____ or ____ moods with other physical or cognitive symptoms that impair daily function.
sad or irritable
Name the four categories of depressive diorders?
major depressive disorder
disruptive mood dysregulation disorder
persistent depressive disorder
premenstrual dysphoric disorder
how can you categorize the differences between the types of depressive disorders is by?
nature of onset
duration
potential etiology
the onset of bipolar disorders is rare to occur before ____ and typically will have an onset during what stage of life
rare before puberty
increased during late adolescence & early adulthood
the typical age of onset for major depressive disorder is from ____ to ____.
mid 20s through the 50s
what is the average age onset for bipolar disorder
15 and 30 years
the peak age of onset for major depressive disorder is?
in the mid 30s
before the intial onset of mania in adolescents, what chatacteristics may they demonstrate
exhibit irritability, hyperactivity, impulsivity, emotional lability, poor judgement, marked anxiety, imsomnia, depression, and psychosis
Women are ____ as likely to suffer from major depressive disorder compared to men.
twice
for bipolar disorder, what is the first mood to be experienced by males specifically and females specifically
Females: major depressive episode
Males: manic episode
men expereince higher rate of ______ thinking and _____ attempts.
suicidal
suicidal
Mean are nearly four times as likely to die by ______. Why?
suicide
because men tend to choose more violent and more lethal suicide methods
mixed features, depressive episodes, and rapid cycling for bipolar disorder is more common in males or females?
females
bipolar episodes increase over the 1st ____years, then _____ as the individual ages
first 10 years
gradually level off and decline
______ is associated with higher rates of many chronic medical conditions.
major depressive disorder
over 80% of individuals with bipolar disorder will have more than ____ mood epidodes during their lifetime
4
if a patient is untreated with bipolar disorders, whta is likely to occur over the persons lifetime
can increase to 10 or more
What is the worlds leading cause of disability?
Major depressive disorder
Postmortem studies found there is small differences in some _____ regions and loss of tissue volume in the ______ in individuals with major depressive disorder.
this suggest what?
cortical
hippocampus
loss of particular brain functions or disturbances of network activity can induce the mood disturbances that are associated with major depressive disorder.
Cyclic mood disorder with bipolar, causes a patient to more through moods known as
Euthymic
Describe euthymic mood changes for bipolar disorders
with or without a period of normal mood
individuals with bipolar disorder can have mood flucuations that continue for ____ or _____
continues for months
OR
Can have one episode with no re occurrence of any mood type
the clinical presentation of a depressive phase of bipolar disorder is the same as ______ disorder
unipolar depression as a major depressive episode
monoamine theory of depression suggests that an imbalance of what is responsbile for the onset of major depressive disorder.
imbalance in normal monoamine neurotransmission may be responsible for the onset of major depressive disorder.
List some mania symptoms
- inflated self-esteem or grandiosity
- decreased need for sleep
- talkative
- flight of ideas
- easily distracted
- increase in goal directed activity
- excessive involvement in activities that have potential for painful consequences
when a mania expisode occurs and the patient feels euphoric, this can result in what adverse effect
reduced medication compliance since the patient wants to experience these feelings of mania
list the neurobiological causes major depressive disorder (6 total)
- neurotransmitters (GABA and Glutamate)
- Hypothalamic-Pituitary-Adrenal (HPA) Axis
- Changes in number, density, and size of neurons
- anatomical changes in the brain (volume changes)
- Changes in brain activity (blood flow and glucose metabolism)
- Increased inflammatory markers (cytokines and CRP)
hypomania episodes are typically ____ than mania episode
shorter
how is hypomania diffrentiated from mania
by the need for hospitilization
what classification of mania is typically experienced when a patient is having a flight of ideas, extremely clever thinking, and increase in energy
hypomania (during a short episode)
if the mania experienced causes hospitalization and is classified as a manic episode, what will the patient get diagnosed as
bipolar 1 disorder
in the presence of bipolar disorder, a mized state typically occurs which what two symptom classes are experienced
mania and clinical drepression will occur simutaneously
Children with depression will often have new _____ problems and have increased _____ compliants
behavioral
somatic
in bipolar disorder, what are examples of symptoms that can be experienced
agitation, anxiety, aggression, confusion, fatigue, impulsiveness, imsomnia, irritability, suicidal ideations, paranoia, delusions, pressured speech, racing thoughts, restlesness, rage
adults with depression typically present with compliants of _____ mood, changes in ____ and ___ habits, and ______ sensitivity.
depressed
sleep and eating
rejection
geriatric depression is characterized by ____ symptoms, including decreased in what four things?
neurovegetative
sleep
interest
appetite
energy
what is rapid cycling defined as for bipolar disorder
having 4 or more episodes per year
rapid cycling in bipolar disorder can be ____ due to antidepressants, unless there is an active treatment with a mood stabilizer present
induce or worsened
the mental status exam is similar to the ____ ____ in medicine.
physical examination
the DSM 5 classifies mania as
>1 week persistent elevated mood or irritable
at least 3 mania symptoms (4 if the mood is irritable)
How is the mental staus exam completed? which assesses what?
through a direct patient interview
designed to assess current behavior, thoughts, perceptions, and functioning.
every patient should have three things performed before diagnosing major depressive disorder. why?
complete physical examination
medication review
basic laboratory workup
because certain medical conditions, substance use disorders, and medications can cause depressive symptoms.
what lab work should be obtained before making a diagnosis of major depressive disorder?
complete blood count with differential
thyroid function
electrolyte test
how does the DSM5 classify hypomania
- at least 4 days of abnormal and persistent elevated expansive, or irritable mood and increase activity or energy
- associated with at least 3 mania symptoms (4 if mood is irritable)
- NOT SEVERE ENOUGH to cause:
- impairement in social/occupation
- required hospitalization
- psychotic features
how does the DSM5 classify major depressive
>2 week period of either depressed mood or loss of interest or pleasure in normal activities with at least 5 symptoms of depression
name the drug therapies associated with depressive symptoms?
antihypertensives
hormonal therapy
acne therapy
interferon products (for Hep C, MS)
how does the DSM5 classify mixed features
- full crieteria for depressive episode with at least 3 manic episodes
- full criteria for manic or hypomanic episode with at least 3 depressive symptoms
list substance use disorders associated with depressive symptoms?
alcoholism
marjuana abuse and dependence
nicotine dependence
opiate abuse and dependence
psychostimulant abuse and dependence
is is essential to perform which test/exams in order to diagnose a patient with bipolar disorder
complete history, including medical, psychiatric, medication history, physical, neurological examination, and labratory test which must be done before diagnosis
list general medical conditions associated with depressive symptoms?
endocrine disorders (hypothyroidism, addision disease, cushing disorder)
deficiency states (percinous anemia, Wernicke encephalopathy, severe anemia)
infections (AIDS, encephalitis, HIV, mononucleosis, STDs, TB)
Collagen disorder
Systemic Lupus Erythematous
Metabolic Disorders
Electrolyte Imbalances (hypokalemia, hyponatremia)
hepatic encephalopathy
cardiovascular disease (coronary artery disease, congestive heart failure, myocardial infarction)
Neurologic disorders (alzheimers disease, epilepsy, Huntingtion disease, MS, pain, Parkinson Disease, poststroke)
Malignant Disease
What labratory test should be performed for a patient with bipolar disorder
complete blood count
blood chemistry
thyroid function test
urinalysis
urine drug screen
the essential feature of bipolar disorder is a history of ______
mania or hypomania that is not caused by any other medical condition, psychiatric disorder, or substance abuse
what are the 3 categories of bipolar disorder
bipolar I disorder
bipolar II disorder
cyclothymic disorder
______ is classified as someone having at least 2 years of hypomanic symptoms nad depresseive symptoms but they do not meet full criteria for hypomania or depressive disorder
cyclomythia disorder (under bipolar category)
for depression, the mood doesnt reach the levels for hypomania or mania, rather it achieves levels of depression allowed to occur classified as
unipolar depression
_____ has periods of both depression and mania
bipolar 1
_______ has periods of depression but the periods of mania that occur are not quite as extreme adn do not last as long as normal mania episodes (AKA hypomania)
bipolar II
_______ is present in individuals experiencing emotional highs and lows similar to bipolar, however the mood shifts in this disease arent as extreme
cyclothymia
According to the DSM 5 for a major depressive episode, a patient must experience what?
5 or more depressive symptoms, at least one theses symptoms must be a depressed mood or loss of interest or pleasure,
symptoms must have been present nearly every day in the same two week period,
and resulted in change in the patient’s level of functioning.
In a normal person, moods shifts will still occur allowing them to have days that they will feel happier and sadder, however these moods
do not have as severe changes as the moods that are experienced in bipolar disorder or cyclothymia
an MRI, CT, or PET scan can reveal changes in the _____ for bipolar disorder
amygdala volume and the presenece of white matter hyperintensities
bipolar is previously known as?
manic depressive illness
_______ that connect the amygdala, hippocampus, and
Bipolar disorder is ______ mood disoder characterized by?
cyclic
mood disorder characterized by unusual shift in mood, energy, activity levels, and the ability to carry out day-to-day tasks
The mood changes in bipolar
in bipolar disorder, the mood change is typically how far apart
months to years, not minute to minute or day to day
when comparing bipolar disorder with the general population, what type of mortality rate do these patients have
2.3 times higher mortailty rate
suicide attempts occur in up to ___% of individuals with bipolar along with ___% of individuals actually complete the act of suicide
50%
10-15%
what age group does bipolar disorder develop in
late teens or early adult years
at least half of all bipolar cases occur before what age
25, with their first symptoms occur in childhood
Women with bipolar disorders are most likely to suffer from a greater number of _____episodes and these episodes are _____
- depressive episodes
- longer and more severe
Men in bipolar disorder are more likely to experience a greater number of ______ episodes compared to women
manic episodes
Major depressive disorder is differentiated from bipolar disorder due to the absence of?
Mania is defined as an abnormally elevated or ________ mood.
Major depressive disorder is characterized by symptoms such as inappropriate ________, increased _________, decreased need for _______, and ______ thoughts.
Elation
irritability
sleep
grandiose
