Mood Disorders Flashcards
Compare the etiology of bipolar to unipolar disorder?
Unipolar cases have older onset (Mid 20’s vs 18). More women have unipolar, but bipolar ratio is about equal. Greater prevalence of mood disorders in relatives of bipolar patients that unipolar.
Define what a mood episode is in general terms?
A distinct and persistent change from a person’s typical mood with accompanying symptoms, lasting 2 weeks for a major depressive episode and 1 week for a manic episode.
Define what is meant by Bipolar with mixed features?
As many as 40% of patients meeting criteria for bipolar disorder have episodes with “mixed features,” referring to manic or depressive episodes in which both depressive and manic symptoms are present. Bipolar illness with four or more mood episodes (mania, hypomania, or depression) within 12 months is specified as “rapid cycling.”
Describe how to differentiate schizophrenia from mania?
It can often be difficult with overlapping symptoms, but manic episodes will often end with the patient going back to a normal/baseline level of functioning.
Describe how to distinguish grief from Major Depressive Disorder?
Often the diagnosis of MDD can be deferred during the first few months after the loss of a loved one. However, the diagnosis of MDD is appropriate any time if the symptoms picture involves markedly impaired functioning, preoccupations of worthlessness, suicidality, psychosis or psychomotor retardation.
Describe Manic Episodes vs Depressed Episodes and associated symptoms?
Manic episodes are characterized by persistent high or irritable mood along with increased energy and/or activity, accompanied by at least three (4, if the mood is irritable) other symptoms such as: decreased need for sleep, racing thoughts, talking excessively, grandiosity and impulsivity.
Depressive3 episodes are characterized by persistent depressed mood and/or loss of interest or pleasure, with at least five associated symptoms including: disturbances of sleep, appetite, energy, concentration, feeling worthless or guilty, suicidal ideation/gestures.
Describe the cardinal features of mania?
Euphoria (elevated mood), hyperactivity, flight of ideas and racing thoughts.
Not all manic episodes are euphoric, however, some are irritable.
These patients often exhibit pressured speech and are hyper talkative. Many display risky impulsive behavior. They will often have decreased need for sleep and be easily distracted.
Describe the difference between Bipolar II disorder and Cyclothymia?
Milder expressions of bipolar disorder with both hypomanic and depressive episodes in the absence of manic or psychotic episodes are diagnosed as Bipolar II if the depressive episodes meet full criteria for a major depressive episode.
It is Cyclothymia if full criteria for a major depressive episode is not met but still with depressive symptoms.
Describe the following types of therapy: CBT, Interpersonal, Psychodynamic, and Supportive.
CBT focuses on negative cognitions and replaces them with more positive/adaptive ones, behaviors that reinforce these thinking patterns, and often has a mindfulness component.
Interpersonal focuses on the present rather that the past, coping, problem solving, social and interpersonal skills.
Psychodynamic explores recurrent relationship conflicts
Supportive involves listening and empathy
Describe the use of antidepressants in Bipolar?
They do not appear to be beneficial and can actually be detrimental, often precipitating mania and/or mixed episodes. The use of SSRI’s can be considered if there is significant comorbid anxiety. When used, it is recommended to use in conjunction with mood stabilizer which may prevent switching to mania.
Describe the use of Lithium in acute mania vs Maintenance in Bipolar patients?
Should be used with an atypical antipsychotic in acute mania until therapeutic levels are reached which can take weeks. It is effective at maintenance.
Describe the varied presentation of depressive episodes, typical vs atypical?
Typical symptoms include dysphoric mood, feelings of worthlessness, guilt, despair, hopelessness, recurrent thoughts of self harm/death. Associated symptoms can include sleep disturbances, fatigue, weight changes, agitation or psychomotor retardation, anhedonia, difficulties concentrating and slowed thinking.
Sometimes major depressive episodes can present without depressed mood or sadness, especially if anhedonia is the predominant feature.
Occasionally, overwhelming agitation can predominate. These patients are often found pacing, wringing their hands, bemoaning their fate, begging for help but never satisfied.
Paranoia and hallucinations can also occur.
Do manic or major depressive episodes by themselves constitute a diagnosis? Why or why not?
They do not constitute a diagnosis because a patient with a mood disorder may experience different types of mood episodes over the course of a single illness and the different episodes would not be diagnoses as separate disorders.
What populations are at risk for suicide?
Age greater than 65, being male, living alone, recent stressors, access to firearms, prior attempts, communication of suicidal intent.
The first few weeks after discharge from inpatient psychiatric care. Family history of suicide in a close family member.
What are the optimal levels for Lithium? Which doses typically achieve these levels?
0.6-0.8 are optimal for efficacy and reducing renal toxicity. Total doses of 1200-2400 mg are typically required to achieve these levels.
