Mood Disorders Flashcards
Major Depressive Episode
The DSM-5 describes a major depressive episode as a condition in which a person has depressed mood or anhedonia (loss of interest or sense of pleasure) and four of the following symptoms: unintended change in weight, sleep disturbance, psychomotor agitation or retardation, fatigue, feelings of worthlessness or guilt, inability to concentrate, and recurrent thoughts of death or thoughts of suicide.
Maniac Episode
A manic episode is defined by the DSM-5 as a period of time (at least 1 week) during which a person’s mood is abnormally elevated, expansive, or irritable in addition to at least three of the following symptoms: inflated self-esteem (grandiosity), decreased need for sleep without fatigue, pressured speech, racing thoughts, distractibility, psychomotor agitation, and excessive involvement in pleasure-seeking activities that may have high risk for undesirable consequences (excessive spending, sexual indiscretions).
Mixed Episode
A mixed episode is present when symptoms of both major depressive and manic episodes are present nearly every day for a week or more and these symptoms are not related to a medication effect or substance.
Hypomanic Episode
A hypomanic episode describes symptoms of a manic episode that are shorter in duration and do not match the severity of a manic episode and thus are not associated with such marked impairment of function. Hypomanic episodes are not debilitating enough to warrant hospitalization or to lead to dangerous consequences.
Mood disorder risk factors
First-degree family history Stress (esp unemployment, family discord) Abuse or trauma drug/alcohol use Death or serious illness of loved one Major life changes
Normal Grief v. Depression Disorder
Symptoms should occur for two months after a major life event. It is common to have depression after the death of a loved one, but grief symptoms should improve after two months
Depression Screening
USPTF recommends screening all patients of all age
Depression and Elderly
Big risk, especially for patients in long term care
Use Geriatric Depression Scale (GDS)
Depression Differentials
Always consider and rule out endocrine, anemia, tox, alcohol causes
Unipolar v. Bipolar Depression
Patients with unipolar depression are sad and often tired and disinterested. Patients with bipolar depression can be sad, but also have periods of mania (including hypomania).
Depression Management
Symptoms and side effect profile are important when selecting agent
SSRI/SNRI are more favorable than atypical antidepressants
Common SSRI/SNRI Antidepressants
Duloxetine
Venlafaxine
Desvenlafaxine
Levomilnacipran
Atypical AD meds
Mitrazapine - useful for anorexic patients
Bupropion - also used for smoking cessation
Bipolar Types
Bipolar 1 - Mania / Hypomania / Depression (refer to specialists promptly)
Bipolar 2 - Hypomania / Depression
It is common to miss hypomania as normal baseline and diagnose with unipolar depression
Bipolar Treatment
Lithium is best managed by specialists
First Gen antipsychotics are just as effective as 2nd Gen
