Mood Disorders Flashcards
What are the mood disorders?
bipolar disorder,
hypomania
major depressive disorder
persistent depressive disorder
premenstrual dysphoric disorder.
cyclothymia, disruptive mood dysregulation disorder
What is the DSM criteria for bipolar 1 disorder?
Bipolar I disorder:
Characterized by the occurrence of 1 or more manic or mixed episodes (the manic episode may have been preceded by and may be followed by hypomanic or major depressive episodes, but these are not required for diagnosis)
Distinct period of abnormally and persistently elevated, expansive, or irritable mood, and increased activity or energy lasting ≥1 week (any duration if hospitalized), present most of the day, nearly every day
During the mood disturbance and increased energy or activity, ≥3 (or 4 if irritable mood only) of the following:
Inflated self-esteem or grandiosity
Decreased need for sleep
Pressured speech
Racing thoughts or flight of ideas
Distractibility
Increased goal-directed activity
Excess pleasurable or risky activity.
Marked impairment not due to a substance or medical condition
In addition, these symptoms:
Do not meet criteria for a mixed episode
Cause functional impairment, necessitate hospitalization, or there are psychotic features
Are not related to substance misuse
Are not due to a general medical condition
Are not caused by somatic antidepressant therapy.
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Criteria for mixed episode:
Criteria are met both for a manic episode and for a major depressive episode during at least a 1-week period
Causes functional impairment, necessitates hospitalization, or there are psychotic features
Symptoms are not due to substance misuse, a general medical condition, or somatic antidepressant therapy.
What is the criteria for a mixed bipolar/depressive episode
Criteria for mixed episode:
Criteria are met both for a manic episode and for a major depressive episode during at least a 1-week period
Causes functional impairment, necessitates hospitalization, or there are psychotic features
Symptoms are not due to substance misuse, a general medical condition, or somatic antidepressant therapy.
What is the criteria for bipolar II disorder
Never had a full manic episode; at least 1 hypomanic episode and at least 1 major depressive episode
Distinct period of abnormally and persistently elevated, expansive, or irritable mood, and increased activity or energy lasting ≥4 but <7 days, and clearly different from usual nondepressed mood, present most of the day, nearly every day
During the hypomanic episode, ≥3 (or 4 if irritable mood only) of the following:
Inflated self-esteem or grandiosity
Decreased need for sleep
Pressured speech
Racing thoughts or flight of ideas
Distractibility
Increased goal-directed activity
Excess pleasurable or risky activity.
Episode is unequivocal change in functioning, uncharacteristic of person, and observable by others
Not severe enough to cause marked impairment, not due to substance or medical condition, and no psychosis (if present, then this is mania by definition)
During the major depressive episode, ≥5 of the following symptoms are present during the same 2-week period, and represent a change from previous functioning. At least one of the symptoms is either depressed mood or loss of interest or pleasure:
Depressed mood most of the day, nearly every day
Markedly diminished interest or pleasure, nearly every day
Significant weight loss when not dieting or weight gain, or decrease or increase in appetite, nearly every day
Insomnia or hypersomnia, nearly every day
Psychomotor agitation or retardation, nearly every day
Fatigue or loss of energy, nearly every day
Feelings of worthlessness or excessive or inappropriate guilt (which may be delusional), nearly every day
Diminished ability to think or concentrate, or indecisiveness, nearly every day
Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation with or without a specific plan.
In addition, these depressive symptoms:
Cause functional impairment (e.g., social, occupational)
Are not better explained by substance misuse, medication side effects, or other psychiatric or somatic medical conditions.
What are the differentials for bipolar mood disorder
Mood disorder due to general medical condition
May be clinically indistinguishable; however, people often have atypical mood symptoms.
Symptoms and signs specific for the underlying medical condition (e.g., stroke, thyroid disease, and multiple sclerosis) may be present.
Substance-induced mood disorder
May be clinically indistinguishable.
The mood disorder is judged to be temporally associated with exposure to the causative substance. Withdrawal states from some substances can last for up to 4 weeks.
MDD
Criteria include depressed mood most of the day, as self-reported or observed by others; diminished interest or pleasure in all or almost all activities; significant weight loss when not dieting, weight gain, or decrease or increase in appetite; insomnia or hypersomnia; psychomotor agitation or retardation; fatigue or loss of energy; feelings of worthlessness or excessive or inappropriate guilt; diminished ability to think or concentrate; recurrent thoughts of death, recurrent suicidal ideation without a specific plan.[1]
However, patients have never had a manic, hypomanic, or mixed episode.
What is the management of bipolar disorder
Acute mania - rapid acting oral antipsychotic or benzodiazepine
Olanzepine
Risperidone
Lorazepam
If no agitation
Mood stabilizer or antipsychotic - lithium, risperidone
Adjunct - ECT
Acute bipolar I
Lamotrigine and lithium (300mg)
Psychosocial interventions (family-focused therapy, interpersonal social rhythm therapy, or cognitive behavioral therapy)
Acute bipolar II
lithium/ lamotrigine/ sertraline/venlafaxine
