Mood disorders Flashcards
What are the 9 cardinal signs of depression?
- Depression (extreme sadness),
- Anhedonia (loss of pleasure / joy in normally pleasure evoking things ie hobbies),
- Changes to appetite,
- Changes to sleep duration,
- Lack of energy
- Reduced concentration
- Psychomotor retardation / agitation (pacing),
- Worthlessness / excessive guilt, &
- Reccurrent thoughts of death or suicide (with or without a plan).
Diagnosis of Major Depressive Disorder requires how many symptoms for what duration?
- 5 of the 9 symptoms
- (must include either depressed mood or anhedonia),
- atleast 2 weeks
Major Depressive Disorder has 4 key subtypes each sharing symptoms from the 9 cardinal symptoms however each having unique features. List the 4 key subtypes of MDD.
**Major Depressive Disorder
**
1. Depression with atypical features.
2. MDD with seasonal pattern.
3. MDD with peripartum onset.
4. MDD with psychotic features. **
Major Depressive Disorder has 4 key subtypes each sharing symptoms from the 9 cardinal symptoms however each having unique features.
What are the unique features to Depression with Atypical Features.
Depression with Atypical Featutures presents with a minimum of any 5 of the 9 cardinal MDD features however uniquiely patients with Depression with Atypical Features present with:
- Mood reactivity (transient improvement in mood depending on circumstances ie increased mood with visitors);
- Rejection sensitivity;
Also… commonly
3. * hyperphagia (increase appetite),
4. * hypersomnia (increased sleep),
5. Leaden paralysis (heaviness of limbs).
Major Depressive Disorder has 4 key subtypes each sharing symptoms from the 9 cardinal symptoms however each having unique features.
What are the unique features / triggers to MDD with seasonal pattern?
MDD with seasonal pattern presents with any 5 of the 9 cardinal depression symptoms howerver they only present during the colder months.
Diagnosis requires 2 depressive episodes (min 2 weeks per episode) and during cold months ONLY, during a 2 year period.
- note the reduced sunlight for persons during colder months in considered significant in the aetiology.
Major Depressive Disorder has 4 key subtypes each sharing symptoms from the 9 cardinal symptoms however each having unique features.
What are the unique features to MDD with psychotic features?
Unlike other forms of MDD, the unique feature of MDD with psychotic features is that the patient has psychotic symptoms (illusions, hallucinations etc) that are mood congruent.
Psychotic features are present during depressive episodes ONLY. (Thus differentiating from schizoeffective disorder).
Major Depressive Disorder has 4 key subtypes each sharing symptoms from the 9 cardinal symptoms however each having unique features.
What are the unique features / triggers to MDD with peripartum onset?
MDD with peripartum onset can present with any 5 of the 9 cardinal depression symptoms however onset is uniquiely during pregnancy or within 12 months of parturitian (delivery).
MDD with peripartum onset is likely related to hormonal changes and stress.
- Postpartum blues occurs within the first 4 weeks of delivery and usually lasts 10days or less.
- Symptoms are crying outbursts, depressed mood, lethargy / fatigue.
What are the cardinal symptoms of a manic episode?
- Grandiosity,
- Pressured speech / more talkative,
- Flight of ideas / racing thoughts,
- Easily distracted / reduced concentration,
- Goal-directed activities,
- Impulsive / reckless behaviour,
- Significantly reduced need to sleep.
What criteria must be met to diagnose a manic episode.
No less than 1 week of 3 or more of the 7 manic episode symptoms, severe enough to cause significant functional impairment (school / work / social) or the presence of psychotic features are required to diagnose a manic episode.
What criteria must be met to diagnose a hypomanic episode?
A minimum of 3 out of the 7 symptoms associated with mania are required however:
* Symptoms must last only greater than 4 days.
* Symptoms are milder - therefore do not lead to functional impairment (work, school, social),
* They do not present with psychotic features,
What criteria must be met to diagnose a hypomanic episode?
A minimum of 3 out of the 7 symptoms associated with mania are required however:
* Symptoms must last only greater than 4 days.
* Symptoms are milder - therefore do not lead to functional impairment (work, school, social),
* They do not present with psychotic features,
Biopolar disorders can be classified into three categories. What are these three called?
- Bipolar I disorder
- Bipolar II disorder
- Cylothymic disorder
What are the treatment options for Mood disorders?
Mood disorders can be treated with:
1. Non-pharmacological options such as Psychotherapies (CBT), lifestyle changes (exercise, healthy diet), bright light therapy for MDD with seasonal pattern.
2. Pharmacological options for depression include SSRI’s, SNRI’s & non-traditional ie Tricyclics. DO NOT use SSRI’s in individuals with history or manic or prone to manic episodes.
3. Pharmacological options for treatment of bipolar disorders includes lithium (main stay - however contraindicated in pts with reduced kidney function due to renal (nephroxicity) toxicity); anticonvulsants (eg); antipsychotics (eg); and benzodiazapines.
Do not use SSRI’s as can cause manic episodes in predisposed individuals.
4. Electroconvulsive therapy (ECT) in refractory cases.
What is the criteria for the diagnosis of Bipolar I disorder?
To diagnose Biopolar I disorder the individual needs to have had atleast 1 manic episode;
plus other hypomanic or depressive episodes;
Note the individual may have periods of remission & stable mood.
What is the criteria for the diagnosis of Bipolar II disorder?
To diagnose Bipolar II disorder an individual must have a history of hypomanic and depressive episodes, with
NO history of manic episodes.
