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Behavioral dynamics > Mood disorders > Flashcards

Mood disorders Flashcards

1
Q

overall state of emotion at a given time
Internal condition visible through external behaviors

A

mood

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2
Q

mood is influenced by ? factors

A

internal and external

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3
Q

Mood is regulated by what neurotransmitters in the brain?

A

Serotonin
Norepinephrine
Dopamine

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4
Q

what are the types of mood disorders

A
  1. Depressive Disorders
  2. Bipolar Disorders
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5
Q

5 types of depressive disorders

A
  1. Major Depressive Disorder
  2. Dysthymia/Persistent Depressive Disorder
  3. Seasonal Affective Disorder
  4. Premenstrual Dysphoric Disorder (PMDD)
  5. Disruptive Mood Dysregulation Disorder
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6
Q

3 types of bipolar disorders

A
  1. Bipolar I Disorder
  2. Bipolar II Disorder
  3. Cyclothymia
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7
Q

For ALL PSYCHIATRIC CONDITIONS, the DSM endorses a criteria-based diagnostic approach that requires 3 conditions:

A
  1. The condition is not caused by the direct effects of any drug or external exposure
  2. The psychiatric disorder is not caused by effects of a medical condition
  3. There is significant impairment of social functioning, occupational functioning, or both.
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8
Q

MDD is MC in who?

A
  1. younger populations
  2. women (2-3x)
  3. Native Americans
  4. low socioeconomic status
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9
Q

MDD - Etiology / Risk Factors

A
  1. Genetics/Biological
    - Neurotransmitter expression / sensitivity - Serotonin, norepinephrine, glutamate, GABA, dopamine
    - Response to antidepressant drugs
    - FH of depression or alcoholism
  2. Life Events
    - Adversity or loss of loved one, job, or relationship
    - Early childhood trauma
    - Postpartum period
  3. Medications
    - Glucocorticoids, Interferons
  4. Personality
    - Low self-esteem
    - Sensitive to stressors
    - Insecure or worried
    - Dependent or unassertive
    - Introverted
  5. Social
    - Lack of close relationships
    - Close individuals with depression
    - Maladaptive learned behaviors from close individuals
  6. Medical Conditions
    - Neurologic, Infectious, Cardiac, Endocrine (adrenal/thyroid), Cancer, Inflammatory
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10
Q

How does the DSM-5 diagnose MDD

A

A depressed mood or anhedonia for ≥ 2 weeks AND ≥ 4 of the following symptoms:
1. Sleep changes (hypersomnia or insomnia)
2. Feelings of worthlessness / guilt
3. Fatigue / ↓energy
4. ↓concentration
5. Significant appetite or weight change
6. Activity changes (psychomotor agitation or retardation)
7. Recurrent thoughts about death or suicide
(SIG E CAPS)

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11
Q

8 MDD episode subtypes

A
  1. Anxiety: high levels of accompanying anxiety
  2. Catatonic: major psychomotor disturbances
  3. Mixed: symptoms of mania (insomnia, racing thoughts, ↑ energy)
  4. Psychotic: with accompanying psychosis (hallucinations, delusions)
  5. Atypical: reactivity to pleasurable stimuli, hyperphagia, hypersomnia
  6. Melancholic: anhedonia, psychomotor changes, insomnia, ↓appetite
  7. Peripartum: during pregnancy or within 4 weeks of birth
  8. Seasonal: associated with a particular season
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12
Q

To have MDD, a patient has to have at least one ?

A

major depressive episode

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13
Q

describe the timelines of major depressive episodes (developing, resolution, reoccurence)

A
  • develops over days to weeks
  • avg time to resolution - 20 wks
  • highest risk of recurrence - within first few months following episode’s resolution
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14
Q

how do the course of MDD varies?

A
  1. Single major depressive episode that resolves
  2. Multiple episodes with few to no s/s between episodes
  3. Persistent, fluctuating depressive s/s with no clear “remission”
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15
Q

high rate of recurrence is during when?

A

lifetime

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16
Q

what are other differentials for MDD

A
  1. Other mood disorders
  2. Substance use/abuse - alcohol, amphetamines
  3. Medication side effects
  4. General medical disorders
  5. grief symptoms associated with ___
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17
Q

3 MDD screenings

A
  1. Two-Question Screen (PHQ-2)
    - Quick, initial screening for depression
    - Asks about the two key symptoms of a depressive episode (depressed mood and anhedonia)
    - Not a stand-alone test - needs follow-up if positive!
  2. Patient Health Questionnaire-9 (PHQ-9)
    - Further evaluates presence and severity of depression
    - Can be used for initial screening or follow-up evaluation
  3. Zung Self-Rated Depression Scale
    - Allows a more in-depth rating of current depressive symptoms
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18
Q

nonpharm management for MDD

A
  1. Psychotherapy
  2. Electroconvulsive Therapy (ECT)
  3. Vagal Nerve Stimulation
  4. Transcranial Magnetic Stimulation (TMS)
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19
Q

tx goals for MDD

A
  1. Provide thorough education
  2. Maintain patient safety
  3. Achieve full remission of symptoms
  4. Achieving remission lowers risk of relapse
  5. Return patient to baseline functioning
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20
Q

what is the preferred approach of MDD tx

A
  1. COMBINATION of pharmacotherapy AND psychotherapy
    - It is acceptable to use either option by itself
    - MC approach - pharmacotherapy only
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21
Q

what type of tx would a pt get if they present with:
- No suicidal/homicidal ideation or behavior
- No psychotic features
- Minimal to no aggressiveness
- Intact judgement
- Able to perform basic ADL and maintain adequate nutritional/hydration status

A

outpatient tx

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22
Q

what type of tx would a pt get if they present with:
- Suicidal/homicidal ideation or behavior with specific plan or intent
- Psychosis
- Catatonia
- Impaired judgement that puts patient/others at risk for harm
- Grossly impaired functioning affecting ability to care for self

A

inpatient tx

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23
Q
  • aka “counseling”
  • CBT or Interpersonal Psychotherapy are most commonly used
  • Family or couples therapy can also be useful
A

psychotherapy

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24
Q

Meditation, muscle relaxation
are what types of nonpharm tx?

A

Relaxation Techniques

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25
Q

Restarting positive activities that ceased due to depression
is what type of nonpharm tx?

A

Behavioral Activation

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26
Q

Use of a small electric current to induce a cerebral seizure while patient is under general anesthesia

A

Electroconvulsive Therapy (ECT)

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27
Q

indications for Electroconvulsive Therapy (ECT)

A
  1. MC for severe, refractory depression
    - 1st Line: severe suicidality, severe psychosis, catatonia, malnutrition d/t food refusal secondary to depressive illness
    - Cannot tolerate other therapies
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28
Q

what is the most efficacious tx for severe MDD

A

Electroconvulsive Therapy (ECT)

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29
Q

be cautious with ECT in pts with ?

A
  1. cardiopulmonary disease
  2. neurologic disease
  3. anticoagulants
    no absolute CIs
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30
Q

SE of ECT

A
  1. Overall, considered safe
  2. MC adverse events:
    - cardiopulmonary
    - HA
    - nausea
    - transient cognitive impairment
    - muscle aches
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31
Q

A device is implanted in the chest wall
Used primarily for refractory epilepsy

A

Vagal Nerve Stimulation - connected to one (left) vagus nerve
May be helpful for refractory depression

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32
Q

Metal coil with magnetic field is placed against scalp to induce depolarization of neurons in a focal area WITHOUT sedation/anesthesia

A

Transcranial Magnetic Stimulation (TMS)

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33
Q

indications for Transcranial Magnetic Stimulation (TMS)

A

Treatment-refractory depression

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34
Q

CI for Transcranial Magnetic Stimulation (TMS)

A
  1. High seizure risk
  2. incompatible implants (metallic, electrical, cochlear)
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35
Q

SE of Transcranial Magnetic Stimulation (TMS)

A
  1. Seizures
  2. HA
  3. scalp pain
  4. transient hearing loss
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36
Q

what supplement:
- Naturally occurs in the body; may raise dopamine levels
- Can be used as an adjunctive option for mild to moderate depression in pregnant patients
- May trigger manic episodes

A

S-Adenosylmethionine (SAMe)

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37
Q

what supplement:
- Natural precursor to serotonin
- Risk of GI upset, serotonin syndrome, eosinophilic myalgia syndrome

A

5-Hydroxytryptophan (5-HTP)

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38
Q

what supplement:
- May work better if combined with antidepressants
- May increase risk of bleeding

A

Omega-3 Fatty Acids

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39
Q

what herbal:
- Increases serotonin, and possibly norepinephrine and dopamine levels
- Risk of GI upset, serotonin syndrome, photosensitivity
- Numerous drug-drug interactions (DDIs)

A

st. john’s wort

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40
Q

what herbal:
- May help with depression; MOA unclear
- Risk of GI upset, mania, bleeding; can be fatal at high doses

A

saffron

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41
Q

what herbal:
- Improved mood in pts being treated for memory loss; may increase sensitivity to serotonin
- May increase risk of bleeding

A

Ginkgo biloba

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42
Q

what supplements could be used as tx for MDD

A
  1. S-Adenosylmethionine (SAMe)
  2. 5-Hydroxytryptophan (5-HTP)
  3. Omega-3 Fatty Acids
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43
Q

what herbals could be used as tx for MDD

A
  1. st. john’s wort
  2. saffron
  3. ginkgo biloba
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44
Q

what are the guidelines for antidepressant use?

A
  1. Start low and go slow
  2. Trial of at least 4 weeks to evaluate full benefit
    - may see improvement as early as week 1, but it generally takes 4-6 weeks to see a response
  3. Rx should be continued for 6+ months after s/s improvement
  4. Gradual down titration is recommended when discontinuing antidepressants
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45
Q

what are the 1st gen antidepressants

A
  1. MAOI
  2. TCA
  3. TeCA
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46
Q

what are the 2nd gen antidepressants

A
  1. SSRI
  2. SNRI
  3. atypical antidepressants
  4. serotonin modulators
  5. ketamine/esketamine
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47
Q
  1. Commonly used as 1st line treatment for MDD
  2. Selectively decreases the action of 5-HT reuptake pump, leading to increased serotonin levels in the synapse
A

SSRIs

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48
Q

Sertraline (Zoloft)

A

SSRI

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49
Q

Citalopram (Celexa)

A

SSRI

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50
Q

Escitalopram (Lexapro)

A

SSRI

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51
Q

Fluoxetine (Prozac)

A

SSRI

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52
Q

Paroxetine (Paxil)

A

SSRI

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53
Q

Fluvoxamine (Luvox)

A

SSRI

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54
Q

Use caution in ____ with SSRIs

A

hepatic impairment
(metabolized mostly by the liver)

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55
Q

CI for SSRI

A

Allergy to SSRI; use of MAOI within 2 weeks

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56
Q

which SSRI must wait 5 weeks before starting MAOI

A

Fluoxetine

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57
Q

SE of SSRI

A
  1. GI Upset
    - nausea
    - diarrhea
    - anorexia
  2. Sleep Change
    - insomnia
    - hypersomnia
  3. Neuro
    - HA
    - dizziness
  4. Sexual Dysfunction
    - ↓libido
    - anorgasmia
    - ED
  5. Psych:
    - anxiety
    - ↑ risk of suicide (MC young adults)
  6. Other:
    - prolonged QT
    - weight gain
    - bleeding
    - orthostatic hypotension
    - serotonin syndrome
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58
Q

what is serotonin syndrome? when does it happen?

A
  • Caused by increased serotonergic activity
  • Typically occurs within 24 hrs (often w/n 6 hrs) of starting/changing medication or overdosing
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59
Q

serotonin syndrome is MC associated with what specific medication?

A

SSRI

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60
Q

s/s of serotonin syndrome

A

Diarrhea
increased bowel sounds
agitation
hyperreflexia
dry mucous membranes
autonomic instability
hyperthermia
HTN
tremor
clonus
seizure
death

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61
Q

tx for serotonin syndrome

A
  1. Supportive care
  2. D/C serotonergic medications
  3. Sedation with benzodiazepines
  4. Normalize vitals and hydration status
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62
Q

which SSRI:
- More GI upset than others in the class, esp. diarrhea
- Less likely to cause prolonged QT, drowsiness
- Slightly higher chance of insomnia SE

A

Sertraline (Zoloft)

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63
Q

which SSRI:
- Most associated with prolonged QT
- Minimal SE profile for this class otherwise
- Least inhibition of hepatic cytochrome enzymes

A

Citalopram (Celexa) / Escitalopram (Lexapro)
- Escitalopram is an isomer of citalopram

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64
Q

which SSRI:
- Shortest half-life (~ 15 hrs)
- Frequently causes somnolence
- Potent inhibitor of 2 cytochrome systems → potential for DDIs

A

Fluvoxamine (Luvox)

65
Q

which SSRI:
- Longest half-life of any in the class (up to 3 days)
- Slightly higher risk of insomnia SE
- SE of anxiety

A

Fluoxetine (Prozac)

66
Q

which SSRI:
- Causes anticholinergic SE, unlike others in the class
- Slightly higher risk of orthostatic hypotension, weight gain, & sexual dysfunction than other SSRIs
- Potential inhibitor of 2 cytochrome systems, so potential for DDIs

A

Paroxetine (Paxil)

67
Q

tamoxifen should NOT be written with ?

A

Fluoxetine (Prozac)
Paroxetine (Paxil)

68
Q

what is often used as first-line therapy, or as second-line therapy for patients who cannot tolerate SSRIs

A

SNRIs

69
Q

Difference between SNRIs and SSRIs

A

SNRIs - works more on NOR
SSRIs - works more on serotonin

70
Q

MOA of SNRIs

A

Blocks reuptake of 5-HT and norepinephrine (NE), increasing their levels in the synapse

71
Q

which SNRI has greater effect on NE

A

Milnacipran (Savella) / Levomilnacipran (Fetzima)

72
Q

Venlafaxine

A

SNRI

73
Q

Desvenlafaxine (Pristiq)

A

SNRI

74
Q

Duloxetine (Cymbalta)

A

SNRI

75
Q

Milnacipran (Savella)

A

SNRI

76
Q

Levomilnacipran (Fetzima)

A

SNRI

77
Q

CI with SNRIs

A
  1. Allergy to SNRIs
  2. use within 2 weeks of an MAOI
  3. Caution if using with other serotonergic drugs
  4. Caution if angle closure glaucoma
78
Q

what SE is not heavily seen in SNRIs compared to SSRIs

A

weight gain

79
Q

which SNRI:
- Higher risk of SE
- More N/V
- Most associated with elevated BP

A

Venlafaxine (Effexor)

80
Q

which SNRI:
- Synthetic form of the major metabolite of venlafaxine
- Less risk of HTN, general SE than venlafaxine

A

Desvenlafaxine (Pristiq)

81
Q

which SNRI:
- Only SNRI with hepatic cytochrome inhibition → most likely to have DDIs
- Least associated with elevated BP
- Has indication for chronic pain relief

A

Duloxetine (Cymbalta)

82
Q

which SNRI:
1. Most likely SNRIs to have pseudo-anticholinergic SE
- Urinary retention, constipation, dry mouth, etc.

A

Milnacipran (Savella) / Levomilnacipran (Fetzima)

83
Q

___ is marketed as more for pain relief than for depression

A

Milnacipran (Savella)

84
Q

what is often used as second-line therapy if pts fail SSRIs; may be first-line in special cases

A

Atypical Antidepressants

85
Q

Bupropion (Wellbutrin; Zyban)

A

Atypical Antidepressants

86
Q

Mirtazapine (Remeron)

A

Atypical Antidepressants

87
Q

Acts as a dopamine-norepinephrine reuptake inhibitor (also antagonizes nicotinic receptors)

A

Bupropion (Wellbutrin; Zyban)

88
Q

which antidepressant antagonizes alpha-2 adrenergic receptors and 5-HT2 and 5-HT3 receptors, which causes increased release of serotonin and norepinephrine

A

Mirtazapine (Remeron)

89
Q

SE of Bupropion (Wellbutrin)

A
  1. Dry mouth, insomnia, nausea, increased risk of seizures
    - Not associated with weight gain or sexual dysfunction
    - Risk of suicidal thoughts/ideation
90
Q

Helpful in patients with depressive symptoms who also need help with tobacco cessation

A

Bupropion (Wellbutrin)

91
Q

CI of Bupropion (Wellbutrin)

A
  1. Allergy to bupropion; seizure disorder
  2. high seizure risk
  3. anorexia or bulimia hx
  4. use within 2 weeks of an MAOI
92
Q

SE of Mirtazapine (Remeron)

A
  1. Dry mouth, drowsiness, sedation, increased appetite, weight gain, sexual dysfunction
    - weight gain > SSRIs, SNRIs
    - sexual dysfunction < SSRIs
    - Risk of suicidal thoughts/ideation
    - orthostatic hypotension < other antidepressants
93
Q

which antidepressant has SE that is helpful in patients with depressive symptoms who also are suffering from insomnia

A

Mirtazapine (Remeron)

94
Q

which antidepressant does have hepatic cytochrome enzyme inhibition, so can cause DDIs

A

Bupropion (Wellbutrin)

95
Q

CI for Mirtazapine (Remeron)

A

Allergy to mirtazapine; use within 2 weeks of MAOI

96
Q

type of antidepressant that fully blocks reuptake of 5-HT

A

Serotonin Modulators

97
Q

which serotonin modulators also antagonize 5-HT receptors, causing increased release of serotonin

A

Nefazodone and trazodone

98
Q

which serotonin modulator also partial agonist of 5-HT receptors, mimicking serotonergic effects

A

Vilazodone and vortioxetine

99
Q

Nefazodone (Serzone)

A

Serotonin Modulators

100
Q

Trazodone (Desyrel)

A

Serotonin Modulators

101
Q

Vilazodone (Viibryd)

A

Serotonin Modulators

102
Q

Vortioxetine (Brintellix/Trintellix)

A

Serotonin Modulators

103
Q

CI of Serotonin Modulators

A
  1. Allergy to drug
  2. use within 2 weeks of an MAOI
  3. Caution if using with other serotonergic drugs
104
Q

SE of Serotonin Modulators

A
  1. Headache, diarrhea, nausea are common
  2. Increased suicide risk
  3. Serotonin syndrome risk
105
Q

which serotonin modulator have these specific SE:
- headache, diarrhea, nausea, sexual dysfunction
- May have faster onset and less sexual dysfunction than SSRIs, SNRIs

A

Vilazodone (Viibryd)

106
Q

which serotonin modulator has these specific SE:
- dizziness, N/V/D/C, sexual dysfunction
- May have faster onset and less sexual dysfunction than SSRIs, SNRIs

A

Vortioxetine (Trintellix)

107
Q

Newly approved to treat severe, refractory depression w/o psychosis

A

ketamine/esketamine

108
Q

why is ketamine/esketamine indicated for short-term therapy only

A
  1. Abuse potential due to SE of euphoria/intoxication - controlled rx
  2. May have neurotoxicity in the long-term setting
  3. Can cause psychotomimetic effects → may induce psychosis
109
Q

if ketamine/esketamine is used long term, what is the treatment?

A

eventually be switched to antidepressants and/or antipsychotics for the longer term

110
Q

which tx acts as an opioid and AMPA (glutamate) agonist, NMDA antagonist
Unclear what exact mechanism causes antidepressant effects

A

Ketamine/Esketamine

111
Q

SE of ketamine/esketamine

A
  1. Psychomimetic, HTN, tachycardia, anxiety, dizziness, HA, N/V
  2. Long-term - abuse/addiction, neurotoxicity, bladder toxicity, hepatotoxicity
  3. May see fewer psychotomimetic effects with esketamine
112
Q

CI with ketamine/esketamine

A
  1. Allergy to medication
  2. aneurysmal disease or AV malformation
  3. hx of ICH (intracranial hemorrhage)
  4. inability to tolerate increase in BP
113
Q

DI of ketamine/esketamine

A
  1. CNS depressants (including opiates)
  2. other nasal sprays
114
Q

which MAO breaks down serotonin and norepinephrine

A

MAOa

115
Q

what works with MAOa to break down dopamine

A

MAOb

116
Q

Tranylcypromine (Parnate)

A

MAOI

117
Q

Phenelzine (Nardil)

A

MAOI

118
Q

Isocarboxazid (Marplan)

A

MAOI

119
Q

Selegiline (Eldepryl)

A

MAOI

120
Q

CI of MAOI

A
  1. Allergy to drug
  2. cardiovascular disease
  3. pheochromocytoma
  4. hepatic or renal impairment
  5. use within 2 weeks of other serotonergic drugs
121
Q

which MAOI has less CI than other MAOI

A

Selegiline

122
Q

SE of MAOI

A
  1. Hypotension
  2. GI upset
  3. urinary hesitancy
  4. headache
  5. myoclonic jerks
  6. edema
  7. Risk of suicidal ideation
  8. Hypertensive Crisis
123
Q

how does Hypertensive Crisis happen with MAOIs?

A
  1. when consuming foods with tyramine
    - Aged cheese, soy sauce, cured meats, tap beer, tofu, sauerkraut

(Less common with transdermal selegiline)

124
Q

Used as second-line treatment for depression due to side effects
Also treat anxiety disorder, pain disorders such as neuropathy and headaches

A

TCAs

125
Q

which TCA class is more potent in blocking 5-HT reuptake than NE reuptake

A

Tertiary Amines

126
Q

which TCA class is more potent in blocking NE reuptake than 5-HT reuptake

A

Secondary Amines

127
Q

Amitriptyline (Elavil)

A

Tertiary Amines - TCA

128
Q

Doxepin

A

Tertiary Amines - TCA

129
Q

Imipramine (Tofranil), Clomipramine (Anafranil), Trimipramine (Surmontil)

A

Tertiary Amines - TCA

130
Q

Nortriptyline (Pamelor)

A

Secondary Amines - TCA
metabolite of amitriptyline

131
Q

Desipramine (Norpramin)

A

Secondary Amines - TCA
metabolite of imipramine

132
Q

Protriptyline (Vivactil)

A

Secondary Amines - TCA

133
Q

CI of TCA

A
  1. Allergy to med
  2. use within 2 weeks of an MAOI
  3. use in acute recovery phase of an MI
134
Q

SE of TCA

A
  1. Anticholinergic; drowsiness; sexual dysfunction; diaphoresis; tremor; weight gain; increased appetite
    - Risk of suicidal ideation
    - Risk of cardiotoxicity (prolonged QT)
    - High potential for fatality in overdoses
    - Cardiac arrhythmia, seizures, anticholinergic toxicity
    - Nortriptyline and desipramine have highest overall tolerability
135
Q

Very similar to TCAs - have an extra cyclic ring
Also used for refractory or atypical depression

A

TeCAs

136
Q

Maprotiline (Ludiomil)

A

TeCAs

137
Q

Amoxapine (Asendin)

A

TeCAs

138
Q

which TeCA blocks reuptake of NE and 5-HT (more potent for 5-HT)

A

Maprotiline (Ludiomil)

139
Q

what TeCA blocks reuptake of NE; blocks dopamine receptors (antipsychotic)
Sometimes classified as secondary amine TCA

A

Amoxapine (Asendin)

140
Q

SE of TeCAs

A
  1. Comparable to TCAs; less anticholinergic SE but more antihistamine-like SE than TCAs
  2. Still have risk for suicidal ideation
141
Q
  • often used in bipolar; may also be helpful for unipolar depression
  • Numerous side effects, risk for toxicity
  • Not as efficacious as antidepressant drugs
A

lithium

142
Q

typically used as add-on to antidepressants

A

Antipsychotics

143
Q

Aripiprazole (Abilify)

A

antipsychotics

144
Q

brexpiprazole (Rexulti)

A

antipsychotics

145
Q

quetiapine (Seroquel)

A

antipsychotics

146
Q

Symbyax (fluoxetine + olanzapine)

A

antipsychotics

147
Q

In order to be diagnosed with PDD (Dysthymia), pts must have ongoing depressive symptoms
for ?

A

two years or longer
- Do not have to be in full major depressive episode for all of the two-year span

148
Q

presentation of PDD (dysthymia)

A
  1. 2+ years of depressed mood most of the time, with no more than 2 months free of s/s, plus two or more of the following:
    - Appetite changes (poor appetite or overeating)
    - Sleep changes (insomnia or hypersomnia)
    - Fatigue or loss of energy
    - Diminished ability - thinking, concentration or decision-making
    - Low self-esteem
    Feelings of hopelessness
  2. Cannot have manic symptoms or secondary cause
  3. Similar subtypes to major depressive episodes in MDD
  4. “With persistent major depressive episode” - full episode criteria for 2 yrs
149
Q

most efficacious tx type for PDD (Dysthymia)

A

combination of pharmacotherapy and psychotherapy

150
Q

1st line pharm tx for PDD (Dysthymia)? 2nd?

A
  1. SSRIs
    - May use other antidepressants
  2. TCAs and MAOIs have shown success in studies
    - Caution with side effects!
151
Q

Type of depression where the depressed mood is in response to an identifiable psychosocial stressor

A

Adjustment Disorder
- Single or multiple stressors
- May be recurrent or continuous stressor

152
Q

which depressive disorder is not classified as a true depressive disorder

A

adjustment disorder
- Significant depressive symptoms, in response to a stressor, that do not meet criteria for a more specific depressive disorder

153
Q

Presentation of adjustment disorder

A
  1. Low mood, tearfulness, or feelings of hopelessness in response to a stressor (within 3 months of onset)
  2. Symptoms are significant, as evidenced by one or both of the following:
    - Significant distress exceeding what would be expected given the nature of the stressor
    - Impaired functioning (social or occupational)
  3. Syndrome does not meet criteria for another psych disorder
  4. Syndrome is not an exacerbation of a preexisting psych disorder
  5. Syndrome is not bereavement
  6. Syndrome resolves within 6 months after stressor and its consequences have ended
154
Q

Recurrent major depressive symptoms occurring consistently at particular times of year

A

Seasonal Affective Disorder

155
Q

Seasonal Affective Disorder is MC during what seasons?

A
  1. Fall-Onset (“Winter depression”)
    - Begins late fall-early winter; remits in summer
    - May also see Spring-Onset (“Summer depression”) (not as common)
156
Q

why does SAD happen?

A

Hypothesis that decreased daylight in winter months triggers depressive symptoms in predisposed individuals

157
Q

difference between Fall vs spring onset for SAD

A
  1. fall
    - Increased sleep
    - Increased appetite - Carbohydrate craving
    - Increased weight
    - Irritability
    - Interpersonal difficulties - Rejection sensitivity
    - Leaden paralysis (limbs feeling heavy)
  2. spring
    - Decreased sleep
    - Decreased appetite
    - Decreased weight
    - Dysphoria
158
Q

Tx for SAD

A
  1. Light Therapy
    - Effective tx for fall-onset SAD
    - Non-psychotic, non-suicidal patients
    - Daily therapy until sufficient daily light is available from other sources (e.g., springtime sun)
  2. SSRIs, psychotherapy have been shown to be useful
159
Q

SE of light therapy for SAD

A
  1. usually few and reversible
    - Photophobia
    - HA
    - fatigue
    - irritability
    - insomnia
    - hypomania

Behavioral dynamics (19 decks)

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