Mood Disorders Flashcards by Katie Keller

What is the most common mental disorder in primary care?

Major Depressive Disorder

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Major Depressive Disorder Types: which one is described below?

Involves only one major depressive episode in a lifetime

Very rare – 85% of single episodes are followed by repeated episodes

12% suicidal attempts

Major Depressive Disorder, Single episode

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Major Depressive Disorder Types: which one is described below?

Involves repeated major depressive episodes separated by a period of at least 2 months during which the individual was not depressed

Major Depressive Disorder, Recurrent

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Major Depressive Disorder Diagnostic Criteria:

Episodes MUST be characterized by 5 or more of the following symptoms nearly
every day for two weeks and at least one of the symptoms include depressed
mood or anhedonia as well as at least one major depressive episode, no history of mania or hypomania, and not the result of a substance or general medical condition

S – sleep disturbances
I – interest loss (anhedonia- diminished interest/pleasure in activies)
G – guilt – feeling of guilty or worthlessness
E – energy loss/fatigue (anergia)
C – concentration difficulties, indecisiveness
A – appetite change
P- psychomotor agitation or retardation
S – suicidal ideation

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List some factors in the development of depression

Biological Differences
Neurotransmitters
Hormones
Inherited Traits
Early Childhood Trauma
Life events

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List the six subtypes of depression

Psychotic
Catatonic
Melancholic
Post-Partum
Seasonal Affective Disorder (SAD)
Atypical

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Which three neurotransmitters are dysfunctional in depression?

Serotonin
dopamine
NE

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Rare form of depression involving disturbances of motor behavior

Characterized by:
Motor immobility or stupor
Blunted affect
Extreme withdrawal
echolalia

Catatonic Depression

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Depression in which clinical features of psychosis are expressed; Formal thought disorder – incoherence, loose association with limited insight in disease

Psychotic Depression

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Subtype of depression characterized by:

Loss of pleasure in most activities
non-reaction to pleasurable stimuli
worsening of symptoms in early morning hours
psychomotor retardation
excessive weight loss or guilt

Women most common

50% of hospitalized depressed patients have this type

Melancholic Depression

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Subtype of depression characterized by:

For most women, symptoms are transient and relatively mild

In the postpartum period, depression is characterized as intense sadness, anxiety, or despair

Can develop psychosis with this type of depression

Typically develops insidiously over the first 3 postpartum months but symptoms can develop acutely

Post-Partum Depression

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Symptoms/signs of Postpartum Psychosis

Hallucinations
Delusions
Rapid mood swings
Thoughts or attempts to hurt self or child

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Subtype of depression characterized by:

Fluctuating of depression - the season of onset is usually autumn and winter and remission usually occur in spring and summer

An individual should demonstrate at least 2 episodes of depressive disturbance in the previous two years, and seasonal episodes should substantially outnumber nonseasonal episodes

More likely to report atypical symptoms such as hypersomnia and increased appetite

Seasonal Affective Disorder (SAD)

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Which depression subtype responds best to SSRIs or SNRIs?

Atypical Depression

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Subtype of depression characterized by:

Characteristics of this subtype are mood reactivity and exclusion of melancholic and catatonic subtypes

In addition, two or more of the following need to be present for at least two weeks:

Increased appetite or significant weight gain
Increased sleep
Rejection sensitivity
Feelings of heaviness in arms or legs that extend far beyond the mood disturbance episodes and result in impairment in social or occupational functioning

This subtype responds best to SSRIs or SNRIs

Atypical Depression

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MDD referral to psychiatry indicated for patients with:

severe depression

Depression unresponsive to initial treatment

Psychotic depression

Depression with other psychiatric diagnosis

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What is the first line medications in MDD?

SSRIs

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What are the only two SSRIs approved in children with MDD?

Prozac and Lexapro

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In the treatment of MDD, which medication is a better option than SSRI if sexual side effects are common (particularly younger men)?

Buproprion

In the elderly with depression, what must you rule out before giving the diagnosis of depression?

untreated medical causes (example: hypothyroidism)

Dementia syndrome of depression is called what?

Pseudodementia

Describe pseudodementia characteristics

Mental confusion dominates the clinical picture

Patient has memory loss and functional decline, but it’s much more abrupt than the onset of Alzheimer’s disease

What are some medical illnesses that are often associated with depression?

Stroke
MI
Thyroid disease
Parkinson’s dementia
Chronic pain syndrome

List some medications/substances that can cause depression

Digitalis
Antihypertensives
BZs
Alcohol
Analgesics
Levodopa
Antibiotics
Steroids
antipsychotics

A chronic, milder mood disturbance that has been present for at least 2 years

Dysthymia

Diagnosed when a patient presents with chronic depression of at least 2 years that has not been severe enough to meet the criteria for MDD (or one year in children) Patient must have two of the following:

S – sleep changes (increase or decrease) E – energy/self esteem (low) A – appetite (increase or decrease) C – concentration (poor concentration or decision making) H - hopelessness

The key to differentiating dysthymia from MDD is what?

the timing and severity

Episodic condition with four potentials: Manic Major depression with manic features Mixed episodes – both depression and mania Hypomanic Must be without other conditions: drug abuse, thyroid storm, menopause, multiple sclerosis, etc Characterize by most recent episode

Bipolar Disorder

List some causes of bipolar disorder

Biological Neurotransmitters Inherited Traits Environment

List some risk factors for bipolar disorder

Having blood relatives (such as parent or sibling) with bipolar disorder Periods of high stress Drug or alcohol abuse Major life changes, such as the death of a loved one Being in your early 20s

Criteria for Mania A. A distinct period of abnormally and persistently elevated, expansive, or irritable mood -At least one week or severe enough to hospitalize B. Mood disturbance plus THREE of the following symptoms (four if the mood is only irritable): DIGFAST List the symptoms for section B C. Marked impairment D. No psychosis E. Not organic

D – distractibility I – indiscretion (excessive involvement in pleasurable activities) G – grandiosity or inflated self esteem F – flight of ideas, racing thoughts A – activity increase S – sleep deficit T – talkativeness or pressure to keep talking

What is the criteria for Hypomania?

All the criteria of a Manic episode except criterion C (marked impairment)

Instead of the clear-cut depression and mania or hypomania; the most prominent signs of bipolar disorder in children and adolescents include:

Explosive temper Rapid mood shifts Reckless behavior Aggression

List some co-occurring conditions with Bipolar disorder you may see

Anxiety disorders Attention-deficit/hyperactivity disorder Addiction or substance abuse

What are the types of bipolar disorder (classifications)?

Bipolar I Disorder Bipolar II Disorder

Describe the features of Bipolar I Disorder

Alteration of full manic and depressive episodes (At least one week or severe enough to be hospitalized) Average onset is 18 years old Average age of actual diagnosis is 30 years old Tends to be chronic High risk for suicide (Poor decision-making, engaging in risky behavior, impulsiveness)

Describe the features of Bipolar II Disorder

Characterized by at least one or more major depressive episodes and at least ONE hypomanic episode for at least 4 days (the patient has never experienced a manic episode or mixed episode) - No marked impairment! No psychotic features! Does not require hospitalization Alteration of major depression with hypomania Average onset is 22 years old Tends to be chronic 10% progress to bipolar I disorder (Doesn’t always progress to I but it can, or patient could stay II forever More common in females

Which type of bipolar disorder is more common in women?

Bipolar II Disorder

What percentage of Bipolar II disorders progress to Bipolar I?

10%

What are some secondary causes of mania that need to be ruled out as a cause?

Toxins Neurologic

List some complications of untreated Bipolar Disorder

Problems related to substance and alcohol abuse Legal problems Financial problems Relationship issues Isolation Loneliness Poor work or school performance Frequent absences from work or school Self harm Suicide

What medication is considered the quintessential bipolar medication?

Lithium

What class of medications should NEVER be used as monotherapy in bipolar disorder? Why?

Antidepressants Can push bipolar patients into mania

What mood disorder is described below: Patients often described as moody, erratic, volatile Like Bipolar II disorder, but less severe No evidence of MDD or manic episode during the first two years of disturbance No psychotic disorder No organic cause

Cyclothymic Disorder

What mood disorder is described below: Trouble adjusting to a stressor An excessive, prolonged reaction to a stressful event or situation, or combination of situations More common in females and adolescents These symptoms are NOT CAUSED by bereavement Patients should not meet the criteria for any other disorder (i.e. MDD, bipolar, etc)

Adjustment Disorder

List some stressors/risk factors for adjustment disorder

Financial difficulties Martial strain Natural disasters Loss of job Death Sexuality issues Major life changes Family conflict School or work changes