Mood Disorders Flashcards
What is the most common mental disorder in primary care?
Major Depressive Disorder
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
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
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
List some factors in the development of depression
Biological Differences
Neurotransmitters
Hormones
Inherited Traits
Early Childhood Trauma
Life events
List the six subtypes of depression
Psychotic
Catatonic
Melancholic
Post-Partum
Seasonal Affective Disorder (SAD)
Atypical
Which three neurotransmitters are dysfunctional in depression?
Serotonin
dopamine
NE
Rare form of depression involving disturbances of motor behavior
Characterized by:
Motor immobility or stupor
Blunted affect
Extreme withdrawal
echolalia
Catatonic Depression
Depression in which clinical features of psychosis are expressed; Formal thought disorder – incoherence, loose association with limited insight in disease
Psychotic Depression
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
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
Symptoms/signs of Postpartum Psychosis
Hallucinations
Delusions
Rapid mood swings
Thoughts or attempts to hurt self or child
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)
Which depression subtype responds best to SSRIs or SNRIs?
Atypical Depression
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
MDD referral to psychiatry indicated for patients with:
severe depression
Depression unresponsive to initial treatment
Psychotic depression
Depression with other psychiatric diagnosis
What is the first line medications in MDD?
SSRIs
What are the only two SSRIs approved in children with MDD?
Prozac and Lexapro
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
