Mood Disorders

Question 1

Mood disorders with depressed mood

Answer 1

major depressive disorder, persistent depressive disorder, adjustment disorder with depressed mood, disruptive mood regulation disorder (child psych), premenstrual dysphoric disorder (women’s psych)

Question 2

Mood disorders with depressed and elevated mood

Answer 2

bipolar I, bipolar II, cyclothymia

Question 3

Mood disorders with depressed mood OR depressed and elevated

Answer 3

mood disorder due to other medical condition, substance/medication induced mood disorder

Question 4

Differentiate ‘mood’ and ‘affect’

Answer 4

Mood is a pervasive and sustained emotion (felt by person). Affect is observed expression (as observed by other person).

Question 5

Criteria for major depressive disorder:

Answer 5

A. At least 5 of 9 for 2 weeks, and at least 1 of first two:

1. depressed mood
2. anhedonia (decr interest/pleasure)
3. anergia (fatigue or loss of energy)
4. appetite/weight change (5% incr/decr in 1 month)
5. insomnia or hypersomnia
6. psychomotor agitation or retardation
7. feelings of worthlessness/guilt
8. poor concentration
9. recurrent thoughts of death or suicide

B. Significant distress or impairment in function

C. Not due to direct use of substance or general medical condition

D. Not better explained by other mental condition

E. Never manic episode

Question 6

What is the monoamine hypothesis in relationship to depressive episodes?

Answer 6

Theory that depression is caused by underactivity in the brain of monoamines, such as dopamine, seratonin (5HT), and norepinephrine (NE).

Question 7

Etiology of depression is divided into three broad categories.

Answer 7

Biological, psyhological, and social etiologies.

Question 8

For each of the three etiologies of depression – discuss the therapy/treatment by each category.

Answer 8

Biological: antidepressants, ECT, light treatment

Psychological: psychotherapy, marital therapy

Social: group therapy, support, reduction of stressors (e.g. time off work)

Question 9

How do antidepressants work?

Answer 9

Based on the monoamine hypothesis – therefore incr monoamine levels by either blocking transmitter reuptake (TCA or SSRI) from synapse or blocking metabolism of them (MAOI).

Question 10

What 5 SSRIs are available in Canada?

Answer 10

fluoxetine (Prozac), fluvoaxmine, paroxetine, sertraline, citalopram

Question 11

What are SE of SSRIs?

Answer 11

GI upset, insomnia, agitation, headache, lower seizure threshold, may precipitate mania, sexual side-effects

Question 12

What are SE of TCAs?

Answer 12

anticholinergic, cardiac ECG changes, antiadrenergic, sedation, weight gain, lower seizure threshold, may precipitate mania

Question 13

MAOIs (monoamine oxidase inhibitors) are not used often – what is the major complication associated to them?

Answer 13

hypertensive crisis caused by ingesting tyramine (food) or sympathomimetics

Question 14

In practice, when dealing with mild depression, what is the best management?

Answer 14

Watchful waiting

Question 15

What is the problem with biological treatment in children/adolescents?

Answer 15

Agitating effect with use of antidepressants, and therefore not first line treatment. There is evidence that it may in fact cause incr suicidal thinking as SE.

Question 16

How does ECT exert its effect on the mind?

Answer 16

We don’t know…it was invented in 1931 and over 80 years later we’re still clueless.

Question 17

Differentiate I and II types of bipolar.

Answer 17

Bipolar I – manic and major depressive episodes

Bipolar II – hypomanic and major depressive episodes

Question 18

What is cyclothymia?

Answer 18

2 years of hypomanic or depressed symptoms without qualifying as a clear mood episode

Question 19

What are the 4 groups of thought form?

Answer 19

Goal-directed/normal – logically from one thought to the next

Circumstantial – get to point eventually but not without a lot of unnecessary detail

Disorganized – typical of schizophrenia, jump from one to next without apparent connection

Flight of ideas – thought disorder of mania, jump from to next but with visible connections

Question 20

What is a manic episode?

Answer 20

1 wk abnormally elevated or irritable mood, and incr energy/goal directed activity, ALSO 3 of the following:

• grandiosity
• decr need for sleep
• more talkative than usual “pressure of speech”
• flight of ideas
• distractability
• incr in goal-directed activity
• excessive involvement in pleasureable activities w/ high potential for painful consequences

Question 21

How does hypomanic differ from manic?

Answer 21

4 d instead of 1 wk disturbance

less severe as judged by lack of marked impairment, psychosis or hospitalization

Question 22

Genetic risk is higher in unipolar (depression) or bipolar disorder?

Answer 22

Bipolar

Question 23

How is bipolar treated?

Answer 23

Biological: anti-psychotics, sedatives, mood stabilizers, ECT

Psychological: psychotherapy

Social: education to pt and family, group support

Question 24

What are two examples of mood stabilizers (as discussed in the Mood Disorders lecture)?

Answer 24

lithium carbonate, sodium valproate

Question 25

What are SE of lithium?

Answer 25

tremor, polyuria, polydipsia, weight gain, hypothyroidism, ECG changes, teratogenesis

Question 26

What is the diagnostic criteria of persistent depressive disorder?

Answer 26

depressed mood, most of day, more days than not, for at least 2 years

2 or more of: poor appetitte/over-eating, insomnia/hypersomnia, anergia, poor concentration, hopelessness, low self-esteem

Question 27

What is adjustment disorder with depressed mood?

Answer 27

emotional or behavioral symptoms occuring in response to a stressor (bad experience), must resolve in 6 months

Question 28

What is serotonin syndrome?

Answer 28

Overdose of TCA, adding SSRI/serotonergic agent to MAOI – causing serotonin toxicity

Question 29

What are symptoms of serotonin syndrome?

Answer 29

tremor and hyperreflexia, spontaneous clonus, muscle rigidity, ocular clonus/agitation, diaphoresis