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PEDIATRICS > MOOD DISORDERS > Flashcards

MOOD DISORDERS Flashcards

1
Q

What are mood disorders characterized by?

A

Mood disorders are interrelated sets of psychiatric symptoms characterized by a core deficit in emotional self-regulation.

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2
Q

What are the two main categories of mood disorders?

A

Depressive disorders and bipolar disorders.

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3
Q

What are the most common psychiatric illnesses seen after ADHD and anxiety in children and adolescents?

A

Mood disorders.

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4
Q

What is Major Depressive Disorder (MDD)?

A

MDD is characterized by at least 2 weeks of a depressed or irritable mood and/or loss of interest in activities, along with several other cognitive and vegetative symptoms.

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5
Q

How is Major Depressive Disorder classified by severity?

A

Mild, moderate, and severe based on the number and intensity of symptoms.

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6
Q

What defines Persistent Depressive Disorder?

A

Persistent depressive mood for at least 1 year in children and adolescents, characterized by lower severity of cognitive symptoms compared to MDD.

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7
Q

What is the core feature of Disruptive Mood Dysregulation Disorder (DMDD)?

A

Severe, persistent irritability and frequent temper outbursts, present for at least 12 months in multiple settings.

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8
Q

What distinguishes DMDD from Oppositional Defiant Disorder (ODD)?

A

DMDD involves more severe irritability and frequent temper outbursts, whereas ODD is characterized by a pattern of oppositional behaviors.

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9
Q

How is Other Specified Depressive Disorder (OSDD) defined?

A

A depressive presentation that causes distress or impairment but does not meet full criteria for any specific depressive disorder.

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10
Q

What is a key diagnostic criterion for a Major Depressive Episode?

A

At least five of the following: depressed mood, loss of interest, weight changes, sleep disturbances, fatigue, feelings of worthlessness, diminished concentration, suicidal thoughts, and psychomotor changes.

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11
Q

What is the age-related prevalence of depressive disorders in the U.S. among adolescents?

A

The prevalence is 4.9% for ages 6-17 and 12.8% for ages 12-17.

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12
Q

What are some common risk factors for depression in youth?

A

Family history of depression, physical/sexual abuse, neglect, chronic illness, academic failure, social isolation, and parental psychopathology.

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13
Q

What are some protective factors against developing depression?

A

Better family function, supportive peer relationships, higher IQ, positive caregiver relationships, and strong caregiver involvement.

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14
Q

What screening tools can be used to assess depression in adolescents?

A

Pediatric Symptom Checklist, Strengths and Difficulties Questionnaire, PHQ-9, and Beck Depression Inventory.

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15
Q

How is Persistent Depressive Disorder (Dysthymia) diagnosed?

A

It requires at least 2 years of depressed mood with two or more additional symptoms, with no period of 2 months without symptoms.

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16
Q

What differentiates DMDD from Bipolar Disorder?

A

DMDD does not include manic or hypomanic episodes, and symptoms are not explained by bipolar disorder.

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17
Q

What medical conditions must be ruled out when diagnosing a depressive disorder?

A

Neurologic disorders, endocrine disorders, infectious diseases, tumors, anemia, and chronic conditions like chronic fatigue disorder or pain disorders.

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18
Q

What is the rate of comorbidity between depressive disorders and other psychiatric disorders?

A

40-90% of youth with a depressive disorder have at least one comorbid psychiatric disorder, and up to 50% have two or more.

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19
Q

What is the prevalence of Disruptive Mood Dysregulation Disorder (DMDD)?

A

DMDD affects about 2-5% of children, with higher rates in preschoolers.

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20
Q

What is the core symptom of Major Depressive Disorder?

A

Depressed mood or loss of interest in almost all activities for most of the day, nearly every day, for at least 2 weeks.

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21
Q

How is the duration of irritability and temper outbursts defined in DMDD?

A

Irritability and temper outbursts must occur for at least 12 months, with no period longer than 3 months without symptoms.

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22
Q

What is a key difference between grief and Major Depressive Disorder in children?

A

Grief is a response to loss, whereas MDD includes symptoms like anhedonia, changes in appetite/sleep, feelings of guilt/worthlessness, and suicidal ideation.

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23
Q

How is the development of depressive disorders influenced by environmental factors?

A

Children with a history of abuse, neglect, school failure, or social isolation are at a higher risk of developing depression.

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24
Q

What is the typical age of onset for Major Depressive Disorder in children?

A

It commonly begins in early adolescence, with the prevalence increasing from ages 6-17 years.

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25
Q

Q: What is the goal of treatment for depression in youth?

A

“A: The goal of treatment is remission (at least 2 weeks with no or very few depressive symptoms) and ultimately recovery (at least 2 months with no or very few depressive symptoms).”

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26
Q

Q: What are the first-line treatments for mild depression in youth?

A

“A: Guided self-help (anticipatory guidance)

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27
Q

Q: What should be considered for youths with moderate to severe depression?

A

“A: Specific manualized psychotherapies (like CBT or interpersonal therapy)

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28
Q

Q: What is the FDA-approved antidepressant for youth depression?

A

“A: Fluoxetine and escitalopram are FDA-approved for youth depression

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29
Q

Q: What are common side effects of SSRIs in children?

A

“A: Common side effects include gastrointestinal upset

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30
Q

Q: How should SSRIs be dosed for fluoxetine and escitalopram?

A

“A: Fluoxetine should be given in the morning (activating)

31
Q

Q: What is the risk associated with SSRIs in patients under age 25?

A

“A: SSRIs carry a black box warning for increased suicidal thinking in patients under age 25

32
Q

Q: When should a second SSRI be considered?

A

“A: If the first trial of an SSRI is unsuccessful after an adequate trial (6-8 weeks at a target dose)

33
Q

Q: What is the recommended treatment for treatment-resistant depression in youth?

A

“A: A combination of a second SSRI and CBT

34
Q

Q: What is the standard duration for maintaining treatment after successful depression treatment?

A

“A: Treatment should continue for 6-12 months due to the high risk of recurrence.”

35
Q

Q: How should SSRIs be discontinued?

A

“A: SSRIs (except fluoxetine) should be gradually discontinued to avoid withdrawal symptoms

36
Q

Q: What are the common treatments for persistent depressive disorder or DMDD?

A

“A: No rigorous studies for pharmacologic or psychosocial treatments

37
Q

Q: When should inpatient treatment for depression be considered?

A

“A: Inpatient treatment should be considered for youth at substantial risk of suicide

38
Q

Q: What is the median duration of a major depressive episode in youth?

A

“A: The median duration is about 5-8 months for clinically referred youth and 3-6 months for community samples.”

39
Q

Q: What percentage of depressed adolescents may experience recurrence within 5 years?

A

“A: The recurrence rate of depression in adolescents is 50-70% within 5 years.”

40
Q

Q: What are the common long-term sequelae of major depressive disorder in youth?

A

“A: Youths with MDD are at risk for suicide

41
Q

Q: What is the prevalence of bipolar disorder I and II in the adult population?

A

“A: Bipolar I has a lifetime prevalence of 0.8-1.6%

42
Q

Q: What are the criteria for diagnosing a manic episode?

A

“A: A manic episode involves at least 1 week of elevated mood

43
Q

Q: How is bipolar II disorder diagnosed?

A

“A: Bipolar II disorder is diagnosed with at least one hypomanic episode and one major depressive episode

44
Q

Q: What environmental factors may contribute to early onset of bipolar disorder?

A

“A: Irritable parenting

45
Q

Q: What is the most common treatment for youth with bipolar disorder?

A

“A: Youth with bipolar disorder are often treated with mood stabilizers and atypical antipsychotics

46
Q

Q: What is the heritability of bipolar disorder?

A

“A: The heritability of bipolar disorder is estimated at 60-90%

47
Q

Q: What symptoms might suggest bipolar disorder in adolescents?

A

“A: Symptoms include elation

48
Q

What is the DSM-5 diagnostic criteria for a hypomanic episode?

A

A distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased goal-directed activity or energy, lasting at least four consecutive days and present most of the day, nearly every day.

49
Q

How many symptoms are needed to meet the DSM-5 criteria for a hypomanic episode?

A

Three (or more) symptoms must be present, or four if the mood is only irritable.

50
Q

What is the minimum duration required for a hypomanic episode to be diagnosed?

A

At least four consecutive days.

51
Q

What is the criterion related to sleep in a hypomanic episode?

A

Decreased need for sleep (e.g., feels rested after only 3 hours of sleep).

52
Q

Which symptom in a hypomanic episode is characterized by an inability to stay still or focused?

A

Distractibility (attention is too easily drawn to irrelevant external stimuli).

53
Q

What is the diagnostic criterion regarding functioning during a hypomanic episode?

A

The episode is associated with an unequivocal change in functioning that is uncharacteristic of the individual when not symptomatic.

54
Q

How is a hypomanic episode related to psychotic features?

A

If there are psychotic features, the episode is by definition manic, not hypomanic.

55
Q

Which conditions should be ruled out when diagnosing a bipolar disorder?

A

Substance use, ADHD, ODD, PTSD, anxiety, and various medical conditions such as neurologic or endocrine disorders.

56
Q

What is the main differential diagnosis for bipolar II disorder?

A

Unipolar depression (MDD) or cyclothymic disorder.

57
Q

How is bipolar I different from bipolar II in terms of hypomanic episodes?

A

Bipolar I requires one manic episode, whereas bipolar II requires one major hypomanic episode and at least one major depressive episode.

58
Q

What characterizes cyclothymia in the context of mood episodes?

A

Symptoms of hypomania and depression without meeting full criteria for a manic, hypomanic, or depressive episode, lasting for at least one year.

59
Q

What are common comorbidities in bipolar disorder?

A

ADHD, ODD, anxiety, conduct disorder, and substance abuse.

60
Q

Which medications are the most efficacious for treating mania in bipolar disorder?

A

Risperidone and olanzapine are the most efficacious.

61
Q

What is the role of lithium in the treatment of bipolar disorder?

A

Lithium is FDA-approved for the treatment of bipolar disorder in patients aged 12 and older and has been shown to reduce the risk of suicide.

62
Q

What medications are commonly used to regulate sleep in patients with bipolar disorder?

A

Benzodiazepines, benzodiazepine receptor agonists, and melatonin receptor agonists.

63
Q

What are the general recommendations for antidepressants in bipolar disorder?

A

Antidepressants alone should not be prescribed for depressive symptoms in bipolar I disorder due to the risk of triggering mania.

64
Q

What are the goals of psychotherapy in the treatment of bipolar disorder?

A

To improve self-regulation, cognitive restructuring, communication, problem-solving, and emotion regulation, particularly in family-focused therapies.

65
Q

What is the typical age of onset for bipolar I disorder?

A

The mean age of onset for the first manic episode is approximately 18 years old.

66
Q

What factors predict a more chronic course in adolescent-onset bipolar I disorder?

A

Premorbid problems, especially with mood and behavioral regulation, and early onset are predictors.

67
Q

How does sleep impairment influence bipolar disorder treatment?

A

Sleep impairment is inversely related to favorable treatment response, making it an important target for treatment.

68
Q

What is the risk of suicide in individuals with bipolar disorder?

A

The lifetime risk of suicide in individuals with bipolar disorder is estimated to be at least 15 times that of the general population.

69
Q

How does the clinical course of bipolar I disorder typically progress with age?

A

Bipolar I is highly recurrent, with patients often experiencing 4 episodes in 10 years as they age.

70
Q

How does bipolar II disorder differ in terms of onset and progression compared to bipolar I?

A

Bipolar II often starts with a depressive episode and is not recognized until a hypomanic episode occurs, with 5-15% of cases later evolving into bipolar I.

71
Q

How are bipolar depression and unipolar depression different in terms of symptoms?

A

Bipolar depression is more likely to involve atypical symptoms such as hypersomnia, lability, and weight instability, whereas unipolar depression may involve more somatic complaints.

72
Q

How common is treatment nonadherence in youth with bipolar disorder?

A

Treatment nonadherence is common, with medication appointments averaging only one visit every two months in one healthcare system study.

73
Q

Which interventions have been shown to help prevent the recurrence of mood symptoms in youth at high familial risk for bipolar disorder?

A

Family-focused treatment has shown effectiveness in hastening and sustaining recovery from mood symptoms in high-familial-risk cohorts.

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