MOOD DISORDERS Flashcards
What are mood disorders characterized by?
Mood disorders are interrelated sets of psychiatric symptoms characterized by a core deficit in emotional self-regulation.
What are the two main categories of mood disorders?
Depressive disorders and bipolar disorders.
What are the most common psychiatric illnesses seen after ADHD and anxiety in children and adolescents?
Mood disorders.
What is Major Depressive Disorder (MDD)?
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.
How is Major Depressive Disorder classified by severity?
Mild, moderate, and severe based on the number and intensity of symptoms.
What defines Persistent Depressive Disorder?
Persistent depressive mood for at least 1 year in children and adolescents, characterized by lower severity of cognitive symptoms compared to MDD.
What is the core feature of Disruptive Mood Dysregulation Disorder (DMDD)?
Severe, persistent irritability and frequent temper outbursts, present for at least 12 months in multiple settings.
What distinguishes DMDD from Oppositional Defiant Disorder (ODD)?
DMDD involves more severe irritability and frequent temper outbursts, whereas ODD is characterized by a pattern of oppositional behaviors.
How is Other Specified Depressive Disorder (OSDD) defined?
A depressive presentation that causes distress or impairment but does not meet full criteria for any specific depressive disorder.
What is a key diagnostic criterion for a Major Depressive Episode?
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.
What is the age-related prevalence of depressive disorders in the U.S. among adolescents?
The prevalence is 4.9% for ages 6-17 and 12.8% for ages 12-17.
What are some common risk factors for depression in youth?
Family history of depression, physical/sexual abuse, neglect, chronic illness, academic failure, social isolation, and parental psychopathology.
What are some protective factors against developing depression?
Better family function, supportive peer relationships, higher IQ, positive caregiver relationships, and strong caregiver involvement.
What screening tools can be used to assess depression in adolescents?
Pediatric Symptom Checklist, Strengths and Difficulties Questionnaire, PHQ-9, and Beck Depression Inventory.
How is Persistent Depressive Disorder (Dysthymia) diagnosed?
It requires at least 2 years of depressed mood with two or more additional symptoms, with no period of 2 months without symptoms.
What differentiates DMDD from Bipolar Disorder?
DMDD does not include manic or hypomanic episodes, and symptoms are not explained by bipolar disorder.
What medical conditions must be ruled out when diagnosing a depressive disorder?
Neurologic disorders, endocrine disorders, infectious diseases, tumors, anemia, and chronic conditions like chronic fatigue disorder or pain disorders.
What is the rate of comorbidity between depressive disorders and other psychiatric disorders?
40-90% of youth with a depressive disorder have at least one comorbid psychiatric disorder, and up to 50% have two or more.
What is the prevalence of Disruptive Mood Dysregulation Disorder (DMDD)?
DMDD affects about 2-5% of children, with higher rates in preschoolers.
What is the core symptom of Major Depressive Disorder?
Depressed mood or loss of interest in almost all activities for most of the day, nearly every day, for at least 2 weeks.
How is the duration of irritability and temper outbursts defined in DMDD?
Irritability and temper outbursts must occur for at least 12 months, with no period longer than 3 months without symptoms.
What is a key difference between grief and Major Depressive Disorder in children?
Grief is a response to loss, whereas MDD includes symptoms like anhedonia, changes in appetite/sleep, feelings of guilt/worthlessness, and suicidal ideation.
How is the development of depressive disorders influenced by environmental factors?
Children with a history of abuse, neglect, school failure, or social isolation are at a higher risk of developing depression.
What is the typical age of onset for Major Depressive Disorder in children?
It commonly begins in early adolescence, with the prevalence increasing from ages 6-17 years.
Q: What is the goal of treatment for depression in youth?
“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).”
Q: What are the first-line treatments for mild depression in youth?
“A: Guided self-help (anticipatory guidance)
Q: What should be considered for youths with moderate to severe depression?
“A: Specific manualized psychotherapies (like CBT or interpersonal therapy)
Q: What is the FDA-approved antidepressant for youth depression?
“A: Fluoxetine and escitalopram are FDA-approved for youth depression
Q: What are common side effects of SSRIs in children?
“A: Common side effects include gastrointestinal upset
Q: How should SSRIs be dosed for fluoxetine and escitalopram?
“A: Fluoxetine should be given in the morning (activating)
Q: What is the risk associated with SSRIs in patients under age 25?
“A: SSRIs carry a black box warning for increased suicidal thinking in patients under age 25
Q: When should a second SSRI be considered?
“A: If the first trial of an SSRI is unsuccessful after an adequate trial (6-8 weeks at a target dose)
Q: What is the recommended treatment for treatment-resistant depression in youth?
“A: A combination of a second SSRI and CBT
Q: What is the standard duration for maintaining treatment after successful depression treatment?
“A: Treatment should continue for 6-12 months due to the high risk of recurrence.”
Q: How should SSRIs be discontinued?
“A: SSRIs (except fluoxetine) should be gradually discontinued to avoid withdrawal symptoms
Q: What are the common treatments for persistent depressive disorder or DMDD?
“A: No rigorous studies for pharmacologic or psychosocial treatments
Q: When should inpatient treatment for depression be considered?
“A: Inpatient treatment should be considered for youth at substantial risk of suicide
Q: What is the median duration of a major depressive episode in youth?
“A: The median duration is about 5-8 months for clinically referred youth and 3-6 months for community samples.”
Q: What percentage of depressed adolescents may experience recurrence within 5 years?
“A: The recurrence rate of depression in adolescents is 50-70% within 5 years.”
Q: What are the common long-term sequelae of major depressive disorder in youth?
“A: Youths with MDD are at risk for suicide
Q: What is the prevalence of bipolar disorder I and II in the adult population?
“A: Bipolar I has a lifetime prevalence of 0.8-1.6%
Q: What are the criteria for diagnosing a manic episode?
“A: A manic episode involves at least 1 week of elevated mood
Q: How is bipolar II disorder diagnosed?
“A: Bipolar II disorder is diagnosed with at least one hypomanic episode and one major depressive episode
Q: What environmental factors may contribute to early onset of bipolar disorder?
“A: Irritable parenting
Q: What is the most common treatment for youth with bipolar disorder?
“A: Youth with bipolar disorder are often treated with mood stabilizers and atypical antipsychotics
Q: What is the heritability of bipolar disorder?
“A: The heritability of bipolar disorder is estimated at 60-90%
Q: What symptoms might suggest bipolar disorder in adolescents?
“A: Symptoms include elation
What is the DSM-5 diagnostic criteria for a hypomanic episode?
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.
How many symptoms are needed to meet the DSM-5 criteria for a hypomanic episode?
Three (or more) symptoms must be present, or four if the mood is only irritable.
What is the minimum duration required for a hypomanic episode to be diagnosed?
At least four consecutive days.
What is the criterion related to sleep in a hypomanic episode?
Decreased need for sleep (e.g., feels rested after only 3 hours of sleep).
Which symptom in a hypomanic episode is characterized by an inability to stay still or focused?
Distractibility (attention is too easily drawn to irrelevant external stimuli).
What is the diagnostic criterion regarding functioning during a hypomanic episode?
The episode is associated with an unequivocal change in functioning that is uncharacteristic of the individual when not symptomatic.
How is a hypomanic episode related to psychotic features?
If there are psychotic features, the episode is by definition manic, not hypomanic.
Which conditions should be ruled out when diagnosing a bipolar disorder?
Substance use, ADHD, ODD, PTSD, anxiety, and various medical conditions such as neurologic or endocrine disorders.
What is the main differential diagnosis for bipolar II disorder?
Unipolar depression (MDD) or cyclothymic disorder.
How is bipolar I different from bipolar II in terms of hypomanic episodes?
Bipolar I requires one manic episode, whereas bipolar II requires one major hypomanic episode and at least one major depressive episode.
What characterizes cyclothymia in the context of mood episodes?
Symptoms of hypomania and depression without meeting full criteria for a manic, hypomanic, or depressive episode, lasting for at least one year.
What are common comorbidities in bipolar disorder?
ADHD, ODD, anxiety, conduct disorder, and substance abuse.
Which medications are the most efficacious for treating mania in bipolar disorder?
Risperidone and olanzapine are the most efficacious.
What is the role of lithium in the treatment of bipolar disorder?
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.
What medications are commonly used to regulate sleep in patients with bipolar disorder?
Benzodiazepines, benzodiazepine receptor agonists, and melatonin receptor agonists.
What are the general recommendations for antidepressants in bipolar disorder?
Antidepressants alone should not be prescribed for depressive symptoms in bipolar I disorder due to the risk of triggering mania.
What are the goals of psychotherapy in the treatment of bipolar disorder?
To improve self-regulation, cognitive restructuring, communication, problem-solving, and emotion regulation, particularly in family-focused therapies.
What is the typical age of onset for bipolar I disorder?
The mean age of onset for the first manic episode is approximately 18 years old.
What factors predict a more chronic course in adolescent-onset bipolar I disorder?
Premorbid problems, especially with mood and behavioral regulation, and early onset are predictors.
How does sleep impairment influence bipolar disorder treatment?
Sleep impairment is inversely related to favorable treatment response, making it an important target for treatment.
What is the risk of suicide in individuals with bipolar disorder?
The lifetime risk of suicide in individuals with bipolar disorder is estimated to be at least 15 times that of the general population.
How does the clinical course of bipolar I disorder typically progress with age?
Bipolar I is highly recurrent, with patients often experiencing 4 episodes in 10 years as they age.
How does bipolar II disorder differ in terms of onset and progression compared to bipolar I?
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.
How are bipolar depression and unipolar depression different in terms of symptoms?
Bipolar depression is more likely to involve atypical symptoms such as hypersomnia, lability, and weight instability, whereas unipolar depression may involve more somatic complaints.
How common is treatment nonadherence in youth with bipolar disorder?
Treatment nonadherence is common, with medication appointments averaging only one visit every two months in one healthcare system study.
Which interventions have been shown to help prevent the recurrence of mood symptoms in youth at high familial risk for bipolar disorder?
Family-focused treatment has shown effectiveness in hastening and sustaining recovery from mood symptoms in high-familial-risk cohorts.
