Mood Disorders Flashcards
What are examples of mood disorders:
They include major depressive disorder (MDD), bipolar I disorder, bipolar II disorder, persistent depressive disorder, and cyclothymic disorder. Some may have psychotic features (delusions or hallucinations).
DSM 5 criteria for MDD
Must have at least five of the following symptoms (must include either number 1 or 2) for at least a 2-week period:
- Depressed mood most of the time.
- Anhedonia (loss of interest in pleasurable activities).
- Change in appetite or weight (↑ or ↓).
- Feelings of worthlessness or excessive guilt.
- Insomnia or hypersomnia.
- Diminished concentration.
- Psychomotor agitation or retardation (i.e., restlessness or slowness). 8. Fatigue or loss of energy.
- Recurrent thoughts of death or suicide.
Symptoms must not be attributable to the effects of a substance (drug or medication) or another medical condition, and they must cause clinically significant distress or social/occupational impairment.
What criteria is needed for manic episode
A distinct period of abnormally and persistently elevated, expansive, or irritable mood, and abnormally and persistently increased goal-directed activity or en- ergy, lasting at least 1 week (or any duration if hospitalization is necessary), and including at least three of the following (four if the mood is only irritable):
- Distractibility.
- Inflated self-esteem or grandiosity.
- ↑ in goal-directed activity (socially, at work, or sexually) or psychomotor
agitation. - ↓ need for sleep.
- Flight of ideas or racing thoughts.
- More talkative than usual or pressured speech (rapid and uninterruptible).
- Excessive involvement in pleasurable activities that have a high risk of nega-
tive consequences (e.g., shopping sprees, sexual indiscretions).
Symptoms must not be attributable to the effects of a substance (drug or medi- cation) or another medical condition, and they must cause clinically significant distress or social/occupational impairment. Greater than 50% of patients with manic episodes have psychotic symptoms.
What is a hypomanic episode
A distinct period of abnormally and persistently ele- vated, expansive, or irritable mood, and abnormally and persistently increased goal-directed activity or energy, lasting at least 4 consecutive days, that includes at least three of the symptoms listed for the manic episode criteria (four if mood is only irritable).
Suicide Risk Factors:
SAD PERSONS
S: Male sex
A: <19 or >45 years D: Depression
P: Previous attempt
E: Excess alcohol or substance use R: Rational thinking loss
S: Social supports lacking
O: Organized plan
N: No spouse
S: Sickness
Symptoms of mania:
DIG FAST
Distractibility Insomnia/Impulsive behavior Grandiosity
Flight of ideas/Racing thoughts Activity/Agitation
Speech (pressured) Thoughtlessness
Differential diagnoses of depressive episodes due to medical cause:
Cerebrovascular disease (stroke, myocardial infarction)
Endocrinopathies (diabetes mellitus, Cushing syndrome, Addison disease, hypoglycemia, hyper/hypothyroidism, hyper/hypocalcemia)
Parkinson disease
Viral illnesses (e.g., mononucleosis) Carcinoid syndrome
Cancer (especially lymphoma and pancreatic carcinoma)
Collagen vascular disease (e.g., systemic lupus erythematosus)
Differential diagnoses of MANIC episodes due to medical cause:
Metabolic (hyperthyroidism) Neurological disorders (temporal lobe seizures, multiple sclerosis)
Neoplasms HIV infection
What is Bipolar I disorder
involves episodes of mania and of major depression; how- ever, episodes of major depression are not required for the diagnosis. It is also known as manic-depression.
What medications can be used to treat bipolar I
- lithium - GOLD STANDARD
**can also reduce of suicide with long term use - anticonvulsants: carbamazepine and valproic acid (espeically good for rapid cycling bipolar and those with mixed features
- atypical antipsychotics: (risperidone, olanzapine, ziprasidone, quetiapine)
Why are antidepressants discouraged as monotherapy for bipolar d/o?
concerns of activating mania or hypomania.
***They are occasionally used to treat depressive episodes when patients concurrently take mood stabilizers.
Diagnosis for Bipolar II d/o
History of one or more MDEs (major depressive episode) and at least one hypomanic episode. Remember: If there has been a full manic episode, even in the past, or if the patient ever has a history of psychosis, then the diagnosis is bipolar I, not bipolar II disorder.
Diagnosis and DSM-5 Criteria for Cyclothymic disorder
Alternating periods of hypomania and periods with mild-to-moderate depres- sive symptoms.
■ Numerous periods with hypomanic symptoms (but not a full hypomanic episode) and periods with depressive symptoms (but not full MDE) for at least 2 years.
■ The person must never have been symptom free for >2 months during those 2 years.
■ No history of MDE, hypomania, or manic episode.
Diagnosis and DSM-5 Criteria for Premenstrual dysphoric disorder
Mood lability, irritability, dysphoria, and anxiety that occur repeatedly during the premenstrual phase of the cycle.
In most menstrual cycles, at least five symptoms (below) are present in the final week before menses, improve within a few days after menses, and are minimal/absent in the week postmenses (should be confirmed by daily ratings for at least two menstrual cycles).
■ At least one of the following symptoms is present: affective lability, irritability/anger, depressed mood, anxiety/tension.
■ At least one of the following symptoms is present (for total of at least five symptoms when combined with above): anhedonia, problems concentrating, anergia, appetite changes/food cravings, hypersomnia/insomnia, feeling overwhelmed/out of control, physical symptoms (e.g., breast tenderness/ swelling, joint/muscle pain, bloating, weight gain).
■ Symptoms cause clinically significant distress or impairment in functioning.
■ Symptoms are not only exacerbation of another disorder (e.g., MDD, panic
disorder, persistent depressive disorder).
■ Symptoms are not due to a substance (medication or drug) or another medical condition.
Treatment for Premenstrual dysphoric disorder
SSRIs are first-line treatment, either as daily therapy or luteal phase-only treat- ment (starting on cycle day 14 and stopping upon menses or shortly thereaf- ter). Oral contraceptives may reduce symptoms. Gonadotropin-releasing hor- mone (GnRH) agonists have also been used, and, in rare, severe cases, bilateral oophorectomy with hysterectomy will resolve symptoms.
