Mood Disorders

Question 1

What are the major symptoms of major depressive disorder? How long must they be present for a diagnosis?

Answer 1

SIG-E-CAPS
S: sleep
I: loss of interest
G: guilt
E: loss of energy
C: concentration difficulty
A: appetite disturbance
P: psychomotor retardation
S: suicidal thoughts 
Must be present >2 weeks

Question 2

29 yo female presents with feeling down for the last few years. It has effected her relationships with family and has made it difficult to go to work. She says that the feeling of being down has never really gone away since she began feeling it.

Answer 2

dysthymia

Question 3

How long must symptoms persist to diagnose dysthymia?

Answer 3

2 years without break in symptoms

Question 4

19 yo female presents with changes in mood seeming to occur every month or so. When asked about the timing of her menstrual cycle, she thinks the symptoms begin the week before her period

Answer 4

Premenstrual dysphoric disorder

Question 5

How long must premenstrual dysphoric disorder symptoms occur for a diagnosis?

Answer 5

Must have symptoms for a year with documentation prospectively of at least 2 menstrual cycles

Question 6

Explain the time line of symptoms for dysthymia

Answer 6

Never ceasing, low mood, not bad enough to be considered major depressive disorder

Question 7

25 yo male presents after wife tells him she thinks he has a psychologic problem. She tells him that his mood is too “up and down.” Sometime his mood is almost manic, and other times he seems so depressed. She’s noticed it since before they got married, which was 2 years ago.

Answer 7

Cyclothymia

Question 8

What are the diagnosis requirements for cyclothymia?

Answer 8

dysthymia with hypomania lasting at least 2 years, but never meeting the criteria for major depression or mania
*mild bipolar

Question 9

What are the diagnosis requirements for Bipolar I?

Answer 9

at least one manic episode with recurrent depression

Question 10

What is a manic episode?

Answer 10

distinct period of abnormal mood elevation lasting at least 1 week or requiring hospitalization

Question 11

What is the difference between Bipolar I and Bipolar II?

Answer 11

Bipolar II involves the same depressive episodes that Bipolar I does, but in Bipolar II there is a hypomanic state that doesn’t meet criteria for mania.
-less severe than Bipolar I

Question 12

What is the time scale of symptoms for a hypomanic state?

Answer 12

persistent, elevated mood with increased energy for at least 4 consecutive days with symptoms present for most of the day, every day in addition to a history of major depression that lasted at least 2 weeks

Question 13

What are some atypical features of mood disorders?

Answer 13

overeating, oversleeping while depressed

-preserved reactivity to reward

Question 14

What are some catatonic features of mood disorders?

Answer 14

• detachment from environment while awake
• negativism including immobility mutism
• refusal to eat or drink
• can be life-threatening

Question 15

What are some melancholic features of mood disorders?

Answer 15

• dense anhedonia
• lack of response to reward
• early morning waking
• diurnal variation worse in morning

Question 16

What the onset criteria for postpartum mood disorder?

Answer 16

within 1 month of childbirth, can include anxiety

Question 17

Compare the commonality of bipolar disorder and major depressive disorder

Answer 17

MDD is 10x more common than bipolar

Question 18

What are some psychotic features of depression?

Answer 18

delusion of poverty, guilt, nihilism, illness, self-disgust, derogatory auditory hallucinations

Question 19

What are some psychotic features of mania?

Answer 19

delusions of special powers, unlimited resources, paranoia, auditory hallucinations

Question 20

What generalization can be made to auditory hallucinations, though not always true?

Answer 20

Auditory hallucinations are generally associated with primary psychotic disorders

Question 21

Does mania involve hallucinations?

Answer 21

yes

Question 22

Does MDD involve hallucinations?

Answer 22

not usually (only 10-15%)

Question 23

What is more than 4 manic episodes in a year considered?

Answer 23

rapid cycling

Question 24

What does it mean for a patient when they have a 1st degree relative with MDD?

Answer 24

Their risk of developing MDD is doubled

Question 25

What does it mean for a patient when they have a 1st degree relative with bipolar disorder?

Answer 25

Their risk of developing bipolar disorder is multipled 5-10 fold

Question 26

If a 60 yo women comes in with symptoms of depression, what should you rule out?

Answer 26

Cause by a medical condition or medication

Question 27

When do the symptoms of premenstrual dysphoric disorder tend to disappear?

Answer 27

very shortly after start of menstruation

Question 28

What risk is increased with anxiety exists with depression?

Answer 28

suicide

Question 29

What brain abnormality is common among patients with a specific genotype regulating 5-HTT and a history of emotional neglect in childhood have?

Answer 29

smaller hippocampus and prefrontal cortex

Question 30

What does negative regulation of the MAPK pathway cause?

Answer 30

depressive symptoms

Question 31

What is the safest and most rapid way to treat mood disorders?

Answer 31

ECT: electroconvulsive therapy

Question 32

What is vagal nerve stimulation approved for?

Answer 32

refractory depression

Question 33

How long do TCAs, MAOIs, and SSRIs usually take to work?

Answer 33

3-5 weeks for clinical effect, 6-8 weeks for full therapeutic response

Question 34

How does CBT work?

Answer 34

identifying bad thinking and maladaptive behavior that contribute to depressed mood, then altering the reinforcing conditions that sustain it