Mood Disorders Flashcards
Major depressive disorder
At least 4 of the following sx for 2 week period (must have depressed mood or anhedonia)
D SIGECAPS
Depressed mood
Sleep loss or increase
Inerest - loss
Guilt - feelings of worthlessness
Energy - fatigue or loss
Concenration - decreased
Appetite - change
Pschomotor agitation or retardation
Suicidal ideation
Manic episode
abnormally and persistently elevated, expansive, or irritable mood lasting >=1 week and >=3 of the following:
DIG FAST
Distractability Insomnia/Impulsive behavior Grandiosity Flight of ideas/racing thoughts Activity/agitation Speech (pressured) Thoughtlessness
Which mood d/o are psych emergency?
Manic episode
Mixed episode
Mixed episode mood d/o
criteria met for both manic and major depressive episode
Irritability is #1 mood state
criteria present every day for at least 1 week
Poor response to lithium
anticonvulsants may help
Hypomania vs mania
Hypomania >= 4 days NO impairment in social or occupational functioning No hospitalization needed No psychotic features
Mania >= 7 days Severe impairment in social or occup. functioning May need hospitalization May have psychotic features
Bipolar person on mood stabilizers but still have severe manic sx…what do you do?
Add antipsychotics
Hospitalize
Get:
Urine tox screen
Mood stabilizer drug levels
Tx depression - what is the algorithm?
SSRI 1st line
- start with SSRI
- if no improvement and/or side effects, switch to another med in SAME class
- if no improvement and/or side effects after 2 trials, switch to different class
atypical depression
Mood reactivity (i.e., mood brightens in response to actual or potential positive events)
At least two of the following:
- Hyperphagia / wt gain
- Hypersomnia
- Leaden paralysis (i.e., heavy, leaden feelings in arms or legs);
- Long-standing pattern of interpersonal rejection sensitivity (not limited to episodes of mood disturbance) that results in significant social or occupational impairment.
Criteria are not met for With Melancholic Features or With Catatonic Features during the same episode.
Respond very well with MAOIs
Bipolar I vs II
Bipolar II - episodes of major depression + hypomania
Hypomania = manic-like sx that are milder and do not need hospitalization and do not cause psychosis
Differentiate 1 vs II by whether there have been any prev episodes of mania
Bipolar II is more common
Bipolar I disorder
May or may not have depressive episodes at times w/ this condition
Can have psychotic features!
Criteria for manic episodes (and must have 1 episode of this):
- distinctly abnormal, elevated, expansive, or irritable mood for at least ONE wk
- abnormally increased goal-directed activity or energy for at least 1 week
At least 3 of following (4 if mood is only irritable):
- DIGFAST
- Distractibility
- Irritability
- Grandiosity / inflated self esteem
- Flight of ideas
- Agitation (psychomotor)
- Sleep (decreased need)
- Talkative / pressured speech
- excessive involvement in dangerous activities
Marked impairment, need for hospitalization, or psychoatic features
Not attributable to substance use or a medical condition
Persistent depressive disorder (dysthymia)
2 years depression (but NOT MDD episode, mania, or hypomania episode)
1 YEAR for children and adolescents
Never asymptomatic for > 2 months
2 listed criteria - CHASES:
- Concentration (poor)
- Hopelessness
- Appetite - poor or overeat
- Sleeping increased or decreased
- Energy decreased or fatigue
- Self esteem decreased
NEVER HAVE PSYCHOTIC FEATURES
Bipolar disorder maintenance therapy
At high risk of relapse after remission from acute episode of mania or deperssion
After 1st episode, maintenance tx for 1 year past time of remission
If 2 episodes, tx long term (years) or lifetime
If 3 or more relapses, lifetime maintenance therapy
Maintenance therapy =
Lithium
Lithium + antipsychotic if relapse
Persistent complex bereavement disorder
Death of someone in close relationship to pt
at least 1 sx that present for >=12 mo after death
- persistent longing for deceased
- intense sorrow + emotional pain
- preoccupation w/ deceased
- preoccupation w/ circumstances of death
At least 6 sx on most days >=12 mo after death
- diff accept death of person
- disbelief
- diff positive reminiscing about person
- bitterness/anger related to death
- self blame
- avoidance of reminders
- desire to die to be with deceased
- difficulty trusting others
- feeling alone
- diminished sense of identity
- difficult pursuing other interests
Clinically significant impairment
Reaction out of proportion to norms for culture or age
Adjunct meds in tx of depression
Terminal ill pts —-> stimulants
Psychotic ppl –> antipsychotics
Nonresponders –> T3, T4, lithium, or L tryptopha
Most effective for tx depression
Pharm + psychotherapy
