Mood Disorders Flashcards
Bipolar Definition
Bipolar disorder is an illness characterised by periods of mood elevation, with mood depression
Bipolar Categories
Bipolar I
- History of at least one episode of mania.
Bipolar II
- History of at least one episode of hypomania plus at least one episode of major depression.
Bipolar disorder not otherwise specified
- Not meeting the criteria of I or II
Mania Criteria
Abnormally and persistently elevated mood lasting at least one week (or hospital admission). With 3+ of:
- Inflated self esteem or grandiosity
- Decreased need for sleep
- Pressured speech (more talkative than usual)
- Flight of ideas or racing thoughts
- Distractibility
- Increase in goal-directed activity
- Excessive involvement in pleasurable activities that have a high potential for painful consequences, such as spending money or sexual indiscretion.
Define Hypomania
A briefer period of symptoms (4+ days) and is often used to refer to less severe symptoms.
Psychosis does not occur with hypomania, but often does with mania.
Mania often leads to hospitalisation, by definition, hypomania does not.
Define Mixed State Mood Disorder
Both depressive and mood elevated (manic and hypomanic) symptoms simultaneously. The most common symptoms are irritability, racing or crowded thoughts, psychomotor agitation or increased talkativeness concurrent with symptoms of depression.
Bipolar Course
The course of bipolar I is marked by relapses and remissions, often alternating manic with depressive episodes. Depressive symptoms are more frequent over the course than manic symptoms.
Define Rapid Cycling in Bipolar
The course of the illness is specified as rapid cycling if 4+ episodes occurred during the previous 12 months.
Mania Management
- For mania (one of)
- > Lithium
- > Valproate
- > Olanzapine
- For short-term containment of associated behavioural disturbance
- > Benzodiazapine
- -> Diazepam
- -> Lorazepam
- ECT
Bipolar Prophylaxis
Cognitive Based Therapies are also effective in preventing relapse
1st Line (one of)
- Lithium (most effective at prevention of manic episodes)
- Olanzapine
- Lamotrigine (most effective at prevention of depression)
2nd Line (one of)
- Valproate (better than lithium for rapidly cycling types)
- Carbamazepine
Bipolar Prognosis
The rate of suicide attempts (25-50%) is higher than other psychiatric conditions, with 15% dying by suicide. There is a high rate of alcohol and substance abuse.
Define Depressive Disorders
Conceptually these symptoms are low mood, anhedonia (loss of enjoyment in formerly pleasurable activities) and decreased energy.
Types of Depressive Disorders
- Disruptive Mood Dysregulation Disorder
- Major Depressive Disorder (Including Major Depressive Episode)
- Persistent Depressive Disorder (Dysthymia)
- Permenstrual Dysphoric Disorder
- Substance/Medication-Induced Depressive Disorder
- Depressive Disorder due to another Medical Condition
- Other Specified Depressive Disorder
- Unspecified Depressive Disorder
Causes of Depression
- Substance abuse
- > Alcohol and drugs
- Medications
- > Isotretinoin (ache treatment)
- > Corticosteroids
- > Beta blockers
- > Levodopa
- > Interferon (hepatitis treatment)
- > Ethanol
- Disturbances in thyroid function
- Nutritional Deficiencies
- > B12 or folate
Major Depressive Disorder Criteria
> 2 consecutive weeks of 5+ of the following (must be include either depressed mood or anhedonia):
- Depressed mood
- Anhedonia
- Insomnia or hypersomnia
- Change in appetite or weight
- Pyschomotor retardation or agitation
- Low energy
- Poor concentration
- Thoughts of worthlessness or guilt
- Recurrent thoughts of suicide or death
Major Depressive Disorder Epidemiology
Lifetime risk of 10-20%, with a female predominance (2:1) and peak incidence in the late 20s. Depression is more common in urban than rural areas and particularly in women from lower socio-economic classes.
Major Depressive Disorder Pathophysiology
The pathogenesis of major depression appears to involve internal factors (genetics and neuroticism), external factors (substance use) and adversity (trauma and parental loss). There is thought to be a decrease in serotonin and noradrenaline.
Major Depressive Disorder Management
- Psychological interventions
- > CBT
- > Interpersonal Psychotherapy
- > Problem-solving psychotherapy
- Antidepressants
- Electroconvulsive therapy (ECT) for catatonic
Define Minor Depressive Disorder
> 2 consecutive weeks
These patients do not exhibit the chronicity of dysthmic disorder, but have several of the nine symptoms in major depression. They require depressed mood or anhedonia, but have less than 5 of the symptoms to meet the criteria of Major Depressive Disorder.
Define Bereavement
< 2 months of a loss
Bereavement may induce great suffering, but it does not typically induce an episode of major depressive disorder (MDD).
When they do occur together, the depressive symptoms and functional impairment tend to be more severe and the prognosis is worse compared with bereavement that is not accompanied by MDD.
Bereavement-related depression tends to occur in persons with other vulnerabilities to depressive disorders, and recovery may be facilitated by antidepressant treatment.
Major Depressive Disorder is generally not given unless symptoms are still present 2 months after the loss.
Define Persistent Depressive Disorder (Dysthymia)
> 2 years in adults, > 1 year in kids
This includes both DSM-IV diagnostic criteria for chronic major depression and dysthymia. Symptom free periods are not > 2 months during the two year period. The depressed mood is accompanied by 2+ of
- Decreased or increased appetite
- Insomnia or hypersomnia
- Low energy
- Poor self esteem
- Poor concentration
- Hopelessness
Adjustment Disorder with Depressed Mood
Disorder ends within 6 months of the stressor ending.
This disorder occurs as a response to an identifiable stressor. The stressor may be a single event or multiple stressors. It is not classified as a mood disorder but describes patients suffering clinically significant symptoms that do not meet earlier criteria.
