Mood Disorders

Question 1

Major Depressive Episode criteria

Answer 1

Sad for 2 weeks OR anhedonia plus 4 of the following:
-Fatigue, insomnia/hypersomnia, appetite changes, poor concentration, suicidal ideation, pathological guilt

Can be melancholic or psychotic

Question 2

Subtypes of MDD

Answer 2

1. Neurotic depression (associated with life events)
2. Melancholia (not related to life events)
3. Atypical (reverse vegetative features ie over eating/sleeping)
4. Seasonal (responsive to light therapy)
   *
5. Psychotic (delusions and hallucinations)
6. Chronic (2 years)
7. Post-partum

Question 3

What is the “kindling” phenomenon

Answer 3

With increasing depressive episodes, there is an increased risk of depression and a decreased association with stressful life events…like a sensitization of a depressed state

Question 4

Serotonin transporter gene

Answer 4

Short allele=worse outcomes (2x greater risk)

Question 5

What is the largest risk factor for depression?

Answer 5

Lack of social support, but risk factors are cumulative

Question 6

What are the areas of the brain implicated in MDD

Answer 6

1. Insular cortex
   - emotionally relevant context for sensory experience
2. Hippocampus
   - Memory, vulnerable to chronic stress
   - See neurodegeneration before onset of illness
3. Amygdala
   - Processing and memory of emotional reactions
   - Gets increased blood flow
   - Inc metab associated with elevated plasma cortisol level
4. Anterior cingulate cortex
   - Integrates emotional stimuli and attentional functions
   - Once ACC begins to atrophy, drugs work less
5. Medial orbitofrontal cortices
   - Smaller
6. VLPFC
   - Executive function
   - Increased bloodflow

Question 7

BDNF polymorphism and depression

Answer 7

BDNF is a neurotrophic factor that promotes learning/memory and neuronal growth and fxn. It may be down-regulated in depression.

MDD pts with met-BDNF instead of val-BDNF have smaller hippocampal volume

Treatment of MDD may restore BDNF fxn

Question 8

Bipolar disorder subforms

Answer 8

1. Rapid cycling (4+ mood episodes in 1 yr, more difficult prognosis)
2. Mixed features (mania/hypomania and depression)
3. Seasonal pattern
4. With psychotic features (often occurs during mania)

Question 9

DSM criteria for mania

Answer 9

7 days of abnormally elevated or irritable mood and at least 3 of:
-Grandiosity, decreased sleep, pressured speech, flight of ideas, distractibility, increased goal-directed activity/agitation, poor judgement/risky behavior

Must have impairment to occupational or social functioning and can’t be due to anything else

Question 10

What is the median age of onset for BPD

Answer 10

17.5 (90% before 30)

Question 11

Suicide in BPD

Answer 11

more likely than MDD to complete suicide, but risk of MDD suicide is greater

Question 12

Treatment of BPD

Answer 12

Combo therapy! Mood stabilizers (lithium, divalproex, cabramazapine, antipsychotics) and ECT