Mood Disorders Flashcards
What disorders is a major depressive episode involved with? With which is it a necessary part of diagnosis?
Isabuildingblock: Necessaryfordiagnosisof: MajorDepressiveDisorder(MDD) BipolarIIdisorder AlwayspartofBipolarIDisorder Butnotnecessaryforthediagnosis
What are the qualifications for a diagnosis of a major depressive episode ?
Fiveormoreofthefollowingsymptomshavebeenpresent,moredaysthat not,forATLEASTa2‐weeks: One of the first two must be present. Depressedmood Diminishedinterestorpleasure Weightlossorgain Insomniaorhypersomnia Psychomotoragitationorretardation(observablebyothers) Lowenergyorfatigue Feelingsofworthlessnessorguilt(excessiveorinappropriate/delusional) Poorconcentrationorindecisiveness Recurrentthoughtsofdeathorsuicidality
NotaMixedepisode(i.e.nocoexistingmanicsymptoms)
Theepisodemustcausedistressorsocial/occupationalimpairment
Notduetosubstanceuse,medicalcondition,orbereavement
What are some examples of emotional/cognitive symptoms of MDE? Neurovegetative ones?
MDEcanbecharacterizedbyacombinationof: Emotonal /cognitivesymptoms,example: Depressedmood Anhedonia Hoplessness SlowedThinking/PoorAttention(Memory) Suicidality
Neurovegitative symptoms,example:
Sleep(mostlypoor,butcouldbebidirectional)
Appetite(mostlypoor,butcouldbebidirectional)
Energy(lossof,unidirectional)
Slowedmovements,stoopedpostures,lossofgesturing
How is a major depressive disorder diagnosed? What are two types? What is the difference?
AtleastoneMDE NohistoryofMixedorManicorHypomanic episode MDD,singleepisode vs recurrenttype InordertohaverecurrentMDD,theindividualmusthave twoMDEseparatedbyatleast2months offullrecovery.
What are the qualifications for a diagnosis of dythymic disorder? What is double depression?
Depressedmood,moredaysthannot,foratleast2year
Children/Adolesents:depressed
OR
irritable moodforatleast1year.
Neversymptom‐freeformorethan2months
Atleast2ormoreassociatedsymptomswhiledepressed:
Poorappetiteorovereating
Insomniaorhypersomnia
Lowenergyorfatigue
Lowself‐esteem
Poorconcentrationordifficultymakingdecisions
Feelingsofhopelessness
NoMDEsduringtheinitial2yearperiod(otherwise–>MDD)
“doubledepression”
ifDysthymic disorderisfollowedbyMDE
NoHistoryofMania,Hypomania,Mixed episodeorCyclothymia
NointhecourseofChronicPsychoticDisorder(Schizophrenia)
Theepisodemustcausedistressorsocial/occupationalimpairment
Notduetoasubstanceuseormedicalcondition
What is Depressive Disorder NOS? What are some examples?
PremenstrualDysphoric Disorder
Markeddepression/anxiety,Affectivelability,Decreaseinterest
Mostmenstrualcyclesforthepast12months
Sx startduringthelastweekoftheluteal phase
Absentforatleast1weekpostmenses
MinorDepressiveDisorder
Depressionforatleast2weeks
Fewerthan5symptomsofMDE
Recurrentbriefdepressivedisorder
AllsymptomsofMDE
>2days,but<2weeks
Atleastoncepermonthoverthelastyear
PostpsychoticdepressivedisorderofSchizophrenia(residual)
MDEsuperimposedonDelusionalDisorder,activephaseofSchizophreniaorPsychosisNOS
Ifcliniciancannotdeterminetheifthedepressionisprimary,duetoGMCorSubstance Induced.
What are the qualifications for a manic episode?
Adistinctperiodofabnormallyorpersistentlyelevated,expansive,orirritable mood,lastingatleast1weekwith>3(4ifmoodisirritable)ofthefollowing
Inflatedself‐esteemorgrandiosity
Decreasedneedforsleep
Moretalkativeorpressuredtokeeptalking
Flightofideasorracingthoughts(subjective)
Distractibility
Increasedgoal‐directedactivityorpsychomotoragitation
Excessiveinvolvementinpleasurableactivitiesthathavehighpotentialforpainful consequences(buyingsprees,sexualindiscretion,foolishinvestments)
Ifhospitalizationisnecessary, Anydurationissufficient
Theepisodemustcausedistressorsocial/occupationalimpairment
Notduetoasubstanceuse(includingsomatictx fordepression)ormedical condition
What are the criteria for a mixed episode?
Criteriaaremetconcomitantly for: ManicEpisode MajorDepressiveEpisode(excepttheduration) Theepisodemustcausedistressorsocial/occupational impairment Notduetoasubstanceuse(includingsomatictx for depression)ormedicalcondition
What are the criteria for a hypomanic episode?
Distinctperiodofelevated,expansive,orirritablemood thatincludesatleast3(4ifmoodisirritable)symptoms of includedinthemanicepisode Atleastfor4days Unequivocalchangeinfunctioning Nomarkedimpairmentinsocial/occupationalfunctioning Nopsychoticfeatures Doesnotrequirehospitalization Notduetoasubstanceuse(includingsomatictx for depression)ormedicalcondition
What is the criteria for a diagnosis of Bipolar type I
ClassicManic ‐ DepressiveDisorder Bydefinition,inordertoreceivediagnosisofbipolarIyou MUSThaveexperiencedatleast oneManic or Mixed episode MostindividualswithbipolardisorderhaveseveralMajor DepressiveEpisodesprecedingtheirfirstManicorMixed episode MDEisnotneededforthediagnosis NotaccountedforbySchizoaffectived/oandnot superimposedonotherprimarypsychoticdisorders.
What is the avg. age of onset for bipolar illness? What is they’re over 45? What is the course of illness like compared to MDD? How so? What is the initial episode normally like? What is the gender prevalence like?
Lifetimeprevalence~1 ‐ 2% Averageageofonsetforbipolarillness=30y.o. FirstonsetManicsympomts >age45 1rstthinkorganic etiology lifecourseofillnessinbipolarIisgenerallyworsethan unipolar depression Moredysfunctionandlifedisruption Moreassociationwithsubstanceuse MoreAttemptedandCompletedsuicides Initialepisodemostcommonlyadepressiveone NOsexdifferenceinprevalence(exceptforrapidcycling subtype)
What are the criteria for Bipolar type II?
HistoryofoneormoreMajorDepressiveEpisodesAND at
leastoneHypomanic Episode
NohistoryofpriorManicorMixedMoodepisode
NotaccountedforbySchizoaffectived/oandnot
superimposedotherprimarypsychoticdisorders
What are the criteria for cyclothymia?
Foratleasttwoyears(1yearfor<18y.o.) IffollowedbyManicepisdoe Cyclothymia and BPDI IffollowedbyMDE Cyclothymia and ?
What are 9 types of mood specifiers?
Severity:Mild,ModerateandSevere(MDE,Manicor Mixedepisodes) Chronic(MDE>2years) MelancholicFeatures(MDE) AtypicalFeatures(MDE&Dysthymia) CatatonicFeatures(MDE,ManicorMixedepisodes) PsychoticFeatures(MDE,ManicorMixedepisodes) Post ‐ partumonset(MDE,ManicorMixedepisode) Rapidcycling(BipolarIorII) Seasonalpattern(MDEinMDDinBPI&II)
What are melancholic features a specifier for? What are the criteria that need to be met for it? What is an implication for treatment?
OnlyforMDE(MDD,BipolarIorII) Oneofthefollowing: Completelossofpleasure Lackofreactivitytousuallypleasurableactivities Threeormoreofthefollowing: Depressionisworseinthemorning Distinctqualityofdepressedmood Earlymorningawakening(atleast2hr) Markedpsychomotorretardationoragitation Significantanorexiaorweightloss Excessiveinappropriateguilt
Responds better to ECT.
What are atypical features a specifier for? What are the criteria that need to be met for it? What is the preferential treatment?
CanbeusetodescribeMDEofMDD,BipolarIorII.Italso
canbeusedasaspecifier forDysthymic d/o
Preservedmoodreactivityandtwoormoreof:
Hypersomnia
Hyperphagia
Leadenparalysis
Long‐standingpatternofinterpersonalrejectionsensitivity
MaypreferentiallyrespondtotreatmentwithMAOI’s
What are catatonic features a specifier for? When is it most commonly seen? What are the criteria that need to be met for it? What is the preferential treatment?
Canbeuseasaspecifier todescribeMDE(inMDDorBP),
ManicorMixedepisode
Twoofthefollowing:
Catalepsy(immobility/waxyflexibility)orStupor
Excessiveandpurposelessactivity
Extremenegativismormutisim
Peculiarityofmovements:posturing,stereotyped
movements,prominentmannerismorgrimacing
MostcommonlyseenwithBipolarDepression
ECT
What are psychotic features a specifier for? What are the criteria that need to be met for it? What is the preferential treatment?
Canbeuseasaspecifier todescribeMDE,ManicorMixed episode Psychotic vs.nonpsychoticdepression mayrepresentdistinctlydifferentdisordersintheir pathogenesis Shouldbedescribedas: moodcongruent voicestellingthepersontheyareworthless moodincongruent afixedbelievethataliensfromMars…. Moodincongruentpsychoticsymptomscouldsuggestthe possibilityofaprimarypsychoticillness Areassociatedwithpoorerprognosis Psychoticsymptomindepressionwarranttreatmentwith BOTHanantidepressantANDanantipsychoticand/orECT
What is rapid cycling a specifier for? What are the criteria? What is the preferenctial treatment? Who is it more common in?
MusthaveBipolarIorII
Musthaveatleast4separatemoodepisodeswithinthe
previous12months(MDE,Manic,MixedorHypomanic)
DOESNOTappeartoruninfamilies
Valproic AcidandCarbamezapine maybesuperiorin
treatingrapidcycling(lithiumisineffective)
Morecommoninyoungfemales
What is seasonal pattern a specifier for? What is it like? What are the criteria? What is a possible treatment? When can it be risky?
AppliestotheMDEofRecurrentMDD,bipolarI&II
MDEsatadistincttimeoftheyear(fallandwinter)
Fullremission(ormanic/mixed/hypomanic episodes)
occuratadistincttimeoftheyear(spring)
Patternshouldoccurforatleast2years
CommonlyreferredtoasSAD=SeasonalAffective
Disorder
TheMDEarelikelytorespondtolighttherapy(Riskfor
“Switching”ifBipolard/o)
Waht is mood disorder due to a general condition? How should it be treated?
Moodsymptomsarebelievedtobethedirect
physiologicalconsequence ofageneralmedicalcondition
History,PhysicalExamand/orLaboratoryfindings
Notanadjustmentd/o(stressofmedicalillness)
NotDelirium
Ingeneralshouldtreatmoodwithpsychotropicand/or
psychotherapyinadditiontotreatingtheprimarymedical
problems(ex,hypothyroidism
What is a substance induced mood disorder?
Substanceuse(orwithdrawalfrom)musthaveoccurred
withinONEMONTHofthemoodsymptoms
Mooddisorderbelievedtobeetiologicallylinkedtothe
substanceuse
examplesinclude:
Mania:corticosteroids,cocaine,amphetamines
Depression:Beta‐blockers,Reserpine,cocaine[withdrawal]
alcohol)
Thedisturbanceisnotaccountedforbyanongoing
primarymood
Nodelirium
What is serotonin made from? What does it dwell in the brain? How is its action terminated? How do suicidal patients differ in respect to 5HT? What effect do SSRIs have? Ecstasy?
Essentialaa Tryptophan CellbodiesinMedianandDorsalRaphe nuclei(Pons) ActionterminationbyreuptakeorMAO‐A Suicidalpatientsdemonstrate: lowCSFmetabolitesofserotonin lowconcentrationofserotoninuptakesitesonplatelets. SSRIs(ex:fluoxitine)blocksreuptake and ↑5HTinsynaptic cleft
Ecstacy (MDMA):Blocksreuptake&↑ thereleaseof5HT
Where does dopamine originate in the brain? What do misostriatal areas control? Misolimbic? Mesocortical? Tuberoinfundibular? How is the action of DA terminated? What effect does amphetamine have? Cocaine? reserpine? Parkinsons?
OriginateformtheVentralTegmental area(MidBrain) Misostriatal (movements) Misolimbic(reward,hallucination) Mesocortical (neurocognitive) Tuberoinfundular ActionterminationMAO‐BandCOMT Amphtamine increaserelease(improvemood,mania) Cocaine stimulaterelease/blocksreuptake(mania) Reserpine depletesDA(depression&movementd/o) Parkinson'sdiseases (depressionandmovementd/o)
Where are the cell bodies associated with NE located? How is its action terminated? What happens in depressed subjects? What supports its role in depression?
CellbodiesinLocusCeruleus (upperPons) ActionterminationbyreuptakeMAO ‐ AandCOMT Upregulation ofpost ‐ synapticadrenergicreceptorsoccur indepressedsubjects NE modulatingantidepressantdrugs(desipramine) stronglysupporttheimportantroleofNEindepression Theantidepressent Mirtazapine Blocks α2presynaptic receptor↑releaseNE&5HT
What plays a central role in regulation of neuroendocrine functioning? What are 3 major neuroendocrine dysfunctional axes that are affected by mood disorders?
Thehypothalamusplaysacentralroleinregulationof
neuroendocrine functioningandreceivesneuronal
(5HT,Dopamine,NE,Acetylcholine,Histamines)
Theneuroendocrine abnormalitiesseeninmooddisorders
likelyrepresentanunderlyinglargerbraindysregulation.
Themajorneuroendocrine dysfunctionalaxesaffectedby
mooddisorders:
Adrenalaxis
Thyroidaxis
Growthhormoneaxis.
How is the adrenal system associated with depression? What is a test for this? In what ways is it useful/not? What effect can prednisone have?
Hypersecretion ofcortisol anddepression(longknownassociation)
Dexamethasone suppressiontest
NOTusefulasadiagnostictool(highlyspecific,butnotsensitive)
Maybepredictiveoflikelihoodofrelapse
Ontheotherhandprednisone(syntheticcorticosteroid)caninducemania/hypomnia issusceptibleindividuals
What is the association between the thyroid axis and depression? How does it work? How can this be used for treatment? How does this relate to mania?
Allnewcasesofdepressionshouldscreenedforthyroid
problems
1/3depressedindividualswithnormalthyroidfunction
haveabluntedreleaseofTSH(thyrotropin)bythe
pituitarytotheadministrationofTRH.
SimilarabnormalitiesofTSHbluntinghavebeennotedin
otherpsychiatricdisorders
Liothyronine(T3)usedtoaugmentantidepressent tx
thyrotoxicosis canmimicaManicpresentation
Describe the cognitive theory?
OriginallyproposedbyAaronBeck. AutomaticThoughts causessadness/anxiety/irritibility CognitiveDistortions: All‐or‐NothingThinking FortuneTelling(catastrophizing) EmotionalReasoning MindReading,etc. NegativeCorebeliefs: trustothers(theworldisahosteltome) controlmyselforenvironment(thingswillneverchange) Selfesteem(Iamanineffectiveperson) Thetherapistwilltrytohelpthepatientbeawareofcognitive distortionandchallengeAutomaticThoughts(earlyon)resultingin reducesymptoms.
Describe the behavioral model.
LearnedHelplessness
Animalmodel:ratsgivensequentialelectricshockseventually
makenoattempttoescapeandstopeating
AdaptiveandMaladaptiveBehaviors
Isanythingreinforcingamaladaptivebehavior?(Operant
Conditioning)
Isthereanythingthatextinguishesadesiredbehavior?(Classical)
Isthereanassociationbetweenabehaviorandenvironmental
cuethatinitiatethebehavior?(ClassicalConditioning)
Ex:Therapistattemptingtotreatdepressionbyteachingthe
patienttoperceivesomecontroloverher/hisenvironment
What is the stress diathesis model? What are some events that predict depression later in like? What events are most likely followed by depression? What is kindling?
Stress‐Diathesismodel=Vulnerbility (Geneticsand/orpsychological)
Eventthatpredictsdevelopmentofdepressionlaterinlife:
lossofaparentbeforetheageof11
Neglectininfancy
Sexualabuse
Eventmostlikelytobefollowedbydepression:
LossofaSignificantOther
Deathofcloserelative
Victimofassault
Maritalproblems(serious)
Dealingwithseparationordivorce
Lossofjob/financialstressors/Lossofhousing/legalproblems/poorsupportsystem
Kindling(easiertorelapsewithlessornostress)
MayrepresentchangesinthefunctionofneurotransmitterCircuitsorintraneuronal signaling mechanisms
