mood disorders Flashcards
1
Q
MDE: criteria
A
- > =5 of SSIGECAPS
- for at least a 2 week period
2
Q
manic episode
A
- abnl expansive/elevated/irritable mood
- > =3 (or >= 4 if irritable mood) of DIGFAST
- lasting at least 1 week
- must cause social/occupational impairment
- 75% of manic pts have psychotic sx
3
Q
manic vs hypomanic
A
- manic: >= 7d (hypomanic: >= 4d), severe impairment, hospitalization may be necessary, psychotic features
4
Q
mixed episode
A
- criteria met for MDE and manic episode
- present nearly every day for >= 1 wk
- irritability usually predominant mood
- poorer response to lithium
5
Q
MDD: diagnosis
A
- may be unaware of depressed mood, may express vague somatic complaints
- > = 1 MDE, no manic/hypomanic episodes
6
Q
MDD: epidemiology
A
- 16.2% lifetime prevalence in US
- avg age of onset 40
- 2x prevalence in women in reproductive years
- women=men in pre and post reproductive years
- 25-50% prevalence in elderly
- increases mortality in other comorbidities
- highest suicide rate of any d/o
7
Q
MDD: sleep disturbances
A
- multiple awakenings
- initial and terminal insomnia (most common disturbance)
- hypersomnia
- REM shifted earlier, decreased stages 3 and 4
8
Q
MDD: pathophys
A
- decreased 5HT and 5HIAA (metabolite) in CSF
- abnl regulation of beta-adrenergic rcptrs
- high cortisol
- abnl thyroid axis
- psychosocial, genetic contribution
9
Q
MDD: prognosis
A
- depressive episodes 6-13 mos untreated
- episodes occur more frequently as d/o progresses
- risk of 2nd episode 50% w/in 2 yrs of first episode
- 15% will eventually commit suicide
- 50-60% have response to antidepressants
10
Q
MDD and ECT
A
- if unresponsive to pharmacotx, cannot tolerate, or need rapid reduction of sx
- premedication: atropine + GA and muscle relaxant
- electricity thru brain
- 8 treatments over 2-3 week period
- retrograde and anterograde amnesia common SE, disappears w/in 6 mos
11
Q
difft features of depressive d/os
A
- melancholic
- atypical: hypersomnia, hyperphagia, reactive mood, leaden paralysis, hypersensitivity ot interpersonal rejection
- catatonic: catalepsy, etc - especially responsive to ECT
- psychotic: 10-25% of hospitalized depression
12
Q
bereavement
A
- aka simple grief
- reaction to major loss
- sx lasting for 2 months
- if nl, no gross disorganization or suicidality
13
Q
normal grief vs depression
A
- normal grief: illusions common, suicidal thoughts rare; sx 2 mos; mild cognitive d/o lasts >1 yr
- tx of depression: antidepressants, mood stabilizers, ECT
14
Q
bipolar I diagnosis
A
- episodes of major depression NOT required
- one manic or mixed episode required
- may be interspersed euthymia, MDE, dysthymia, or hypomania
- may have psychotic during depressive or manic episodes
- rapid cycling: 4+ mood episodes in 1 yr
15
Q
bipolar I: epidemiology
A
- lifetime prevalence 1%
- women = men
- onset usually before 30 yo
16
Q
bipolar I: pathophys
A
- biological, environmental, psychosocial, genetic factors
- MZ twin concordance: 40-70%
- highest genetic link of all psychiatric d/os
17
Q
bipolar I: prognosis
A
- untreated manic episode: 3 months
- 90% with manic episode will have repeat w/in 5 yrs
- worse prognosis than MDD
- lithium prophylaxis b/w episodes decreases risk of relapse
- 25-50% attempt suicide, 15% die
18
Q
SEs of lithium use
A
- weight gain
- tremor
- GI disturbances
- fatigue
- cardiac arrhythmias
- seizures
- goiter/hypothyroidism
- leukocytosis
- coma
- nephrogenic DI
- polydipsia
- alopecia
- metallic taste
19
Q
best tx for manic pregnant woman
A
ECT
20
Q
bipolar I: Tx
A
- lithium: 70% show reduction of mania; long term suicide risk reduction; 25% mortality rate from acute overdose (low TI)
- anticonvulsants (carbamazepine) as mood stabilizers, esp for rapid cycling
- atypical antipsychotics
- antidepressants DISCOURAGED
- psychotherapy
- ECT
21
Q
postpartum mania
A
- antidepressants and lithium as prophylaxis in subsequent pregnancies
- contraindications to breastfeeding
22
Q
bipolar II: diagnosis
A
- aka recurrent MDEs with hypomania
- hx of 1+ MDE and 1+ hypomanic episode
23
Q
bipolar II: epidemiology
A
- more prevalent than bipolar I
- women > men
- onset before age 30
- often misdiagnosed as unipolar depression
24
Q
bipolar II: pathophys, prognosis, tx
A
- same as bipolar I
25
dysthymic d/o: diagnosis
- depressed mood most days for >= 2 yrs
- >= 2 of: CHASES
- can't be w/o sx for 2 months
26
dysthymic d/o: epidemiology
- 6% lifetime prevalence
- women 2-3x more common than men
- onset before 25yo in 50%
27
dysthymic d/o: prognosis and tx
- 20% develop major depression
- 20% develop bipolar
- >25% have lifelong sx
- cognitive tx and psychotherapy most effective
- SSRIs or other antidepressants useful only in conjunction with psychotherapy
28
double depression
- MDD + dysthymic d/o in residual period
29
cyclothymic d/o
- alternating periods of hypomania and periods w/ mild-mod depressive sx
- at least 2 yrs
- never sx-free for > 2mos
- no hx of MDE or manic episode
30
cyclothymic d/o: epidemiology
- <1% lifetime prevalence
- may coexist with BPD
- onset 15-25 yo
- women = men
31
cyclothymic d/o: prognosis and tx
- chronic course
- 1/3 eventually bipolar
- tx: antimanic agents as with bipolar
32
postpartum major depression
- onset w/in 4 weeks of delivery
33
adjustment d/o diagnosis
- maladaptive behavioral/emotional sx develop after stressful life event
- sx w/in 3 mos of event, end w/in 6 mos, cause significant impairment
- NOT sx of bereavement
- stressful event is NOT life-threatening
34
adjustment d/o epidemiology
- very common
- females 2x of males
- most frequently dx in adolescents
35
adjustment d/o prognosis and tx
- chronic if stressor is recurrent
- supportive psychotherapy most effective
- group tx, pharmacotx for assoc sx
