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mood disorders Flashcards

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1
Q

MDE: criteria

A
  • > =5 of SSIGECAPS

- for at least a 2 week period

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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
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3
Q

manic vs hypomanic

A
  • manic: >= 7d (hypomanic: >= 4d), severe impairment, hospitalization may be necessary, psychotic features
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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
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5
Q

MDD: diagnosis

A
  • may be unaware of depressed mood, may express vague somatic complaints
  • > = 1 MDE, no manic/hypomanic episodes
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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
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7
Q

MDD: sleep disturbances

A
  • multiple awakenings
  • initial and terminal insomnia (most common disturbance)
  • hypersomnia
  • REM shifted earlier, decreased stages 3 and 4
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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
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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
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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
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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
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12
Q

bereavement

A
  • aka simple grief
  • reaction to major loss
  • sx lasting for 2 months
  • if nl, no gross disorganization or suicidality
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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
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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
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15
Q

bipolar I: epidemiology

A
  • lifetime prevalence 1%
  • women = men
  • onset usually before 30 yo
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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
Q

dysthymic d/o: diagnosis

A
  • depressed mood most days for >= 2 yrs
  • > = 2 of: CHASES
  • can’t be w/o sx for 2 months
26
Q

dysthymic d/o: epidemiology

A
  • 6% lifetime prevalence
  • women 2-3x more common than men
  • onset before 25yo in 50%
27
Q

dysthymic d/o: prognosis and tx

A
  • 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
Q

double depression

A
  • MDD + dysthymic d/o in residual period
29
Q

cyclothymic d/o

A
  • 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
Q

cyclothymic d/o: epidemiology

A
  • <1% lifetime prevalence
  • may coexist with BPD
  • onset 15-25 yo
  • women = men
31
Q

cyclothymic d/o: prognosis and tx

A
  • chronic course
  • 1/3 eventually bipolar
  • tx: antimanic agents as with bipolar
32
Q

postpartum major depression

A
  • onset w/in 4 weeks of delivery
33
Q

adjustment d/o diagnosis

A
  • 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
Q

adjustment d/o epidemiology

A
  • very common
  • females 2x of males
  • most frequently dx in adolescents
35
Q

adjustment d/o prognosis and tx

A
  • chronic if stressor is recurrent
  • supportive psychotherapy most effective
  • group tx, pharmacotx for assoc sx

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