Mood Disorders

Question 1

Epidemiology of mood disorders

Answer 1

• neuropsychiatric disorders = half of all causes of disability worldwide
• depression impacts 120 million people worldwide
• 2nd most common psychiatric illness in US

Question 2

Proposed etiology of mood disorders

Answer 2

• heritable component (numerous genes)
  
  • bipolar > unipolar depression
• likely due to interactions between neurobiologic vulnerabilities, genetics, stress, etc.
• mood disorders arise from disruptions in neural circuitry
  
  • amygdala, prefrontal cortex, cingulated, striatum, thalamus, hippocampus
  • serotonin, NE, DA play important roles in these circuits
  • activation of HPA axis connected to stress and depression

Question 3

HPA axis and depression

Answer 3

• Hypothalamus induces anterior pituitary to release adrenocortictropin (ACTH) ==> cortisol release @ adrenal gland ==> impacts metabolism and behavior
• hippocampus inhibits HPA; amygdala excites HPA
• sustained elevations of glucocorticoids ==> damage to hippocampal neurons ==> decreased ihibition @ HPA ==> hippocampal atrophy in some depressed patients

Question 4

Dx of depression

Answer 4

• 5+ sx for 2+ weeks; must have sad mood or anhedonia
  
  • SIGECAPS
  • Sleep (increased/decreased)
  • Interest (decreased)
  • Guilt
  • Energy (decreased)
  • Concentration (decreased)
  • Appetite (increased/decreased)
  • Psychomotor changes (increased/decreased)
  • Suicidal ideation

Question 5

Subtypes of depression

Answer 5

• atypical = mood reactivity, leaden paralysis, reverse neurovegetative symptoms (increased appetite, weight gain, hypersomnia)
• Psychotic depression (often with auditory hallucinations, nihilistic delusions)
• Melancholic: mood worse in the morning, early morning awakening, anorexia, weight loss, guilt, psychomotor retardation.
• Seasonal Affective: Mood typically worsens in the fall and winter, improves in the spring and summer.

Question 6

Characteristics of bipolar disorder (general)

Answer 6

• Bipolar disorder is best considered on a spectrum, ranging from extreme mood swings to cyclothymia to hypomanias + major depression (Bipolar II) to frank manias (Bipolar I).
• Manias can be induced by medications (most often antidepressants or steroids) or brain injuries (secondary manias)

Question 7

Domains of bipolar disorder sx

Answer 7

• manic mood and behavior (euphoria, grandiosity, pressured speech, impulsivity, excessive libido, recklessness, social intrusiveness, and diminished need for sleep,
• dysphoric mood and behavior (depression, anxiety, irritability, hostility, and violence or suicide)
• psychosis (delusions and hallucinations)
• cognitive symptoms (racing thoughts, distractibility, disorganization, and inattentiveness

Question 8

Dx of bipolar disorder

Answer 8

• Mania: distinct period of abnormally elevated, increased goal-directed energy for most of the day for 1+ week, +3-4 sx
  
  • DIGFAST
  • Distractibility
  • Insomnia (decreased need for sleep)
  • Grandiosity
  • Flight of ideas
  • Activities (increased)
  • Speech (pressured, non-stop)
  • Thoughtlessness (impulsive, rechless)
• Sx must co-occur + ==> significant social/personal disruption

Question 9

Hypomania =

Answer 9

• same sx as mania
• shorter time course (< or = 4 days)
• causes less social impairment

Question 10

DDx for mood disorders (general)

Answer 10

• mood disorder
• medical illness
• substance abuse
• meds side effects
• personality

Question 11

Medical illness precipitation mood disorders

Answer 11

• Endocrine: e.g. Cushings, Hyper/hypothyroidism, steroids)
• Infections: e.g. HIV, influenza, meningitis, Creutzfeld-Jakob
• CNS: e.g. stroke, tumor, Multiple Sclerosis, epilepsy
• Metabolic: e.g. hypercalcemia

Question 12

Substance abuse/withdrawal/medication SEs precipitating mood disorder

Answer 12

• Substances of Abuse: Cocaine, Alcohol, Amphetamine/stimulants, Hallucinogens (LSD, PCP, mescaline), Benzodiazepines
• Prescribed treatments: Amantadine, Methyldopa withdrawal, Interferon, steroids, chemotherapy agents

Question 13

Characteristics of suicide risk

Answer 13

• suicide = 11th leading cause of death @ all ages (US)
  
  • 2nd leading cause of death @ 25-34 yo
  • 33,000 completed suicides/yr
• 10-15% of pts w/severe MDD suicide
• 4:1 male to female suicide ration
• women attmpt suicide 2-3x more
• 50-75% of first attempts end in death