mood disorders Flashcards
Understand epidemiology of mood disorders and disability, both world wide and in the United States.
neuropsychiatric diseases account for half of all causes of disability worldwide. • Depression affects approximately 120 million people worldwide • Anxiety disorders are the most common psychiatric illnesses
What are mood disorders
complex neuropsychiatric disorders that affect emotion (depression, mania), cognition (thought disorder, memory, concentration, focus, executive function), visceral activity (appetite, bowel function, nausea) and psychomotor activity (sleep, insomnia, agitation, psychomotor retardation).
Genetics of mood disorders
- Mood disorders are heritable, though the current genetic transmission is poorly understood and likely involves a number of genes that increase risk.
- Bipolar disorder appears more heritable than unipolar depression, with risk to offspring increased 10-fold over the general population if one parent is affected, compared to a 3-fold increase in unipolar depression.
- Mood disorders are heritable, though the current genetic transmission is poorly understood and likely involves a number of genes that increase risk.
- Bipolar disorder appears more heritable than unipolar depression, with risk to offspring increased 10-fold over the general population if one parent is affected, compared to a 3-fold increase in unipolar depression.
neuroendrocrine dysfunction in depression
Stress > corticotropin releasing factor from hypothalamus > release of adrenocorticotropin from anterior pituitary > ACTH stimulates synthesis of cortisol from adrenal cortex > cortisol affects metabolism and behavior, and prolonged elevations may damage hippocampal neurons causing reduced dendritic branching and loss of spines.
Diagnosis of depression
5 or more symptoms that have persisted for 2 weeks or more, are a change from previous function, and patient experiences sad mood or anhedonia. SIGECAPS: Sleep (insomnia or hypersomnia), Interest (diminished), Guilt (often without content, or excessive), Energy (decreased), Concentration (decreased), Anhedonia (loss of interest in previously pleasurable activities), Psychomotoric changes (either increased or decreased activity) and Suicidal ideation (either thoughts of suicide, plans, intent or actual attempts).
5 or more symptoms that have persisted for 2 weeks or more, are a change from previous function, and patient experiences sad mood or anhedonia. SIGECAPS: Sleep (insomnia or hypersomnia), Interest (diminished), Guilt (often without content, or excessive), Energy (decreased), Concentration (decreased), Anhedonia (loss of interest in previously pleasurable activities), Psychomotoric changes (either increased or decreased activity) and Suicidal ideation (either thoughts of suicide, plans, intent or actual attempts).
What symptoms of depression does the hypothalamus facilitate
insomnia, energy, appetite, libido
What symptoms of depression does the frontal cortex and hippocampus facilitate
memory, worthlessness, hopelessness, guilt, suicidality
What symptoms of depression does the striatum and amygdala facilitate
anhedonia, anxiety, motivation
depression subtypes
• Atypical • Psychotic depression • Melancholic • Seasonal Affective
What is atypical depression
mood reactivity, leaden paralysis, reverse neurovegetative symptoms (increased appetite, weight gain, hypersomnia)
what is psychotic depression
often with auditory hallucinations, nihilistic delusions
what is melancholic depression
mood worse in the morning, early morning awakening, anorexia, weight loss, guilt, psychomotor retardation
what is seasonal affective depression
Mood typically worsens in the fall and winter, improves in the spring and summer
bipolar symptom domains
- manic mood and behavior (euphoria, grandiosity, pressured speech, impulsivity, excessive libido, recklessness, social intrusiveness, and diminished need for sleep. 2. dysphoric mood and behavior (depression, anxiety, irritability, hostility, and violence or suicide)
- psychosis (delusions and hallucinations)
- cognitive symptoms (racing thoughts, distractibility, disorganization, and inattentiveness).1. manic mood and behavior (euphoria, grandiosity, pressured speech, impulsivity, excessive libido, recklessness, social intrusiveness, and diminished need for sleep. 2. dysphoric mood and behavior (depression, anxiety, irritability, hostility, and violence or suicide)
- psychosis (delusions and hallucinations)
- cognitive symptoms (racing thoughts, distractibility, disorganization, and inattentiveness).
Diagnosis of mania
A distinct period of abnormally & persistently elevated, expansive or irritable mood, and persistently increased goal-directed activity or energy, present most of the day nearly every day lasting at least 1 week (or any duration if hospitalization necessary), plus 3 or more symptoms (if euphoric), or 4 or more symptoms (if irritable).
Manic symptoms
DIGFAST: Distractibility, Insomnia (note: decreased NEED for sleep), Grandiosity, Flight of Ideas, Activity (increased energy and activities), Speech (pressured, non-stop) and Thoughtlessness (no thinking through of actions; impulsive and reckless)
hypomanic diagnosis/symptoms
Hypomanic symptoms are the same as mania, but do not persist as long (four days) and do not cause such a degree of social impairment as seen in mania.
bipolar I vs II
Patients only have to have mania to be diagnosed with bipolar I disorder; they must have hypomania + major depression to be diagnosed with bipolar II disorder.
What mood state do most patients with bipolar spend the majority of their time in?
depression- Ratios of depression to mania in bipolar I disorder is 3:1 and depression to hypomania 37:1 in bipolar II disorder
Understand differential diagnosis of mood disorders.
mood disorders, mood illness, substance abuse, medication side effect and personality
Medical Illnesses precipitating mood disorders
• 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
Which abused substances can precipitate mood disorders
Cocaine, Alcohol, Amphetamine/stimulants, Hallucinogens (LSD, PCP, mescaline), Benzodiazepines
Which prescribed treatments can precipitate mood disorders
Amantadine, Methyldopa withdrawal, Interferon, steroids, chemotherapy agents
risk factors for suicide
4:1 Male:Female suicide ratio but women attempt suicide 2-3X more often than men
