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Mood Disorders Flashcards

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1
Q

Definition of an Adjustment Disorder

A

Out of proportion mood or behavioral change in response to an identifiable stressor

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2
Q

2 types of stressors

A

Lingering vs. unexpectant stressors
Undesirable change increases emotional strain
Unexpectant stressors are more provocative

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3
Q

5 types of adjustment disorders

A

Adjustment Disorder w/ depression
Adjustment Disorder w/ anxiety
Adjustment Disorder w/ dep and anxiety
Adjustment Disorder w/ disturbance of conduct
Adjustment Disorder w/ disturbance of conduct and mixed mood

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4
Q

How do you make a diagnosis of an adjustment disorder

A

diagnosis of exclusion
Other mental disorders are not present (except Axis II)
May present with a few PTSD symptoms
Re-experiencing trauma is not common
Degree of emotional reaction is disproportionate to stressor
There is marked impairment of occupational, academic, interpersonal function
The symptoms are not part of normal bereavement

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5
Q

Epidemiology of Adjustment disorder

A

Onset, within 3 months of stressor
Lasts ~ 6mos after end of stressor
If they do last longer then suspect depression
Adolescents&raquo_space; Adults

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6
Q

Ddx for adjustment disorder

A 
Bereavement
Dysthymia
Major Depressive disorder
PTSD
GAD
Brief Psychotic Disorder
Conduct Disorder
Somatization Disorder
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7
Q

situational adaptive factors that alleviate stress

A

Financial security
Emotional Resources (family/friends/church/neighbors)
Occupational contentment
Weather

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8
Q

intrapersonal adaptive factors that alleviate stress

A

Social skills
Intelligence
Flexibility
Coping strategies

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9
Q

2 provoking factors that trigger stress

A

Chronic mental d/o

Past emotional trauma /unresolved conflicts

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10
Q

What is the first line treatment for adjustment disorders?

A

Psychotherapy—1st choice
Individual
Family
Behavioral

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11
Q

2 types of medications used for adjustment disorders

A 
SSRIs 
If pt cannot undergo psychotherapy
If symptoms are too unmanageable
BDZ
If anxiety  is overwhelming, poor sleep
Temporary treatment
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12
Q

Definiton of a major depressive disorder

A

Persistent low mood, sadness, tearfulness, apathy that affects interpersonal, occupational, academic function

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13
Q

What is major depressive disorder characterized by?

A

is characterized by one or more Major Depressive Episodes (i.e., at least 2 weeks of depressed mood or loss of interest accompanied by at least four additional symptoms of depression

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14
Q

When is the onset of major depressive disorder

A

any age, including children, usually 30-40 y/o
Younger onset predicts recurrent episodes
12-20% acute episode→ chronic
15% w/ depression → suicide

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15
Q

Risk factors for major depressive disorder

A

Psychosocial stress can precipitate risk, but becomes less important with recurrence

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16
Q

Psychosocial aspect of major depressive disorder

A

Nature vs. Nuture: both are important
Degree of biochem imbalance and psychosocial vulnerability
Past traumatic episodes have an accumulative effect
Lack of social support
h/o child abuse/neglect/physical/emotional

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17
Q

2 types of screening tools for major depressive disorder

A

PH-Q 9 pt hx question 9
pance
SIG: E CAPS

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18
Q

AD to SIGECAPS for the diagnosis of depression

A

anhedonia, dysphoria

sleep, interest, guilt, energy, concentration, appetite, psychomotor, suicide

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19
Q

emotional symptoms of major depressive disorder

A 
Anxiety
Tearfulness
Apathy
Anhedonia/low drive sex
Emotional flatness/”flat affect”
Irritability
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20
Q

ideation symptoms for major depressive disorder

A 
Worthlessness
Helplessness
Hopelessness
Guilt
Aggression
Suicidality
Homicidality
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21
Q

Neurovegetative/somatic symptoms for major depressive disorder

A 
Weight loss/gain
Anorexia/hyperphagia
Insomnia/hypersomnolence
Psychomotor retardation/agitation
Low energy/fatigue
Low concentration 
Tearfulness
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22
Q

what are some medical conditions that present with depression

A 
Pancreatic CA
Bronchogenic CA
Hypothyroidism
Cushing’s Syndrome
CVA (L>R)
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23
Q

other psych conditions that need to be considered with depression

A 
Seasonal affective disorder (SAD)
Schizophrenia
Dysthymia
Cyclothymia
Bipolar disorder
Grief
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24
Q

psychopharmacology treatment for major depressive disorder

A 
SSRIs
Have replaced older TCAs
Better side effect profile
─ SNRIs
─ TCAs
─ Antipsychotics (delusional/hallucinations)
─ MAOIs (Nardil, Emsam)
Severe anxiety, fatigue, hypersomnolence, wt gain
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25
Q

Electroconvulsive therapy

A

Electro-Convulsive-Therapy
Very effective for refractory, severe depression, SI
Depression with psychosis

26
Q

non pharm treatment for major depressive disorder

A

Newer Approaches
Electroconvulsive therapy
Psychotherapy

27
Q

Psychotherapy

A 
Psychotherapy and Rx have best outcome
w/ severe depression Rx alone is better than psychotherapy alone
CBT
Interpersonal 
Problem solving
Family
Marriage
28
Q

Newer approaches for major depressive disorder

A

Transcranial Magnetic Stimulation
Vagal Nerve Stimulation
Deep brain stimulation

29
Q

irritable depression

A 
Anxiety/agitation
Tearfulness
Obsessional 
Rumination
Irritability
Aggression/suicidality/homicidality
30
Q

melancholic depression

A

Apathy
Low motivation
Anhedonia

31
Q

Complicating factors for major depressive disorder

A

Risk for CVD/MI death
Untreated depression lasts wks-mos or becomes chronic (years)
Depression treatment can take up to ~20wks w/ mediocre response (~50% failure rate)
Older age shortens remission intervals
Chronic depression suicide ↑ risk

32
Q

Prognosis of major depressive disorder

A 
Worsens w/ each recurrence
Worse w/ delusions
worse w/earlier age onset
Poor treatment response related to  # of recurrences
Inversely related
33
Q

What are 2 clinical cues for suicide

A

Verbal:
“I can’t take it anymore” “It too much for me” She’ll be better off without me” “I wish I could be with my husband” (who passed away)
Behavioral:
Distribution of prized possessions
Putting personal affairs in order—prematurely
Ingestion of inappropriate harmful medication

34
Q

7 steps for assessing suicide potential?

A
  1. Can the patient carry out the act?
  2. Past hx of prior suicide attempts
  3. Hx of mental illness, cognitive/affective impairment
  4. Current emotional, economic resources
  5. Complete SIG E CAPS, PH-Q 9 and mental status exam
  6. Hallucinations/delusions?
  7. Agitation/anxiety
35
Q

What is dysthymic disorder

A

Less severe form of depression; not dysfunctional
Present for at least 2 years
Can have symptom remission no more than 2 consecutive months
Has felt “depressed all their lives.”
Usually no suicidality
20% of dysthymic patients will develop MDD

36
Q

Epidemiology of dysthymic disorder

A 
Less prevalent than MDD
But ~40% of MDD meet criteria for dysthymia
“double depression”
Women > men
Less severe than MDD, but more chronic
37
Q

symptom presentation of dysthymic disorder

A

Depressed mood plus 2 or more:

Insomnia/hypersomnia
Anorexia/hyperphagia
Low energy
Low concentration
Low self esteem
Hopelessness
38
Q

Treatment for dysthymic disorder

A 
Group/family, individual therapy
Insight oriented
Cognitive therapy
Behavioral therapy
Interpersonal therapy
Overall, they respond well to psychotherapy/ Rx tx
39
Q

What is contraversal for the treatment of dysthymic disorder?

A

SSRI’s and SNRI’s

40
Q

Definition of bipolar depressive disorder

A

Recurrent and chronic mood disorder characterized by alternating periods of extreme mood elevation and depression accompanied with functional impairment.

41
Q

Bipolar I and II are characterized by?

A

are characterized by one or more Manic or Mixed Episodes, usually accompanied by Major Depressive Episodes

42
Q

What are symptoms of mania?

A

Lack of sleep, not feeling tired during the day
Impulsivity, Involved in risky activities: drugs, sex, gambling, shopping
Speech: high volume and rate, uninterruptable
Flight of ideas
Euphoric (elevated, expansive) mood
Engaged in multiple activities, creative
Psychomotor agitation/increased energy
Behaviors can become bizarre
Grandiosity, self perceived talents, religious

43
Q

hypomania

A

Does not affect functionality
Does not present with psychosis
No need for hospitalization

44
Q

epidemiology of bipolar depressive disorder I

A

Genetics have stronger links in BPD than MDD
Higher SES
Women > men
Suicide rates higher in men
Unipolar and Bipolar seen in 1st degree relatives
Patients less than 50 years old are at highest risk for Bipolar Episode (Depression/Mania or mixed)

45
Q

1st onset of Manic episode for bipolar depressive disorder I

A

Early adolescence to peak age onset 20-25 y/o

46
Q

biochemical factors for bipolar depressive disorder I

A

The up regulation of Monoamine Neurotransmission and receptor fnx
Changes in the limbic system/ prefrontal cortex

47
Q

Psychosocial factors for bipolar depressive disorder I

A

Major life stressors:
More important in early BP disease
Rapid cycling occurs with aging w/o “triggers”
≥ 4 manic/depressive episodes

48
Q

Psychopharmacological treatment for bipolar depressive disorder I

A

Mood stabilizers
Antipsychotics
Antidepressants: Avoid monotherapy—can give with Lithium in the severely depressed

49
Q

mood stabilizers for bipolar depressive disorder I

A

are mainstay—acute and maintenance tx
Lithium—gold standard (Safe in pregnancy—monitor levels)
Valproic acid, but more clinicians use VPA (Avoid in Pregnancy)
Lamotrigine/lamictal

50
Q

antipsychotics for bipolar depressive disorder I

A

especially mania with psychosis: Faster acting than mood stabilizer
Zyprexa (Olanzapine)
Risperdal
Seroquel

51
Q

Non-Pharm treatment for

A

Electroconvulsive Therapy
For recalcitrant cases or if patient requests

Psychotherapy:
Cognitive behavioral therapy as tolerated and while not Manic
some cannot undergo such self reflection and examination
Psychopharmatherapeutics and psychotherapy is best

psychosocial
Good social support

52
Q

Prognosis for bipolar depressive disorder I

A

Most will have 2nd episode 2-4 yrs after 1st Event

Maintenance/prevention is core treatment goal of therapy

53
Q

Clinical characteristics of bipolar II

A

Mostly characterized by MDD and at least one hypomanic episode in patient’s life time
Less severe mania—hypomania
Rapid cycling may be more common than in BP I

DDX/Etiology very much like BPD I

54
Q

Treatment for bipolar II

A

Mood Stabilizer—acute and prophylactic tx
Lithium—gold standard
Valproic acid, but more clinicians use VPA
Lamotrigine/lamictal
Zyprexa/Prozac combination

Atypical Antipsychotics

Antidepressants

55
Q

What is cyclothymic disorder?

A

characterized by at least 2 years of numerous periods of hypomanic symptoms that do not meet criteria for a Manic Episode and numerous periods of depressive symptoms that do not meet criteria for a Major Depressive Episode

It is a milder form of BP II

Cycling is more frequent than in BP I or II

Does not meet the criteria for BP I or II

56
Q

Epidemiology of cyclothymic disorder?

A

Onset is in the teens to early adulthood
Prevalence is ~1% and 5% in Psychiatric population
men = women

57
Q

Etiology of cyclothymic disorder? (2)

A

Genetics
Greater occurrence of mood disorders in FHX
Triggers
Losses or interpersonal stressors mostly due to their hypomania—out of control behaviors

58
Q

Clinical features for cyclothymic disorder?

A

Characterized by extreme dysthymia and hyperthymic
Uninhibited and excited/cheerful
Impulsive
Erratic
shorter duration than BPD
Mood lability can occur within hours of each other
Frequent geographical moves
Career instability
Multiple interpersonal failed relationships

59
Q

3 DDx for cyclothymic disorder

A

Hypothyroidism (for all mood disorders)

Borderline personality disorder
Can have both CD and borderline PD (Personality Disorder)

ADHD in children and adolescents

60
Q

treatment for cyclothymis disorder

A

Lithium combined with one of the following:
All Antidepressants can shift pt to hypomania
Use Antidepressants carefully with close monitoring
Psychotherapy

Psych (6 decks)

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