Mood Disorders Flashcards
What are the major types of unipolar disorders?
1) Adjustment disorder with depressed mood - excessive distress or impairment within 3 months of stressor
2) Dysthymic disorder
3) Major depression
What are the major types of bipolar disorder?
1) Bipolar I - mania with or w/o depression
2) Bipolar II - depression with hypomania
How is depression diagnosed?
At least 5/9 of the below symptoms for at least 2 weeks PLUS depressed mood and/or anhedonia (loss of interest):
- Guilt (feelings of worthlessness/self reproach)
- Loss of energy/fatigue
- Diminished ability to think/concentrate
- Increased or decreased appetite
- Psychomotor agitation/retardation
- Insomnia or hypersomnia
- Suicidal ideation
Describe the diurnal component of depression.
Depression can be most severe in the morning and improve toward the evening
What is the leading cause of disability/burden of disease worldwide?
Depression (particularly in middle/high income countries)
What is minor depression?
3 symptoms for > 2 weeks but < 2 years
What symptoms are associated with depression?
- Anxiety => 50%
- Psychosis => 1%
- Somatization:
- Body aches, pains, headaches, GI distress
What is the lifetime prevalence of a Major Depressive Disorder in the U.S.?
20%
What is the prevalence of Major Depression amongst men and women in the U.S.?
Women> Men (2:1)
Describe the role of family history on Major Depression.
A family history of Major Depression increases a patient’s risk of depression by 1.5-3 times
How does depression impact health care costs?
Depression is associated with a doubling of health care costs and overall worsens health outcomes
What is primary depression?
Primary depression is depression not related to a pre-existing, chronic, non-mood disorder
What is secondary depression?
Secondary depression is related to pre-existing chronic, non-mood disorder - ie anorexia, somatization, psychoactive substance dependence, anxiety disorder, rheumatoid arthritis
What is dysthymic disorder?
Dysthymic disorder is diagnosed after 2 years of depressed mood NOT MEETING CRITERIA FOR MDE
- only 2/9 symptoms required
- 1 year of symptoms in children (for diagnosis)
- No more than 2 months symptom free
- Increased risk of suicide (>> MDD)
What are the features of psychotic depression?
- Perception distortion
- Delusional thought content
- Auditory hallucinations
- Persecutory in nature
- Delusional guilt
- Somatic delusions
What is mania?
In mania, mood is abnormally elevated, expansive, or irritable for at least ONE WEEK
What are the diagnostic behaviors for mania?
3 of the following:
- Grandiosity
- Decreased need for sleep
- Pressured speech
- Flight of ideas
- Distractibility
- Increase in activity
- Activities resulting in painful consequences
What is hypomania?
Hypomania is similar to mania, except that individuals are fully function and are usually more productive than usual
- Symptoms must last longer than 4 days
What is the male/female prevalence of dysthymic disorder?
Male = Female
What is a mixed mood disorder?
A mixed mood disorder includes mania and depressive symptoms > 1 week with SIGNIFICANT dysfunction
Define cyclothymia.
Cyclothymia includes fluctuating minor depressive, hypomanic episodes
- No prior major depressive, manic, or mixed episodes over a 2 year period
- Symptom free periods do NOT last longer than 2 months
- Bipolar (I or II) may develop after 2 years
What is the age of onset for major affective disorders?
Dysthymic disorder:
- Early onset 21
Major Depressive Disorder:
- Mostly 20s and 40s
- First time depression >50yo considered medical in etiology
Biopolar:
- 15-19 (Treatment sought 20-24)
When are women most vulnerable to mood disorders?
Women are most vulnerable to mood disorders when the rate of change of estrogens is the greatest:
- Menarche
- Pregnancy
- Post partum
- Late luteal phase of the menstrual cycle
- Perimenopause
What is the relationship with mood disorders and socioeconomic status (SES)?
- Increased depression in lower SES groups
- Increased bipolar disorder in higher SES groups
