Mood Disorders Flashcards
MDD requires 1 of these 2
depressed mood
anhedonia
the other diagnostic criteria is
5 or more of the second cateogry in greater than 2 weeks
3 associated symptoms of MDD and which one isnt common
anxiety
somatization
psychosis*
lifetime prevalence MDD
17%
MDD is the #__ cause of years lost due to disability and #___ contributer to overall health burden
1,3
more than ___% of suicide happens in MDD patients
60
leading cause of death in US
MDD
atypical MDD
improved moods with positive events
Melancholic MDD
among the most severe form
Psychotic MDD
include psychosis
catatonic MDD
immobile
post-partum MDD
after pregnancy
chronic MDD
recurrent
untreated episodes of depression generally last
4-6 months
major dysthmic disorder
depressed mood everyday for >2 years, no more than 2 months symptom free
associated with >2 symptoms
(chronic, but less symptoms)
dysthmic disorder and m:f prevalence
equal male to female
remission with dysthimic
less than 10% per year
risk of suicide in dysthmici
equal to or greater than MDD
mania/hypomanic episodes
three or four of symptoms
Four if irritable
mania
symptoms >1 week, significant dysfunction
hypomania
symtoms >4 days; limited dysfunction
mixed
mania+ depressive symptoms>1 week; significant dysfunction
Bipolar I disorder (3)
at least one manic or mixed episode
no need for prior depressive episode
more servere illness than BPII and easier to diagnose
BP II disorder (3)
at least one previous major depressive episode
at least one hypomanic episode
less severe than BP I; difficult to diagnose
Cyclothymia (4)
fluctuating minor depressive, hypomanic episodes
no prior MDD, manix, or mixed episodes
over 2 year period, no symptom free period >2 months
after 2years, BPI or BP2 may develop
BID prevalence
1%, men = women
BIID prevalence
0.5%, women > men
3 phases of bipolar treatment
antidepressants
antimanic
maintenance/prevention of episodes
5 options for mood stabilizing drugs
Lithium** valproic acid/depakote carbamazepine (tegretol) lamotrigine (lamictal)--may not prevent mania; no acute effect atypical antipsychotics
ECT
generalized cortical seizure induced
treatments 2-3xs per week for total 6-15 tx
50-70% remission rates
surgical approaches
white matter disconnection: 22-75% efficacy
TMS/rTMS-50% efficacy
TMS/rTMS
non-invasive technique for generating current in cortex and modulating neural network activity
daily treatments lasting about an hour; 15-30 tx
risk of seizure
slow rTMS
facilitate long term depression
fast rTMS
facilitate long-term potentiation
vagus nerve stimulation efective in
30-40% patients
DBS targets
sub-collaosal cingulate- activity goes down when responding to treatment
64% feel better
other targets MDD
inferior thalamic peduncle, lateral habenula
OCD indicated
subthalamic nucleus
Tourette’s located
centromedian nucleus of thalamus, internal globus pallidus
Addictions
NA
