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Psychiatry > Mood disorders > Flashcards

Mood disorders Flashcards

1
Q

Synonym for mood disorders?

A

Affective disorders

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2
Q

DSM-IV for major depressive EPISODE?

A

2 wk period of at least 5 of these and MUST INCLUDE #1 or #2

  1. Depressed mood
  2. Anhedonia
  3. Change in appetite or weight
  4. Feelings of worthlessness or excessive guilt
  5. Insomnia or hypersomnia
  6. Diminished concentration
  7. Psychomotor agitation or retardation
  8. Fatigue or loss of energy
  9. Recurrent thoughts of death or suicide
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3
Q

DSM-IV for manic episode? Psychotic symptoms associated?

A

1 week of elevated, expansive, or irritable mood with AT LEAST 3 (or 4 IF IRRITABLE)

  1. Distractability
  2. Inflated self-esteem or grandiosity
  3. Increase in goal-directed activity
  4. Dec need for sleep
  5. Flight of ideas or racing thoughts
  6. More talkative or pressured speech (rapid/uninterruptible)
  7. Excessive involvement in pleasure activities with high risk of neg consequences like spending sprees or boning everything

75% of manics have PSYCHOTIC SX!!

Theses are PSYCH EMERGENCIES

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4
Q

Mixed episode? Predominant sx? Rx?

A

Criteria met for both manic and MD episodes; must be present nearly every day for at least 1 week

IRRITABILITY predominates

Poorer response to lithium so give anticonvulsants

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5
Q

Hypomanic episode?

A

Lasts at least 4 days (unlike at least 7 for manic)

No marked impairment, no hospitalization needed, and no psychotic features (unlike full manic)

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6
Q

Medical causes of depressive episode?

A 
CVD
Endocrinopathies (cushings/addison's, hypoglycemia, hyper/hypothyroid, hyper/hypocalcemia)
Parkinson's
Viral eg. mono
Carcinoid syndrome
Cancer, esp. pancreatic and lymphoma
Collagen vascular eg. lupus
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7
Q

Medical causes of manic episode?

A 
Hyperthyroidism
Temporal lobe seizures
MS
Neoplasms
HIV
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8
Q

Medication/substance-induced depressive episodes?

A 
ETOH
Antihypertensives
Barbiturates
Corticosteroids
LEVODOPA
Sedative-hypnotics
Anticonvulsants
Diuretics
Sulfonamides
Stimulant withdrawal
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9
Q

Medication/substance-induced mania?

A 
Corticosteroids
Sympathomimetics
Dopamine agonists
Antidepressants
Bronchodilators
LEVODOPA
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10
Q

MDD DSM-IV criteria?

A
  • At least one major depressive episode
  • No hx of manic or hypomanic

COULD HAVE PSYCHOTIC FEATURES (DELUSIONS OR HALLUCINATIONS)
2x in female than male
Elderly 25-50%

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11
Q

Sleep problems with MDD?

A

Multiple awakenenigs
Hard to fall asleep, early wakeup
Hypersomnia
REM shifted earlier in night and stages 3 & 4 decreased

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12
Q

Neuro abnormalities in MDD?

A

Dec brain & CSF levels of serotonin and 5-HIAA (its main metabolite).
Beta-adrenergic receptors abnormally regulated

DRUGS try to up the serotonin, norepineiphrine, and dopamine

High cortisol
Thyroid abnormalities

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13
Q

Facts about depression

A

~2/3 contemplate suicide, 10-15% commit

Episodes left untreated are self-limiting but usually last 6-13 months.
Episodes occur more frequently as the disorder progresses.
Risk of subsequent episode 50% in first 2 years after 1st episode.

Hospitalization indicated if at risk for suicide, homicide, or unable to care for self

All meds are equally effective but differ in side effect profiles.

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14
Q

How long for antidepressant to work?

A

4-8 weeks

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15
Q

SSRI side effects

A

HA, GI disturbance, sexual dysfunction, rebound anxiety

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16
Q

TCA side effects

A

Most lethal in overdose!!

Sedation, weight gain, orthostatic hypotension, anticholinergic effects.
Prolonged QT syndrome can get worse.

17
Q

MAOI side effects

A

Good for refractory depression

MC is orthostatic hypotension

Risk of hypertensive crisis w/ tyramine foods or sympathomimetics

Risk of serotonin syndrome w/ SSRIs

18
Q

Serotonin syndrome?

A

Autonomic instability, hyperthermia, seizures.

Coma or death…

19
Q

Adjuvant meds in depression?

A

Stimulants (eg. methylphenidate);

Good for terminally ill or refractory

20
Q

When is ECT indicated?

A

If pt can’t take antidepressants (eg. elderly or pregnant)
If rapid reduction of sx needed (eg. suicidal)
If unrepsonsive to pharm

21
Q

Melancholic depression

A

40-60% of hospitalized patients with major depression

Anhedonia, early morning awakenings, psychomotor disturbance, excessive guilt, anorexia

22
Q

Atypical depression

A

Hypersomnia/phagia, leaden paralysis, REACTIVE MOOD, hypersensitivity to interpersonal rejection

MAOIs OFTEN USEFUL

23
Q

Catatonic depression

A

Immobility, purposeless motor activity, extreme negativism or mutism, bizarre postures, echolalia
MAY ALSO BE APPLIED TO BIPOLAR DISORDER

TREATED WITH ANTIDEPRESSANTS AND ANTIPSYCHOTICS CONCURRENTLY

24
Q

Psychotic depression

A

10-25% of hospitalized depressions

Delusions or hallucinations obvi

25
Q

Bipolar I disorder DSM-IV? Prognosis?

A

Episodes of mania and major depression; but episodes of major depression are NOT REQ FOR DIAGNOSIS (just are usually present)

Only req: one manic or one mixed episode (10-20% experience only manic episode)

Between episodes may have euthymia, major depressive episodes, dysthymia, hypomanic episodes **NONE REQ FOR DX

MAY HAVE PSYCHOTIC FEATURES, either during the depressive OR the manic episode

M=F; onset usually before 30

Untreated manic episodes usually last ~3 months. Episodes more frequent as disease progresses.
Only 7% don’t have any recurrence after 1st episode

WORSE PROGNOSIS than MDD bc only 50-60% have significant improvement with lithium rx.

Lithium ppx between episodes dec risk of relapse.

26
Q

Pharm and other rx for bipolar?

A
  • Lithium
  • Anticonvulsants (carbamazepine or VPA)
  • Olanzapine

ECT, but usually more rx’s needed compared to depression

27
Q

What are the anticonvulsants in bipolar disorder best in treating?

A

Rapid cycling bipolar and mixed episodes

28
Q

Rapid cycling?

A

Occurrence of 4 or more mood episodes in 1 year (major depressive or manic or mixed, etc)

29
Q

Lithium side effects?

A
  • Weight gain
  • Tremor
  • GI disturbances
  • Fatigue
  • Arrythmias
  • Seizures
  • Goiter/hypothyroidism
  • Benign leukocytosis
  • Coma
  • Polydipsia/polyuria
  • Alopecia
  • Metallic taste
30
Q

Bipolar II

A

Aka. Recurrent major depressive episodes with hypomania

DSM-IV: One or more MD episodes and at least one HYPOMANIC episode; if they EVER had a manic episode it’s automatically Bipolar I.

31
Q

Dysthymic disorder? Prognosis? Rx?

A

Chronic mild depression, usually without discrete episodes and rarely need hospitalization

DSM-IV:

  1. Depressed mood for majority of time/most days for at least TWO YEARS; at least one year in children
  2. At least two:
    - Poor concentration or difficulty in decision making
    - Feelings of hopelessness
    - Poor appetite or overreating
    - Insomina or hypersomnia
    - Low energy or fatigue
    - Low self-esteem

IN 2 YEAR PERIOD, HAS NEVER BEEN WITHOUT THOSE SX FOR >2 MONTHS AT A TIME

MUST NEVER HAVE HAD A MANIC OR HYPOMANIC EPISODE…this would be bipolar or cyclothymic disorder, respectively

2-3x F > M
Onset before 25 in 50%

20% develop major depression
20% develop bipolar
>25% will have lifelong sx

SSRIs, TCAs, MAOIs with cognitive therapy and insight-oriented therapy

32
Q

Double depression? Prognosis? Rx?

A

Major depressive disorder with dysthymic disorder during residual periods

33
Q

Cyclothymic disorder? Prognosis? Rx?

A

“Ups and downs”

DSM-IV:

  • Numerous pds with HYPOMANIC sx and periods with depressive sx for at least 2 years
  • Never sx free for >2 mo during that time
  • No hx of MD episode or manic episode (so lighter on both)

**May coexist with borderline personality disorder
*Onset usu 15-25
*M=F
1/3 eventually dx with bipolar

Rx: Bipolar meds

Psychiatry (5 decks)

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