Mood disorders Flashcards
Unipolar depression epidemiology
Avg age of onset 29 ave # of lifetime episodes: 4 Prevalence: 12 month - 7% lifetime - 17% all depression life-time prevalence: 21
Unipolar depression risk factors
female sex - 1.5-3x starting in early adolescence divorce age non-black&nonhispanic, non-white non-studying adolescent
Major depression diagnosis
MDD = major depressive disorder; (MDE: episode) Neurovegetative/vegetative symptoms DSIGECAPS: >=5 of the following for >= 2 weeks, one of criteria must be either depressed mood or anhedonia: Depressed mood Sleep disturbance loss of Interest in pleasurable activities Guilt low Energy Concentration difficulties Appetite disturbance Psychomotor retardation Suicidal ideation
Major depressive disorder comorbidities
borderline personality disorder anxiety disorders OCD eating disorders substance misuse
BAD-I diagnosis
>=1 manic episode +/- MDEs Expansive/irritable mood nad persistently increased goal-directed activity or energy plus >=3 (or >=4 if mood is only irritable) of the following, lasting >=1 week: DIGFAST Distractiliby Increase in goal-directed activity Grandiosity Flight of ideas Activities with high potential for painful consequences Sleep decreased Talkative/pressure of speech
Marked FUNCTIONAL IMPAIRMENT
BAD-II diagnosis
Abnormally/persistently elevated, expansive, or irritable mood plus abnormally & persistently increased activity/energy lasting >-4 days, during which >=3 of following occur:
DIGFAST
Unequivocal change in functioning observable by OTHERS
Episode is not severe enough to cause marked impairment in function/require hospitalization
Bipolar affective disorder comorbidities
ADHD
substance misuse
anxiety disorders
Bipolar I overview
> =1 manic episode +/- depressive episodes
Bipolar II overview
> =1 hypomanic episode +/- >=1 depressive episodes
never had full mania
Cyclothymic disorder diagnosis
> =2 y (1 in children/adolescents), numerous periods with hypomanic symptoms that do not meet criteria for hypomanic episode + numerous periods with depressive diagnoses that do not meet criteria for MDE
No symptom-free period >=2 mo at a time
during 2 y period, hypomanic/depressive symptoms have been present for at least half of the time
Have never met criteria for MDE, manic episode or hypomanic episode
Symptoms cause clinically significant distress or impairment
GMC rule out
general medical condition!
TSH, Na, B12, UTI
Liver disease, renal disease, cardiac disease, dementia, neurological disease
Dysthymia diagnosis
persistent depressive disorder
Depressed mood for most of day, for more days than not, for >=2 years (1 in children/adolescents)
While depressed, >=2 of :
- vegetative symptoms: appetite/sleep/energy changes
- psychological symptoms: low self-esteem, poor concentration/indecisiveness, feeling of hoplelessness
No symptom free period >=2 months at a time
clinically significant distress or impairment
Biogenic amine hypothesis
changes in neurotransmitter levels and regulation
deficiencies in dopamine, serotonin, norepinephrine
leading to receptor upregulation
Neurobiology of mood disorders
Biogenic amine hypothesis
post-synaptic receptor changes
neuropeptide, neuroendocrine and hormonal changes (cortisol, TSH)
regional brain dysfunction (blood flow, regional metabolism alterations)
Signal transduction abnormalities
Norepinephrine role in mood
energy
interest
motivation
anxiety, irritability
