mood disorders Flashcards
mood disorder types
MDD, BPI/II, dysthymic disorder, cyclothymic disorder. may have psychotic features (delusion or hall)
Major depressive episode criteria
need 5/9 sx for at least 2wks
1) depressed mood
2) anhedonia
3) change in appetite or body wt
4) feelings of worthlessness or excessive guilt
5) insomnia or hyperemia
6) diminished concentration
7) psychomotor agitation or retardation (restlessness or slowness)
8) fatigue or loss of energy
9) recurrent thoughts of death or suicide
sx most not be due to substance use or med condition, most cause occupational or social impairment
depression sx
Sleep
Interest
Guilt
Energy
Concentration
Appetite
Psychomotor activity
Suicidal ideation
suicide and major depressive episode
pt who has been previously hospitalized for major depressive episode and has a 15% risk of committing suicide later in life
manic episode criteria
period of ban and persistently elevated, expansive or irritable mood lasting at least 1wk with 3/7
1) distractability
2) inflated self esteem or grandiosity
3) incr in goal directed activity (social, work or sexual)
4) decr need for sleep
5) flight of ideas or racing thoughts
6) more talkative or pressured speech
7) excessive involvement in pleasurable activities that have high risk of neg cones
75% have psych sx
it is a psych emergency and can make pt dangerous to self and others
sx of mania
DIG FAST
distractability, insomnia, grandiosity
flight of ideas, activity/ agitation, speech, thoughtlessness
mized episode
criteria met for both manic and major depressive episode and last for everyday of 1 week. psych emergency
hypomanic episoe
distinct period of elevated, expansive or irritable mood that has 3 sx of manic episode. but cause no marked impairment in social or occupational func. no hospitalization. no psychotic features
DD for depressive episode secondary to
cerebrovascular disease, endocrinopathies, parkinson’s, viral, carcinoid syndrome, cancer (lymphoma, pancreatic carcinoma)
medical causes of manic episode
metabolic (hyperthyroidism), neuro, neoplasm, HIV
MDD DSM
at least 1 MDE. no hx of manic or hypomanic episode
MDD epidemiology
prevalence 15%, any age but av onset 40yo, 2M=F, prevalence in elderly. 15% eventually commit suicide
2/3 think about suicide, 1/2 gets tx
MDD v sleep
multiple awakenings, initial and terminal insommnia, hypersomnia, REM sleep shifted to earlier in night
seasonal affective disorder triad
irritability, carbohydrate drawing, hypersomnia
depression NT
decr brain and CSF 5HT and its main metabolite 50HIAA. ban reg of beta adrenergic R. so drug incr 5HT, NE, and dopamine helps.
high cortisol, ban thyroid axis.
antidepressants v MDD
decr length and severity of sx. may be used prophylactically btw MDE to reduce risk of subset episode. all antidepressants are equally effective but differ in SE. takes 4-8wks to work
serotonin syndrome
autonomic instability hyperthermia, seizures. may cause coma or death. caused by combined use of MAOIs and SSRI
Electroconvulsive therapy (ECT)
I: unresponsive to or can’t tolerate pharmacotherapy or rapid decr in sx is desired.
premed with atropine –> general anesthesia –> admin M relaxant. induce general seizure by passing current of eccentricity across brain.
SE: retrograde amnesia. disappear w/in 6mo.
types of depressive disorders
Melancholic: 4060%. anhedonia, early morning awakenings, psychomotor disturbances, excessive guilt, anorexia.
Atypical: hypersonmia, hyperphagia, reactie mood, leaden paralysis, hypersensitivity to interpersonal rejection
Catatonic: icatalepsy, purposeless motor activity, extreme negativism or mutts, bizarre postures, echolalia.
psychotic- 10-20% delusions or hallu.
bipolar I DSM
1 manic or mixed episode.
btw manic episode there may be interspersed ethymia or MDE, dysthymia or hypomanic episode but not required.
bipolar epi, couse and prog
1%. F=M. onset bf 30yo. untreated epi lasts ~3mo. only 7% of pt has no recurrence after 1st episode. worse prog than MDD.
BP tx
lithium prophylaxis btw episode to help decr risk of relapse
pharm- litium, anticonvulsants, olanzapine
psychotherapy- supportive, family, group
ECT-tx manic episode.
rapid cycling
occurrence of 4 or more mood episodes in 1year.
BP II DSM
hx of 1 or more MDE with at least 1 hypomanic episode.
dysthymic disorder CHASES and 2Ds
chronic mild depression with no discrete episode. rarely need hospitalization. Never have psychotic features.
poor Concentration or difficulty making decisions
feeling Hopeless
poor Appetite or overeating
inSomnia or hypersonmia
low Energy or fatigue
low Self-esteem
2 years of depression. 2 listed criteria. never asx for >2mo
dysthymic disorder DSM
A)depressed mood for majority of at least 2years (1y in children)
B) at least 2 of
1) poor concentration or difficulty making decisions
2) hopelessness
3) poor appetite or overeating
4) low energy or fatigue
5) low self -esteem
C) during 2 y - person not been w/o sx for more than 2mo a a time. no MDE
Double depression
MDE+ dysthymic disorder in residual periods. 2or 3M=F. onnset bf 25in 50%. 20% –> MDD. 25% lifelong sx.
tx: cog therapy, insight oriented psychoterapy.
can use antidepressants
cyclothymic disorder
DSM: numerous periods with hypomanic s and periods of depressive sx for at least 2 y pt never were of sx for >2mo no hx of MDE or manic episode 15-25yo m=f 1/3--> BP tx: antimanic agents as in BP
anxiety disorder NT
incr NE and decr GABA/serotonin.
anxiety disorder epidemiology
F>M. more freq in higher socioeconomic groups
anxiety disorder types
panic D, agoraphobia, specific and social phobia, OCD, PTSD, acute distress D, GAD, anxiety secondary to medical condition, substance induced anxiety D
