mood disorders

Question 1

mood disorder types

Answer 1

MDD, BPI/II, dysthymic disorder, cyclothymic disorder. may have psychotic features (delusion or hall)

Question 2

Major depressive episode criteria

Answer 2

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

Question 3

depression sx

Answer 3

Sleep
Interest
Guilt

Energy

Concentration
Appetite
Psychomotor activity
Suicidal ideation

Question 4

suicide and major depressive episode

Answer 4

pt who has been previously hospitalized for major depressive episode and has a 15% risk of committing suicide later in life

Question 5

manic episode criteria

Answer 5

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

Question 6

sx of mania

Answer 6

DIG FAST
distractability, insomnia, grandiosity
flight of ideas, activity/ agitation, speech, thoughtlessness

Question 7

mized episode

Answer 7

criteria met for both manic and major depressive episode and last for everyday of 1 week. psych emergency

Question 8

hypomanic episoe

Answer 8

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

Question 9

DD for depressive episode secondary to

Answer 9

cerebrovascular disease, endocrinopathies, parkinson’s, viral, carcinoid syndrome, cancer (lymphoma, pancreatic carcinoma)

Question 10

medical causes of manic episode

Answer 10

metabolic (hyperthyroidism), neuro, neoplasm, HIV

Question 11

MDD DSM

Answer 11

at least 1 MDE. no hx of manic or hypomanic episode

Question 12

MDD epidemiology

Answer 12

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

Question 13

MDD v sleep

Answer 13

multiple awakenings, initial and terminal insommnia, hypersomnia, REM sleep shifted to earlier in night

Question 14

seasonal affective disorder triad

Answer 14

irritability, carbohydrate drawing, hypersomnia

Question 15

depression NT

Answer 15

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.

Question 16

antidepressants v MDD

Answer 16

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

Question 17

serotonin syndrome

Answer 17

autonomic instability hyperthermia, seizures. may cause coma or death. caused by combined use of MAOIs and SSRI

Question 18

Electroconvulsive therapy (ECT)

Answer 18

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.

Question 19

types of depressive disorders

Answer 19

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.

Question 20

bipolar I DSM

Answer 20

1 manic or mixed episode.

btw manic episode there may be interspersed ethymia or MDE, dysthymia or hypomanic episode but not required.

Question 21

bipolar epi, couse and prog

Answer 21

1%. F=M. onset bf 30yo. untreated epi lasts ~3mo. only 7% of pt has no recurrence after 1st episode. worse prog than MDD.

Question 22

BP tx

Answer 22

lithium prophylaxis btw episode to help decr risk of relapse
pharm- litium, anticonvulsants, olanzapine
psychotherapy- supportive, family, group
ECT-tx manic episode.

Question 23

rapid cycling

Answer 23

occurrence of 4 or more mood episodes in 1year.

Question 24

BP II DSM

Answer 24

hx of 1 or more MDE with at least 1 hypomanic episode.

Question 25

dysthymic disorder CHASES and 2Ds

Answer 25

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

Question 26

dysthymic disorder DSM

Answer 26

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

Question 27

Double depression

Answer 27

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

Question 28

cyclothymic disorder

Answer 28

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

Question 29

anxiety disorder NT

Answer 29

incr NE and decr GABA/serotonin.

Question 30

anxiety disorder epidemiology

Answer 30

F>M. more freq in higher socioeconomic groups

Question 31

anxiety disorder types

Answer 31

panic D, agoraphobia, specific and social phobia, OCD, PTSD, acute distress D, GAD, anxiety secondary to medical condition, substance induced anxiety D