Mood Disorders

Question 1

Epidemiology

Answer 1

*neuropsychiatric diseases account for half of all causes of
disability worldwide
*Depression affects approximately 120 million people worldwide
*Anxiety disorders are the most common psychiatric illnesses in the US, followed by mood disorders

Question 2

Etiology and Genetics

Answer 2

*Mood disorders are heritable, though the current genetic transmission is poorly understood
*Bipolar disorder appears more heritable than unipolar depression
*No clear etiology has emerged for any psychiatric illness. They likely are the product of a complex interaction between neurobiologic vulnerabilities, genetics, stress, character, medical illness
*disruptions in neural circuitry involving the amygdala, prefrontal cortex, cingulated, striatum, thalamus and hippocampus and others. Serotonin, norepinephrine and
dopamine do play an important role in modulating these circuits

Question 3

Classification

Answer 3

Mood disorders are divided into:
1) Bipolar Disorders (Bipolar I, Bipolar II, CycloThymic Disorder, Bipolar Disorder NOS)

2) Depressive Disorders (Major Depressive Disorder, Dsythymic Disorder, Depressive Disorder NOS)

Question 4

Depression diagnosis

Answer 4

*Diagnosis of depression is made when patients suffer from 5 or more symptoms that have persisted for 2 weeks or more, are a change from previous function, and patient experiences sad mood or anhedonia.

Question 5

Bipolar Disorder

Answer 5

Bipolar disorder symptoms can be divided into 4 domains::

1. manic mood and behavior
2. dysphoric mood and behavior
3. psychosis
4. cognitive symptoms

Question 6

Diagnosis of Bipolar Disorder

Answer 6

Diagnosis of mania: A distinct period of abnormally & persistently elevated, expansive or irritable mood, and persistently increased goal‐directed activity or
energy, present most of the day nearly every day lasting at least 1 week (or any duration if hospitalization necessary), plus 3 or more symptoms (if euphoric), or 4 or more symptoms (if irritable).

• Symptoms must co‐occur and cause significant social/personal disruption
• Hypomanic symptoms are the same as mania, but do not persist as long (four days)
• most patients with bipolar disorder spend the majority of their mood states in depression.

Question 7

Medical Illnesses precipitating mood disorders:

Answer 7

• Endocrine: e.g. Cushings, Hyper/hypothyroidism, steroids)
• Infections: e.g. HIV, influenza, meningitis, Creutzfeld‐Jakob
• CNS: e.g. stroke, tumor, Multiple Sclerosis, epilepsy
• Metabolic: e.g. hypercalcemia

Question 8

Substances Intoxication/withdrawal/side effect associated with mood disorders

Answer 8

• Substances of Abuse: Cocaine, Alcohol, Amphetamine/stimulants, Hallucinogens (LSD, PCP, mescaline), Benzodiazepines
• Prescribed treatments: Amantadine, Methyldopa withdrawal, Interferon, steroids, chemotherapy agents

Question 9

Suicide

Answer 9

• 11th leading cause of death all ages
• 2nd leading cause of death 25‐34 year olds
• 10‐15% of patients with severe MDD suicide
• 4:1 Male:Female suicide ratio
• Women attempt suicide 2‐3X more often than men

Question 10

What is SIGECAPS?

Answer 10

Symptoms of depression
SIGECAPS:
Sleep (insomnia or hypersomnia),
Interest (diminished)
Guilt (often without content, or excessive)
Energy (decreased)
Concentration (decreased)
Anhedonia (loss of interest in previously pleasurable
activities)
Psychomotoric changes (either increased or decreased activity)
Suicidal ideation (either thoughts of suicide, plans, intent or actual attempts).

Question 11

Subtypes of Depression

Answer 11

• Atypical: mood reactivity, leaden paralysis, reverse neurovegetative symptoms (increased appetite, weight gain, hypersomnia)
• Psychotic depression (often with auditory hallucinations, nihilistic delusions)
• Melancholic: mood worse in the morning, early morning awakening, anorexia, weight loss, guilt, psychomotor retardation.
• Seasonal Affective: Mood typically worsens in the fall and winter, improves in the spring and summer.

Question 12

Diagnosing Bipolar I vs Bipolar II

Answer 12

Bipolar I: only have to have mania

Bipolar II: hypomania + major depression

Question 13

What is DIGFAST?

Answer 13

Symptoms of mania :
Distractibility
Insomnia (note: decreased NEED for sleep)
Grandiosity
Flight of Ideas
Activity (increased energy and activities)
Speech (pressured, non‐stop)
Thoughtlessness (no thinking through of actions; impulsive and reckless).