Mood Disorders Flashcards
Define Mood Disorder
1 or more major depressive episodes
Onset of MDD
usually in mid 20s
Male-to-female ratio for mood disorder
1:2
Symptoms of depressive episode
Sleep; Interest(decreased); Guilt; Energy (decreased); Concentration (decreased); appetite or weight; Psychomotor agitation or retardation; Suicide ideation
Requirement for MDD
depressed mood or anhedonia and 5 more S&S from SIG E CAPS for 2-week period
Atypical Depression
weight gain, hypersomnia, and rejection sensitivity
Postpartum Depression
Occurs within 1 month postpartum, psychotic symptoms are common
Seasonal Depression
Depressive episodes during a particular seasons, usually in the winter. Responds well to light therapy +/- antidepressants
Double Depression
major depressive episode in a patient with dysthymia. Has poorer prognosis that MDE alone
Pharmacotherapy Timeframe for MDD
effective in 50-70% patient, allow 2-6weeks to take effect; treat for 6+ months
Pharmacotherapy for MDD (drug classes)
SSRIs, Atypicals, SNRIs, TCAs, MAOIs
Best treatment combination for MDD
Pharmacotherapy + Psychotherapy
When to use ECT
Refractory depression or psychotic depression, or if rapid improvement in mood is needed; also used for intractable mania and psychosis
Adverse Effects of ECT
postictal confusion, arrhythmias, HA, and anterograde amnesia
TCA toxicity
3 C’s; Convulsions, Coma, Cardiac Arrhythmias
Medical conditions that can cause mood disorder
hypothyroid, parkinson, CNS neoplasm, ceoplasms, stroke (esp ACA), dementias, parathyroid
Substances that can cause mood disorders
illicit drugs, alcohol, antihypertensives, corticosteroids, OCPs
A constellation of symptoms that resemble MDE but do not meet the criteria for MDE. Occurs within 3 onths of an identifiable stressor
Adjustment disorder with depressed mood
Timeframe for normal bereavement
after loss of loved one, no severe impairment/suicidality. Should last
milder, chronic depression with depressed mood present most of the time for at least 2 years; often resistent to treatment
Dysthymia
Contraindications of ECT
MI/stroke, intracranial mass, and high anesthetic risk
Length of time to wait to start MAOI if patient was on fluoxetine
5 weeks
Length of time to wait to start MAOI if pateint was on SSRIs
2 weeks
Time of onset for postpartum blues
within 2 weeks of delivery
Sadness, moodiness, emotional lability. No thoughts about hurting the baby.
Postpartum “blues”
Time of onset for postpartum psychosis
2-3 weeks postdelivery
Delusions and depression after giving birth. May have thoughts about hurting the baby.
Postpartum psychosis
Time of onset postpartum depression
1-3 months postdelivery
Delusions and depression, sleep disturbances and anxiety, thoughts about hurting the baby
Postpartum depression
Average age of onset for bipolar and gender preference
20y/o; male and female are equal
Bipolar I
Involves at least 1 manic or mixed episode (usually requires hospitalization)
Bipolar II
Involves at least 1 MDE and 1 hypomanic episode
Rapid cycling
Involves 4+ episodes (MDE, manic, mixed, or hypomanic) in 1year
Cyclothymic
Chronic and less severe, alternating periods of hypomania and moderate depression for >2years
Symptoms of Mania
DIG FAST
Distractibility, Insomnia, Grandiosity/Goal directed, FLight of ideas, Acitivities/Agitation, Sexual indiscretions, Talkativeness/pressured speech
Describe a manic episode
1 week or more of persistently elevated, expansive, or irritable mood plus 3 DIGFAST symptoms (can have psychotic symptoms)
Acute therapy for bipolar mania
Antipsychotics
Maintenance therapy for bipolar mania
mood stabilizers such as lithium, carbamazepine, valproic acid, lamotrigine
Drug for refractory agitation associated with bipolar mania
Benzodiazepines
Treatment for bipolar depression
Mood stabilizers 1st and then add an antidepressant to avoid inducing mania
ECT for refractory cases
Treatment for patients with severe depression or bipolar II with predominantly depressive features
Augment antidepressants with low-dose lithium (blood levels 0.4-0.6mEq/L)
