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ICM - Exam 1 > Mood Disorders > Flashcards

Mood Disorders Flashcards

1
Q

Dissociation

A

splitting off clusters of mental contents from conscious awareness

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2
Q

Intellectualization

A

engagement in abstract thinking to ward off conflict or disturbing feeling

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3
Q

Projection

A

what is emotionally unacceptable in the self is unconsciously rejected and attributed to others

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4
Q

Rationalization

A

attempts to make unacceptable feeling acceptable by justification

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5
Q

Reaction formation

A

person adopts ideas and behaviors that are the opposite of impulses harbored consciously or unconsciously (ie, excessive moral zeal may be a reaction to strong but repressed asocial impulses)

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6
Q

Sublimation

A

unacceptable conscious drives are redirected into personally and socially acceptable channels

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7
Q

Substitution

A

an unacceptable emotion is replaced by one that is more acceptable

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8
Q

Mood Disorders: 3 Major Divisions

A
  • Depressive Disorders
  • Bipolar Disorders
  • Depression associated with medical illness/alcohol/substance abuse
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9
Q

Mood Disorders are defined by

A

a pattern of episodes over time

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10
Q

Major Depressive Episode (DSM-IV and DSM-5) Definition

(A)

A

At least five of the following symptoms nearly every day for two weeks:

  1. Depressed mood (or irritability in adolescents)
  2. Anhedonia
  3. Change in weight or appetite
  4. insomnia or hypersomnia
  5. psychomotor agitation or retardation
  6. Fatigue or loss of energy
  7. Feelings of worthlessness or guilt
  8. Diminished ability to think or concentrate
  9. Recurrent thoughts of death or suicide
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11
Q

Major Depressive Episode (DSM-IV and DSM-5) Definition

(B-F)

A

B. Impairment or distress

C. No organic factor. Bereavement is no longer an exclusion in DSM-5.

D. Mixed state now a specifier.

E. No schizophrenia or schizoaffective disorder

F. Anxiety now a specifier.

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12
Q

Pathophysiology of MDE

A
  1. Increased cortisol/CRH
  2. 2nd messenger system changes
  3. transcription factor changes
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13
Q

MDD occurs in ___% of the population

A

15%

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14
Q

MDD Diagnosis involves alterations in… (7)

Increased risk for what?

A
  1. Mood
  2. Appetite
  3. Sleep
  4. Energy
  5. Activity
  6. Thoughts
  7. Cognition

Increased suicide risk.

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15
Q

Questions to probe for anhedonia

A

Change in:

  • Sex drive?
  • Activities/hobbies?
  • Enjoyment of being by yourself or with others?
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16
Q

Typical and atypical change in sleep in MDD

A

Redced sleep is typical, increased is atypical

increased sleep is generally not restful

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17
Q

In MDD, look for ___ or ___ ideas

A

delusional or overvalued

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18
Q

If a person has tried to harm themselves, has come close, or has persistent thoughts of suicide, assess ________.

A

for dangerousness

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19
Q

Manic Episode Dx (A-E)

A

Elevated or expansive lasting at least one week

Elevated or irritable mood characterized by:

  • Grandiosity
  • Little need for Sleep
  • Pressured speech
  • Distractibility
  • Increase in activities- goal directed and risk taking

DOESNT meet criteria for mixed episode

Marked impairment in function

Not due to substance or medical condition

20
Q

Manic episodes commonly manifest as what two types of mood

A

Elevated or irritable

21
Q

Question to check for grandiosity

A

“Have you felt that you were a very important person or that you had special plans, powers, talents, or abilities?”

22
Q

Question for delusional ideas?

A
  • ´Has there ever been a time when you’ve had ideas that you later realized were not true?
  • How about ideas that you felt very sure about but no one else believed?”
23
Q

Mixed episode =

A

Over a 1 week period, patient satisfies criteria for both Manic episode and MDE

24
Q

Differnce between mania and hypomania

A

Mania requires a week of elevated mood plus 3-4 symptoms;

Hypomania requires 4 days plus 3-4 symptoms

**Hypomania may include mild or moderate impairment, but may also be associated with enhancement of function

25
Q

Depression- 2 Major subtypes

A

Major Depression = episode of depressed mood daily for a minimum of 2 weeks

Dysthymic Disorder = pattern of chronic ongoing mild depressive symptoms

26
Q

Pathophys of MDD

A
  1. Three neurotransmitters are implicated (serotonin, norepinephrine, and dopamine)
  2. Possible misregulation of cortisol
27
Q

4-pronged method of treatment for MDD

A
  • Psychotherapy (CBT)
  • Medication
    • SSRI
    • SNRI
    • TCA
    • MAOI
  • ECT (electroconvulsive therapy)
  • TMS (transcranial magnetic stimulation)
28
Q

Major Depressive Disorder

Specific Steps and Follow Up

A
  • Address Suicidality by direct questioning
  • Patient education to increase adherence to medications
  • Evaluate treatment response in 2 months (75% of patients improve by that time)
29
Q

Bipolar I

A

Mixed episodes of mania and depression within the same week

30
Q

Bipolar II

A

History of depression with hypomanic episodes

31
Q

Cyclothymia

A

Cyclic hypomanic and depressive episodes

32
Q

“Kindling effect” of bipolar

A

over time episodes can be more easily stimulated, increased susceptibility to an event

33
Q

Bipolar Mania/Hypomania : Treatment

A

Mood stabilizers

  • Lithium carbonate
  • Valproic acid
34
Q

Bipolar Depression : Treatment

A

Atypical antipsychotics

  • Seroquel (quetiapine)
  • Symbyax (fluoxetine/olanzapine)
35
Q

Comorbidities for bipolar

A
  • Any substance abuse disorder = 42%
    • Alcohol (33) Marijuana (16)
  • Any anxiety disorder = 42%
    • Panic (20) Social (16)
  • Any eating disorder = 11%
    • Bullemia > Anorexia
36
Q

Percent of Affective disorder patients that consult physician

A

85%

Only half of those people are seeing a psychiatrist

37
Q

Screening tool for depression

A

PHQ-9

38
Q

Patients with recurrent epilepsy and self-reported diabetes have what in common?

A

Higher comorbidity with depression than their counterparts

Epilepsy = Recurrent is 3.6, Controlled is less than 1

Diabetes = S.R. is 2.5, diagnostic is less than 1

39
Q

Classic offender drugs f

or causing depression

A
  • Catecholamine depletion or blockade
    • reserpine, propranolol, cocaine withdrawal
  • Cholinergic agonists
    • physostigmine, insecticide poisoning
  • CNS depressants
    • valium, barbiturates

Other: Steroids, H² Blockers, analgesics.

40
Q

Disease causes of depression

(6 categories with examples)

A
  • *Endocrine** – hypothyroidism (rarely hyperthyroidism), Cushing’s disease.
  • *Neurologic** – CVA (esp. frontal), Parkinson’s, Huntington’s, Alzheimer’s.
  • *Infectious** – HIV, hepatitis, mononucleosis, influenza.
  • *Neoplastic** – lung, pancreas, CNS.
  • *Metabolic** – folate or B12 deficiency, high calcium, low magnesium.
  • *Other** – alcoholism, any condition causing CNS depression.
41
Q

Specific Organic Causes of Mania: Drugs and Medications

A
  • Sympathomimetics – stimulants (amphetamine, cocaine), decongestants, weight loss preparations.
  • Dopamine agonists - L-DOPA, bromocriptine.
  • Antidepressants
  • Steroids
42
Q

Specific Organic Causes of Mania: Diseases (5 categories)

A
  • *Endocrine** – Hyperthyroidism.
  • *Neurologic** – Temporal lobe seizures, temporal lobe CVA, MS, Huntington’s.
  • *Infectious** – HIV, encephalitis.
  • *Neoplastic** – CNS tumors.
  • *Metabolic** – Hypocalcemia, dialysis encephalopathy.
43
Q

Mood Disorder is a common condition: about one in __ persons will have major depression during their lifetime, and about 1 in ___ will have bipolar illness

A

Depression = one in 6

Bipolar = one in 25

44
Q

The average age of onset is ___ for bipolar illness and ___ for unipolar depression

A

20, 25

45
Q

Risk for _______is 2x greater in women than men. Risk for ________ is equal in men and women

A

Depression

Bipolar

46
Q
A

ICM - Exam 1 (8 decks)

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