Mood disorders Flashcards
Discuss epidemiology of mood disorders and disability, both world wide and in the United States.
- neuropsychiatric diseases account for half of all causes of disability worldwide
- depression and mood disorders account for nearly a quarter of the total causes of disability
- depression: 120 million (
Epidemiology of depression
50% in tx (20% adequately treated)
30 y: median age of onset
18-44 highest rates
risks: unemployed, separated, divorced, living in urban settings, female
atypical depression
mood reactivity, leaden paralysis, reverse neurovegetative symptoms (increased appetite, weight gain, hypersomnia)
psychotic depression
often with auditory hallucinations, nihilistic delusions
melancholic depression
mood worse in the morning, early morning awakening, anorexia, weight loss, guilt, psychomotor retardation
differential diagnosis of mood disorders
mood disorder
medical illness: endocrine (Cushings, Hyper/hypothyroidism, steroids), infections (HIV, influenza, meningitis, Creutzfeld-Jakob), CNS (stroke, tumor, Multiple Sclerosis, epilepsy), metabolic (hypercalcemia)
substance abuse:
cocaine, alcohol, amphet/stim, hallucinogens (LSD, PCP, mescaline), BDZs
prescribed tx/medication side effect
(amantadine, methylodpa withdrawal, interferon, steroids, chemo)
personality
Depression and HPA axis
- depression is often associated with neuroendocrine dysfunction
- activation of HPA axis to stress (hypothal secretes CRF, stimulates synth of ACTH (adrenocorticotropin) from anterior pituitary, which stim synth/rel of glucocorticoids (cortisol) from the adrenal cortex.
- the hippocampus is inhibitory to HPA and amgydala is excitatory
- hippocampal damage can occur with sustained elevated glucocorticoids. (inhibition decreased, and further increase in glucocort)
- see hippocampal atrophy in some, not all depressed pts
bipolar disorder symptoms domains
-considered on a spectrum
Manic mood and behavior:
euphoria, grandiosity, pressured speech, impulsivity, excessive libido, recklessness, social intrusivess, diminished need for sleep
Psychotic sx:
delusions, hallucinations
dysphoric or negative mood and behavior:
depression, anx, irritability, hostility, violence, suicide
Cognitive sx:
racing thoughts, distractibility, disorganization, inattentiveness
**there is no clear etiology of bipolar disorder. (Many factors play role including poss white matter abnormalities)
risk factors for suicide, demographics, epidemiology.
- 1.4% all deaths in US and the 11th leading cause of death all ages
- 2nd leading cause of death 25-34 year olds
- In the US, ~ 300,000 attempts and 33,000 completed suicides per year.
- 10-15% of patients with severe MDD suicide
- 4:1 Male:Female suicide ratio
- 79 % of those who commit suicides are men
- Women attempt suicide 2-3X more often than men
- 2/3 of all completers had contact with PCP within a month of their suicide
- 56-75% of first attempts end in death
- 3-7% of all attempters will eventually kill themselves
Which is more heritable: bipolar disorder or unipolar depression?
bipolar
-both should be though of disruptions in neural circuitry (not chemical imbalances)
What is the etiology for psychiatric illnesses?
There is no clear etiology.
Classification of mood disorders DSM IV
for V look at phone
Bipolar disorders: bipolar I bipolar II cyclo-thymic disorder bipolar disorder NOS
Depressive disorders:
Major depressive disorder
dysthymic disorder
depressive disorder NOS
-Due to med condition or due to substance
Dx of depression
patients must experience 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.
Sleep (insom/hypersom) Interest (diminished) Guilt/feeling worthless Energy (decreased) Concentration (decreased) Anhedonia (loss of int in activities)/appetite disrup Psychomotor changes Suicidal Ideation
seasonal affective depression
Mood typically worsens in the fall and winter, improves in the spring and summer.
depression is highly
recurrent (50% after 1 episode)
