Mood disorders Flashcards
What conditions must be met for a diagnosis of depression?
Patient must have
1) 5 or more symptoms (SIGECAPS)
2) have persisted for 2 weeks or more
3) are a change from previous function
4) Patient experiences sad mood or anhedonia
What does SIGECAPS stand for?
S - Sleep I - Interest G - Guilt E - Energy C - Concentration A - Anhedonia P - Psychomotor S - Suicidal
What are the subcategories of depression?
Atypical - mood reactivity, reverse neurovegetative (weight gain, hypersomnia)
Psychotic depression - auditory hallucinations, nihilistic delusions
Melancholic - mood worse in the morning, early morning awakening, anorexia, weight loss, guilt, psychomotor
Seasonal Affective - Mood worsens in fall and winter, improves in spring and summer
What is bipolar disorder?
Bipolar disorder is a spectrum from extreme mood swings to cyclothymia to hypomanias with major depression (Bipolar II) to frank manias (Bipolar I). Manias can be induced by medications (antidepressants, steroids) or brain injuries (secondary manias).
What are the subcategories of bipolar disorder?
Manic mood and behavior - euphoria, grandiosity, impulsivity, high libido, diminished sleep
Dysphoric mood and behavior - depression, anxiety, irritability, hostility, violence, suicide
Psychosis - delusions and hallucinations
Cognitive symptoms - racing thoughts, distractibility, disorganization, inattentiveness
How is Bipolar disorder diagnosed?
Patients must experience:
1) A distinct period of abnormality & elevated, expansive, or irritable mood
2) Persistently increased goal-directed activity or energy
3) Mood and energy must be present most all day for at least 1 week
4) Plus 3 DIGFAST symptoms, or 4 if irritable
What does DIGFAST stand for?
D - Distractibility I - Irritability G - Grandiosity F - Fight of Ideas A - Activity S - Speech T - Thoughtlessness
What is the definition of hypomania?
Hypomania is the presence of manis symptoms that do not persist as long (~4 days instead of a week or more) and do not cause the same degree of social impairment as seen in mania.
What is the difference between Bipolar I and Bipolar II diagnostic criteria?
Bipolar I - Patients must only have mania.
Bipolar II - Patients must have hypomania AND major depression.
However, most patients spend the majority of their mood states in depression. Depression:Mania in Bipolar I is 3:1 and 37:1 in Bipolar II
Is Bipolar or Unipolar depression more heritable?
Bipolar is more heritable (10x increase in risk to child), Unipolar shows 3x risk to child.
Is depression a chemical imbalance?
Depression is not best thought of as a chemical imbalance. The exact etiologies are unknown, but appear to be disruptions in neural circuitry affecting the amygdala, prefrontal cortex, stratum, thalamus, hippocampus and others. Serotonin, norepinephrine, and dopamine all play a role in regulation of these structures.
Where does suicide rank as a cause of death?
11th leading overall cause of death in US
2nd leading cause of death in 25-34 year olds
10-15% of patients with MDD
4:1 male:female death by suicide
2-3:1 female:male attempt suicide
56-75% of first attempts end in death
What substances (abused or prescribed) as associated with depression?
Substances of abuse: Cocaine, alcohol, amphetamine, hallucinogens, Benzodiazepines
Prescription treatments: Amantidine, Methyldopa withdrawal, Interferon, steroids, chemotherapy agents
