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Clin Med III - Psych, Genetics > Mood Disorders > Flashcards

Mood Disorders Flashcards

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1
Q

Define adjustment disorder

A

Out of proportion mood or behavioral change in response to an IDENTIFIABLE stressor

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2
Q

Types of stressors in adjustment disorder?

A
  • Lingering

- Unexpectant (more provocative)

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3
Q

Diagnosis of adjustment disorder

A

Diagnosis of exclusion

  • History of stressor
  • Degree of emotional reaction is disproportionate to stressor
  • Marked impairment of function
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4
Q

Who is MC affected by adjustment disorder?

A

Adolescents (more frequent change in their lives and still learning who they are)

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5
Q

When does adjustment disorder present? How long does it last?

A
  • Onset w/in 3 mos of stressor

- Lasts approx 6 mos after end of stressor

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6
Q

What are adaptive factors that alleviate stress?

A
  • Situational (financial security, emotional resources, agreeable weather)
  • Interpersonal (resiliency, coping, intelligence)
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7
Q

What are provoking factors that trigger stress?

A
  • Chronic mental disorder

- Past emotional trauma/unresolved conflicts

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8
Q

What is 1st line treatment of adjustment disorders?

A

Psychotherapy (individual, family, behavioral)

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9
Q

Pharm treatment of adjustment disorder

A
  • SSRIs

- BZDs

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10
Q

What is the most powerful stressor?

A

Loss of a loved one (loss of a child even worse)

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11
Q

Symptoms and duration of normal grief

A
  • Searching behaviors, shock/numbness, crying spells

- Lasts about 6-12 months (sometimes longer)

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12
Q

Define persistent complex bereavement disorder

A

Out of proportion bereavement from expected norms

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13
Q

What type of grief has a high risk for developing major depressive disorder?

A

Complex grief

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14
Q

What is the best way to prevent major depressive disorder from developing with complex grief?

A

Begin antidepressant as soon as symptoms are recognized

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15
Q

Define major depressive disorder

A

Persistent low mood, tearfulness, apathy that affects interpersonal, occupational, academic function

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16
Q

Onset of major depressive disorder?

A
  • Any age

- Younger predicts recurrent episodes

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17
Q

Pathophys of major depressive disorder

A
  • Biochemical: NE/serotonin/DA disturbance, excess cortisol

- Psychosocial: nature vs. nurture, past traumatic episodes, lack of social support

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18
Q

Screening tools for major depressive disorder

A
  • PH-Q9 (20 or over is severe, 15-19 moderately severe)

- SIG: E CAPS (1 or 2 major symptoms - anhedonia and/or dysphoria plus 3-4 minor symptoms from SIGECAPS)

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19
Q

Principles in history taking for major depressive disorder

A
  • Transitioning: from no hope to positive steps out
  • Symptom assumption: don’t assume symptoms aren’t related to anything medical
  • Normalization: don’t just tell them everything is fine
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20
Q

Classification of major depressive disorder symptoms

A
  • Neurovegetative/somatic (wt loss/gain, low energy)
  • Emotional (apathy, anhedonia)
  • Ideation (worthlessness, guilt, suicidality)
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21
Q

Pharm treatment of major depressive disorders

A
  • SSRIs
  • SNRIs
  • TCAs (more SEs)
  • Antipsychotics
  • MAOis (for severe anxiety, fatigue, hypersomnolence, wt gain)
22
Q

Non-pharm treatment of major depressive disorder

A
  • ECT for severe depression
  • Transcranial magnetic, vagal nerve, deep brain stimulation
  • Psychotherapy
23
Q

What meds best treat irritable depression?

A

SSRIs

24
Q

What meds best treat melancholic depression?

A

DA/NE reuptake inhibitors

25
Q

What shortens the intervals between depressive episodes?

A

Older age

26
Q

What is the terminal stage of depression?

A

Suicide

27
Q

Clinical clues of suicidal ideation

A
  • Verbal

- Behavioral (distribution of prized possessions, putting personal affairs into order)

28
Q

What psych condition has the highest suicide rate?

A

Bipolar depression in men

29
Q

Treatment plan for suicidal patient?

A

ESCORT pt to ER, make sure they get there and call ahead to ER to let them know

30
Q

Treatment plan if pt is agitated and a present danger to self or others?

A

Conditional involuntary psych admission (“section 12”)

31
Q

Define dysthymic disorder

A

At least 2 years of depressed mood for more days than not (slightly less severe version of MDD but more chronic)

32
Q

What is MC - MDD or dysthymic disorder?

A

MDD

33
Q

How does dysthymic disorder relate to MDD?

A
  • Less severe but more chronic

- 20% of pts will develop MDD

34
Q

Treatment of dysthymic disorder

A
  • Psychotherapy

- SSRIs, SNRIs (controversial efficacy)

35
Q

What is bipolar disorder characterized by?

A

1 or more manic/mixed episodes usually accompanied by major depressive episodes

36
Q

Types of bipolar disorder

A
  • Bipolar I characterized by mania: can exist w/ or w/o MDD
  • Bipolar II characterized by hypomania: at least 1 MDD episode
  • Cyclothymia: hypomania, less severe depression
37
Q

Define mixed state

A

Concurrent mania and depression equally

38
Q

Clinical presentation of manic episodes

A
  • Abrupt with rapid behavior escalation
  • Onset of 1st episode early 20s
  • Self limiting days to months
39
Q

Pharm treatment of bipolar I

A
  • Mood stabilizers: Lithium (gold standard), valproic acid, lamotrigine
  • Antipsychotics especially mania with psychosis (faster acting than mood stabilizers)
  • Antidepressants (avoid monotherapy)
40
Q

Which mood stabilizer is safe in pregnancy for bipolar I?

A

Lithium

41
Q

Which mood stabilizer should be avoided in pregnancy for bipolar I?

A

Valproic acid

42
Q

Non-pharm treatment of bipolar I

A
  • ECT
  • Psychotherapy
  • Good social support, economic stability
43
Q

Prognosis of bipolar I

A
  • Most will have 2nd episode 2-4 yrs after 1st event

- Maintenance/prevention is core treatment goal

44
Q

Clinical characteristics of bipolar II

A
  • MDD and at least 1 hypomanic episode
  • Less severe mania (hypomania)
  • Rapid cycling may be MC than in BP I
45
Q

Rapid cycling is MC in BPD I or II?

A

BPD II (but even more in cyclothymic disorder)

46
Q

Pharm treatment of bipolar II

A
  • Mood stabilizers (Lithium)
  • Atypical antipsychotics
  • Antidepressants
47
Q

Define cyclothymic disorder

A
  • At least 2 years of hypomania and depressive symptoms (that don’t meet criteria for a manic or major depressive episode)
  • Milder form of BPD II
48
Q

Onset of cyclothymic disorder?

A

Teens to early adulthood

49
Q

Define rapid cycling

A

More than 4 depression/hypomanic episodes a year

50
Q

Treatment of cyclothymic disorder

A

Lithium combined with one of:

  • Antidepressant
  • Psychotherapy

Clin Med III - Psych, Genetics (9 decks)

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