Mood Disorders Flashcards
Define adjustment disorder
Out of proportion mood or behavioral change in response to an IDENTIFIABLE stressor
Types of stressors in adjustment disorder?
- Lingering
- Unexpectant (more provocative)
Diagnosis of adjustment disorder
Diagnosis of exclusion
- History of stressor
- Degree of emotional reaction is disproportionate to stressor
- Marked impairment of function
Who is MC affected by adjustment disorder?
Adolescents (more frequent change in their lives and still learning who they are)
When does adjustment disorder present? How long does it last?
- Onset w/in 3 mos of stressor
- Lasts approx 6 mos after end of stressor
What are adaptive factors that alleviate stress?
- Situational (financial security, emotional resources, agreeable weather)
- Interpersonal (resiliency, coping, intelligence)
What are provoking factors that trigger stress?
- Chronic mental disorder
- Past emotional trauma/unresolved conflicts
What is 1st line treatment of adjustment disorders?
Psychotherapy (individual, family, behavioral)
Pharm treatment of adjustment disorder
- SSRIs
- BZDs
What is the most powerful stressor?
Loss of a loved one (loss of a child even worse)
Symptoms and duration of normal grief
- Searching behaviors, shock/numbness, crying spells
- Lasts about 6-12 months (sometimes longer)
Define persistent complex bereavement disorder
Out of proportion bereavement from expected norms
What type of grief has a high risk for developing major depressive disorder?
Complex grief
What is the best way to prevent major depressive disorder from developing with complex grief?
Begin antidepressant as soon as symptoms are recognized
Define major depressive disorder
Persistent low mood, tearfulness, apathy that affects interpersonal, occupational, academic function
Onset of major depressive disorder?
- Any age
- Younger predicts recurrent episodes
Pathophys of major depressive disorder
- Biochemical: NE/serotonin/DA disturbance, excess cortisol
- Psychosocial: nature vs. nurture, past traumatic episodes, lack of social support
Screening tools for major depressive disorder
- 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)
Principles in history taking for major depressive disorder
- 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
Classification of major depressive disorder symptoms
- Neurovegetative/somatic (wt loss/gain, low energy)
- Emotional (apathy, anhedonia)
- Ideation (worthlessness, guilt, suicidality)
Pharm treatment of major depressive disorders
- SSRIs
- SNRIs
- TCAs (more SEs)
- Antipsychotics
- MAOis (for severe anxiety, fatigue, hypersomnolence, wt gain)
Non-pharm treatment of major depressive disorder
- ECT for severe depression
- Transcranial magnetic, vagal nerve, deep brain stimulation
- Psychotherapy
What meds best treat irritable depression?
SSRIs
What meds best treat melancholic depression?
DA/NE reuptake inhibitors
What shortens the intervals between depressive episodes?
Older age
What is the terminal stage of depression?
Suicide
Clinical clues of suicidal ideation
- Verbal
- Behavioral (distribution of prized possessions, putting personal affairs into order)
What psych condition has the highest suicide rate?
Bipolar depression in men
Treatment plan for suicidal patient?
ESCORT pt to ER, make sure they get there and call ahead to ER to let them know
Treatment plan if pt is agitated and a present danger to self or others?
Conditional involuntary psych admission (“section 12”)
Define dysthymic disorder
At least 2 years of depressed mood for more days than not (slightly less severe version of MDD but more chronic)
What is MC - MDD or dysthymic disorder?
MDD
How does dysthymic disorder relate to MDD?
- Less severe but more chronic
- 20% of pts will develop MDD
Treatment of dysthymic disorder
- Psychotherapy
- SSRIs, SNRIs (controversial efficacy)
What is bipolar disorder characterized by?
1 or more manic/mixed episodes usually accompanied by major depressive episodes
Types of bipolar disorder
- 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
Define mixed state
Concurrent mania and depression equally
Clinical presentation of manic episodes
- Abrupt with rapid behavior escalation
- Onset of 1st episode early 20s
- Self limiting days to months
Pharm treatment of bipolar I
- Mood stabilizers: Lithium (gold standard), valproic acid, lamotrigine
- Antipsychotics especially mania with psychosis (faster acting than mood stabilizers)
- Antidepressants (avoid monotherapy)
Which mood stabilizer is safe in pregnancy for bipolar I?
Lithium
Which mood stabilizer should be avoided in pregnancy for bipolar I?
Valproic acid
Non-pharm treatment of bipolar I
- ECT
- Psychotherapy
- Good social support, economic stability
Prognosis of bipolar I
- Most will have 2nd episode 2-4 yrs after 1st event
- Maintenance/prevention is core treatment goal
Clinical characteristics of bipolar II
- MDD and at least 1 hypomanic episode
- Less severe mania (hypomania)
- Rapid cycling may be MC than in BP I
Rapid cycling is MC in BPD I or II?
BPD II (but even more in cyclothymic disorder)
Pharm treatment of bipolar II
- Mood stabilizers (Lithium)
- Atypical antipsychotics
- Antidepressants
Define cyclothymic disorder
- 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
Onset of cyclothymic disorder?
Teens to early adulthood
Define rapid cycling
More than 4 depression/hypomanic episodes a year
Treatment of cyclothymic disorder
Lithium combined with one of:
- Antidepressant
- Psychotherapy
