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Psychiatry - First Aid > Mood Disorders > Flashcards

Mood Disorders Flashcards

1
Q

What is a mood disorder vs mood episode?

A

a mood episode is a distinct period of time in which some abnormal mood is present (depression, mania, mixed-state, hypomania)

a mood disorder is defined by the pattern of mood episodes

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2
Q

To receive a diagnosis of major depressive episode, you have to have at least 5 of what symptoms?

A 
depressed mood
anhedonia (loss of interest) 
change in appetite or body weight
feelings of worthlessness or guilt
insomnia or hypersomnia
diminished concentration
psychomotor agitation or retardation
fatigue or loss of energy
recurrent thoughts of death or suicide
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3
Q

How long do these symptoms need to be present to be called a major depressive episode?

A

2 weeks

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4
Q

A manic episode needs at least three of what symptoms?

A

distractibility
inflated self-esteem or grandiosity
increase in goal-directed activity (socially, work, sexually)
decreased need for sleep
flight of ideas or racing thoughts
pressured speech
excessive involvement in pleasurable activities that have a high risk of negative consequences

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5
Q

How long must these symptoms be present to call it a manic episode?

A

only 1 week

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6
Q

What percentage of manic patient swill have psychotic symptoms?

A

75%

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7
Q

If they meet both criteria for major depressive episode and manic episode for 1 week, what’s the diagnosis? What is the most predominant mood state here?

A

a mixed episode

irritability is the most common

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8
Q

What are the criteria for a hypomanic episode?

A

a distinct period of elevated, expansive or irritable mood that includes at least three of the manic episode criteria (4 if the mood is irritable)

lasting at least 4 days

no marked impairment of social or occupational functioning

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9
Q

What are some potential MEDICAL causes of a depressive episode?

A

CVA or MI
Endocrinopathies like DM, Cushings, Addisons, hypoglycemia, hyper/hypothyroid,
Parkinsons
Viral illnesses like mono
carcinoid syndrome
cancer (esp lymphoma and pancreatic carcinoma),
SLE

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10
Q

What are some medical causes of a manic episode?

A 
Hyperthyroidism
Temporal lobe epilepsy
MS
Neoplasms
HIV infection
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11
Q

What are some medication/substances that can induce a depressive episode?

A 
Alcohol
Antihypertensives
Barbiturates
Corticosteroids
Levodopa
Sedative-hypnotics
Anticonvulsants
Antipsychotics
Diuretics
Sulfonamides
Withdrawal from psychostimulants
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12
Q

What are some medications/substances that can induce a manic episode?

A 
antidepressants
sympathomimetics
dopamine
corticosteroids
levodopa
bronchodilators
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13
Q

What does one need to rule out in order to make the diagnosis of major depressive disorder?

A

have to rule out any history of manic or hypomanic episodes

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14
Q

What is the lifetime prevalence of MDD in the US?

A

16%

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15
Q

What is the average age of onset for MDD?

A

40

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16
Q

What are the typical sleep problems that occur in MDD?

A

multiple awakenings
initial and terminal insomnia (hard to fall asleep and early morning awakenings)
Hypersomnia (excessive sleepiness)
REM sleep shifted to earlier in the night and stages 3 and 4 decrease

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17
Q

What neurotransmitter is thought to be most likely related to depression?

A

decreased serotonin

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18
Q

If left untreated, what is the usual progression of a depressive episode?

A

will be typically self-limiting, but usually lasts from 6-13 months

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19
Q

As major depression progresses, do episodes occur more or less frequently?

A

more frequently

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20
Q

The risk of a subsequent major depressive episode is ___% in the first 2 years after the first episode.

A

50%

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21
Q

50-60% of patients will show a response to antidepressants. How long do they typically take to work?

A

4-8 weeks

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22
Q

What are the typical side effects of the SSRIs?

A

headache
GI disturbance
sexual dysfunction
rebound anxiety

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23
Q

What are the typical side effects of the TCAs?

A 
sedation
weight gain
orthostatic hypotension
anticholinergic effects
can aggravate prolonged QTC syncrome
24
Q

What are the main side effects of the MAOIs?

A

hypertensive crisis with sympathomimetics of tyramine-rich foods
serotonin syndrome with other meds
orthostatic hypotension

25
Q

What are some examples of adjunct medications that can be added to antidepressants to increase effect?

A

stimulants like methylphenidate
antipsychotis like abilify
Lithium
liothyronine or levothyroxine

26
Q

What are the typical features of melancholic depression?

A

anhedonia, early morning awakenins, psychomotor disturbance, excessive guilt, anorexia

this is in 40-60% of hospitalized patients with MDD

27
Q

Describe the features of atypical depression?

A 
hypersomnia
hyperphagia
reactive mood
leaden paralysis
hypersensitivity to interpersonal rejection
28
Q

What’s first line med therapy for atypical depression?

A

MAOIs actually

29
Q

What are the features of catatonic depression?

A 
catalepsy (immobility)
purposeless motor activity
extreme negativism
mutism
bizarre postures
echolalia

(note, these can also be applied to bipolar)

30
Q

What type of treatment does catatonic depression respond particularly well to?

A

ECT

and usually treated with antidepressants and antipsychotics concurrently

31
Q

What are 5 stages of grief in the Kubler-Ross model?

A 
denial
anger
bargaining
depression
acceptance
32
Q

How long do bereavement symptoms typically last?

A

2 months

33
Q

True or false: bereavement can involve suicidality and still be considered normal grief.

A

false

34
Q

True or false: illusions and hallucinations are common in normal bereavement.

A

false - illusions are common in grief, but hallucinations are more associated with major depression

35
Q

What is the only criteria for bipolar 1 disorder?

A

the occurrence of one manic or mixed episode

there may be euthymic, depressive, dysthymic, or hypomanic episodes interspersed between manic episodes, but these are not required for the diagnosis

36
Q

Bipolar 1 wins the prize for what among all the major psychiatric disorders?

A

has the highest genetic link of all the psychiatric disorders - there is a 40-70% monozygotic twin concordance rate

37
Q

Untreated manic episodes will typically last how long?

A

3 months

38
Q

As bipolar 1 disorder progresses, episodes typically occur more or less frequently?

A

more frequently

39
Q

What percentage of individuals will have a repeat manic episode within 5 years?

A

90%

40
Q

What percentage of bipolar patients will attempt suicide and what percentage will succeed?

A

25-50% will attempt suicide at some point in their lives

15% will die by suicide

41
Q

What medications can be used as mood stabilizers in bipolar disorder 1?

A

lithium

anticonvulsants (cabamazepine [particularly for rapid cyclers] or valproid acid)

42
Q

What adjunct medications can be used on top of the mood stabilizers?

A

atypical antipsychotics like olanzapine, quetiapine, ziprasidone)

43
Q

Why can’t you use antidepressants as monotherapy in bipolar 1?

A

can induce mania

44
Q

What are some of the side effects of lithium?

A

weight gain, tremor, GI disturbances, fatigue, cardiac arrhythmias, seizures, hypothyroid, leukocytosis, coma, nephrogenic diabetes insipidus, polydipsia, alopecia, metallic taste

45
Q

What is the best treatment for a manic woman in pregnancy?

A

ECT

46
Q

What’s the definition of rapid cycling in bipolar 1?

A

the occurrence of four or more mood episodes in 1 year

47
Q

What are the criteria for bipolar II?

A

history of one or more major depressive episodes and at least one hypomanic episode

(but if there is a history of a full manic episode, this has to be bipolar I)

48
Q

Which is more prevalent - bipolar I or II?

A

bipolar II

49
Q

Does treatment differ between bipolar I and II?

A

Not yet, but there hasn’t been much research on bipolar II

50
Q

What are the criteria for dysthymic disorder?

A

chronically depressed mood for the majority of time most days for at least 2 years (in adults, only 1 yr in adolescents)

plus at least two of the following:
poor concentration or difficulty making decisions
feelings of hopelessness
poor appetite or overeating
insomnia or hypersomnia
low energy or fatigue
low self esteem

can’t be without these symptoms for more than 2 months at a time

no major depressive episodes and no manic or hypomanic episodes

(so 2 years of depression with 2 listed criteria, never asymptomatic for more than 2 months)

51
Q

What is double depression?

A

Patients with major depressive disorder with dysthymic disorder during residual periods.

52
Q

What is the prognosis for dysthymic disorder?

A

20% will progress to MDD
20% will develop bipolar disorder
over 25% will have lifelong symptoms

53
Q

What’s cyclothymic disorder?

A

alternating periods of hypomania and periods with mild to moderate depressive symptoms for at least 2 years, never symptoms free for over 2 months

can’t have a history of major depressive or manic episodes

54
Q

Describe the timing for an adjustment disorder.

A

emotional or behavioral symptoms begin within 3 months after the event and end within 6 months after the stressor is terminated

55
Q

What is the most effective treatment for an adjustment disorder?

A

supportive psychotherapy with pharmacotherapy for associated symptoms

Psychiatry - First Aid (18 decks)

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