Mood Disorders Flashcards
What is a mood disorder vs mood episode?
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
To receive a diagnosis of major depressive episode, you have to have at least 5 of what symptoms?
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
How long do these symptoms need to be present to be called a major depressive episode?
2 weeks
A manic episode needs at least three of what symptoms?
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
How long must these symptoms be present to call it a manic episode?
only 1 week
What percentage of manic patient swill have psychotic symptoms?
75%
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 mixed episode
irritability is the most common
What are the criteria for a hypomanic episode?
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
What are some potential MEDICAL causes of a depressive episode?
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
What are some medical causes of a manic episode?
Hyperthyroidism Temporal lobe epilepsy MS Neoplasms HIV infection
What are some medication/substances that can induce a depressive episode?
Alcohol Antihypertensives Barbiturates Corticosteroids Levodopa Sedative-hypnotics Anticonvulsants Antipsychotics Diuretics Sulfonamides Withdrawal from psychostimulants
What are some medications/substances that can induce a manic episode?
antidepressants sympathomimetics dopamine corticosteroids levodopa bronchodilators
What does one need to rule out in order to make the diagnosis of major depressive disorder?
have to rule out any history of manic or hypomanic episodes
What is the lifetime prevalence of MDD in the US?
16%
What is the average age of onset for MDD?
40
What are the typical sleep problems that occur in MDD?
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
What neurotransmitter is thought to be most likely related to depression?
decreased serotonin
If left untreated, what is the usual progression of a depressive episode?
will be typically self-limiting, but usually lasts from 6-13 months
As major depression progresses, do episodes occur more or less frequently?
more frequently
The risk of a subsequent major depressive episode is ___% in the first 2 years after the first episode.
50%
50-60% of patients will show a response to antidepressants. How long do they typically take to work?
4-8 weeks
What are the typical side effects of the SSRIs?
headache
GI disturbance
sexual dysfunction
rebound anxiety
What are the typical side effects of the TCAs?
sedation weight gain orthostatic hypotension anticholinergic effects can aggravate prolonged QTC syncrome
What are the main side effects of the MAOIs?
hypertensive crisis with sympathomimetics of tyramine-rich foods
serotonin syndrome with other meds
orthostatic hypotension
What are some examples of adjunct medications that can be added to antidepressants to increase effect?
stimulants like methylphenidate
antipsychotis like abilify
Lithium
liothyronine or levothyroxine
What are the typical features of melancholic depression?
anhedonia, early morning awakenins, psychomotor disturbance, excessive guilt, anorexia
this is in 40-60% of hospitalized patients with MDD
Describe the features of atypical depression?
hypersomnia hyperphagia reactive mood leaden paralysis hypersensitivity to interpersonal rejection
What’s first line med therapy for atypical depression?
MAOIs actually
What are the features of catatonic depression?
catalepsy (immobility) purposeless motor activity extreme negativism mutism bizarre postures echolalia
(note, these can also be applied to bipolar)
What type of treatment does catatonic depression respond particularly well to?
ECT
and usually treated with antidepressants and antipsychotics concurrently
What are 5 stages of grief in the Kubler-Ross model?
denial anger bargaining depression acceptance
How long do bereavement symptoms typically last?
2 months
True or false: bereavement can involve suicidality and still be considered normal grief.
false
True or false: illusions and hallucinations are common in normal bereavement.
false - illusions are common in grief, but hallucinations are more associated with major depression
What is the only criteria for bipolar 1 disorder?
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
Bipolar 1 wins the prize for what among all the major psychiatric disorders?
has the highest genetic link of all the psychiatric disorders - there is a 40-70% monozygotic twin concordance rate
Untreated manic episodes will typically last how long?
3 months
As bipolar 1 disorder progresses, episodes typically occur more or less frequently?
more frequently
What percentage of individuals will have a repeat manic episode within 5 years?
90%
What percentage of bipolar patients will attempt suicide and what percentage will succeed?
25-50% will attempt suicide at some point in their lives
15% will die by suicide
What medications can be used as mood stabilizers in bipolar disorder 1?
lithium
anticonvulsants (cabamazepine [particularly for rapid cyclers] or valproid acid)
What adjunct medications can be used on top of the mood stabilizers?
atypical antipsychotics like olanzapine, quetiapine, ziprasidone)
Why can’t you use antidepressants as monotherapy in bipolar 1?
can induce mania
What are some of the side effects of lithium?
weight gain, tremor, GI disturbances, fatigue, cardiac arrhythmias, seizures, hypothyroid, leukocytosis, coma, nephrogenic diabetes insipidus, polydipsia, alopecia, metallic taste
What is the best treatment for a manic woman in pregnancy?
ECT
What’s the definition of rapid cycling in bipolar 1?
the occurrence of four or more mood episodes in 1 year
What are the criteria for bipolar II?
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)
Which is more prevalent - bipolar I or II?
bipolar II
Does treatment differ between bipolar I and II?
Not yet, but there hasn’t been much research on bipolar II
What are the criteria for dysthymic disorder?
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)
What is double depression?
Patients with major depressive disorder with dysthymic disorder during residual periods.
What is the prognosis for dysthymic disorder?
20% will progress to MDD
20% will develop bipolar disorder
over 25% will have lifelong symptoms
What’s cyclothymic disorder?
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
Describe the timing for an adjustment disorder.
emotional or behavioral symptoms begin within 3 months after the event and end within 6 months after the stressor is terminated
What is the most effective treatment for an adjustment disorder?
supportive psychotherapy with pharmacotherapy for associated symptoms
