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mood disorders Flashcards

1
Q

mood disorder overview

A 
Major Depressive Disorder
Persistent Depressive Disorder
Premenstrual Dysphoric Disorder
Bipolar I Disorder
Bipolar II Disorder
Cyclothymic Disorder
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2
Q

MDD prevalence

A

approximately 7%

  • 18- to 29-year-old individuals&raquo_space;> age 60 years or older
  • Females experience 1.5- to 3-fold higher rates than males
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3
Q

Causes of Depression

A
  • The biopsychosocial model
  • Monoamine Hypothesis: due to deficiency of monoamines: serotonin, dopamine, NE
  • Diathesis-Stress/Dual-Risk Model
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4
Q

MDD dx criteria:
5 (or more) symptoms have been present during the same 2-week period and represent a change from previous functioning;
at least one of the symptoms is either (1) depressed mood or (2) loss of interest or pleasure

A
  • Depressed mood
  • Anhedonia – loss of interest or pleasure in all, or almost all, activities
  • Significant weight change (loss when not dieting or weight gain)
  • Insomnia or hypersomnia
  • Psychomotor agitation or retardation
  • Fatigue or loss of energy nearly every day.
  • Feelings of worthlessness or excessive or inappropriate guilt
  • Diminished ability to think or concentrate, or indecisiveness
  • Recurrent suicidal thoughts
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5
Q

MDD criteria acronym

A

SIG E CAPS
Suicidal thoughts
Interests decreased
Guilt
Energy decreased
Concentration decreased
Appetite disturbance (increased or decreased)
Psychomotor changes (agitation or retardation)
Sleep disturbance (increased or decreased)

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6
Q

MDD subtypes

A
  • With mood-congruent psychotic features
  • With mood-incongruent psychotic features
  • With catatonia
  • With peripartum onset
  • With seasonal pattern
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7
Q

MDD With peripartum onset

A

if full criteria are not currently met for a major depressive episode, most recent episode of major depression if onset of mood symptoms occurs during pregnancy or in the 4 weeks following delivery

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8
Q

MDD With seasonal pattern

DSM – IV Seasonal Affective Disorder

A

onset and remission of major depressive episodes certain time of year
Most episodes begin in fall or water and remit in spring

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9
Q

MDD dx

A
  • Hamilton Rating Scale for Depression

- Beck Depression Inventory

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10
Q

Persistent Depressive Disorder Prevalence

A

2%

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11
Q

Persistent Depressive Disorder Criteria timeline

DSM-IV dysthymic disorder

A

Depressed mood for most of the day, for more days than not, as indicated by either subjective account or observation by others, for at least 2 years
Note: In children and adolescents >1 year.


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12
Q

Persistent Depressive Disorder Criteria
(DSM-IV dysthymic disorder)
2 (or more) of the following:

A
  • Poor appetite or overeating.
  • Insomnia or hypersomnia.
  • Low energy or fatigue
  • Low self-esteem
  • Poor concentration
  • Feelings of hopelessness.
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13
Q

more Persistent Depressive Disorder Diagnostic Criteria

A

During the 2-year period (1 year for children or adolescents) of the disturbance, the individual has never been without the symptoms in Criteria A and B for more than 2 months at a time.

  • Criteria for MDD may be continuously present for 2 years.
  • There has never been a manic episode or a hypomanic episode, and criteria have never been met for cyclothymic disorder
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14
Q

MDD/PDD tx: meds

A

Psychotropic medications:
SSRI – selective serotonin reuptake inhibitor – fluoxetine, sertraline
SNRI – serotonin norepinephrine reuptake inhibitor – venlafaxine, duloxetine
NDRI – norepinephrine and dopamine reuptake inhibitor – bupropion

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15
Q

MDD/PDD tx: therapy

A

CBT – Cognitive Behavioral Therapy
Psychodynamic Therapy
Interpersonal Therapy

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16
Q

Premenstrual Dysphoric Disorder Prevalence

most common symptom??

A

Twelve-month prevalence of premenstrual dysphoric disorder is between 1.8% and 5.8% of menstruating women
-irritability.

17
Q

PMDD dx criteria:
For most menstrual cycles during the past year, at least 5 of the following 11 symptoms (including at least 1 of the first 4 listed) were present:

A
  • Markedly depressed mood, feelings of hopelessness, or self-deprecating thoughts
  • Marked anxiety, tension, feelings of being “keyed up” or “on edge”
  • Marked affective lability (eg, feeling suddenly sad or tearful or experiencing increased sensitivity to rejection)
  • Persistent and marked anger or irritability or increased interpersonal conflicts
  • Decreased interest in usual activities
  • Subjective sense of difficulty in concentrating
18
Q

PMDD dx criteria symptoms part 2

A
  • Lethargy, easy fatigability, or marked lack of energy
  • Marked change in appetite, overeating, or specific food cravings
  • Hypersomnia or insomnia
  • A subjective sense of being overwhelmed or out of control
  • Other physical symptoms, such as breast tenderness or swelling, headaches, joint or muscle pain, a sensation of bloating, or weight gain
19
Q

PMDD symptoms must have been present ??

A

present for most of the time during the last week of the luteal phase, must have begun to remit within a few days of the onset of menstrual flow, and must be absent in the week after menses.

20
Q

PMDD tx

A

Hormone therapy: OCTs, Estrogen, GnRH agonists

-Anti-depressant – can be just for the course of the symptoms

21
Q

Bipolar disorder causes

A

Genetics

  • Structural MRI: Increase in volume of the lateral ventricles, globus pallidus
  • Functional MRI: abnormal modulation between ventral prefrontal and limbic regions – amygdala
  • Kindling Hypothesis
  • Early life stress and dysfunction of HPA axis, leads to overactivation
22
Q

Bipolar I disorder dx criteria

A
  • it is necessary to meet the following criteria for a manic episode.
  • The manic episode may have been preceded by and may be followed by hypomanic or major depressive episodes.
23
Q

Manic Episode

A

persistently elevated, expansive, or irritable mood and abnormally and persistently increased goal-directed activity or energy, lasting at least 1 week

24
Q

Manic episode criteria
3 (or more) of the following symptoms (four if the mood is only irritable) are present:
(drawn out DIGFAST)

A
  • Inflated self-esteem/ grandiosity.
  • Decreased need for sleep
  • More talkative than usual
  • Flight of ideas
  • Distractibility
  • Increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation (i.e., purposeless non-goal-directed activity).
  • Excessive involvement in activities that have a high potential for painful consequences
25
Q

Bipolar I prevalence

A

The 12-month prevalence estimate in the continental United States was 0.6% for bipolar I disorder
-The lifetime male-to-female prevalence ratio is approximately 1.1 : 1

26
Q

Bipolar II Disorder

A

Necessary to meet the following criteria for a current or past hypomanic episode and the following criteria for a current or past major depressive episode

27
Q

Hypomanic Episode

A

A distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased activity or energy, lasting at least 4 consecutive days and present most of the day, nearly every day

28
Q

Hypomanic episode:
3 (or more) of the following symptoms have persisted (four if the mood is only irritable): (same as manic episode criteria, except only have for 4 days instead of 1 week)

A
  • grandiosity
  • insomnia
  • more talkative than usual
  • Flight of ideas
  • Distractibility
  • Increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation
  • Excessive involvement in activities that have a high potential for painful consequences
29
Q

Bipolar II prevalence

A

In the United States, 12-month prevalence is 0.8%

Bipolar I, bipolar II, and bipolar disorder not otherwise specified yield a combined prevalence rate of 1.8% in U.S.

30
Q

Mania mnemonic

A 
DIG FAST 
Distractibility 
Indiscretion 
Grandiosity 
Flight of ideas 
Activity increase 
Sleep deficit 
Talkativeness
31
Q

Cyclothymic disorder

A

For at least 2 YEARS (at least 1 YEAR in children and adolescents) there have been numerous periods with hypomanic symptoms that do not meet criteria for a hypomanic episode and numerous periods with depressive symptoms that do not meet criteria for a major depressive episode.

32
Q

Cyclothymic disorder: During the above 2-year period (1 year in children and adolescents), the hypomanic and depressive periods have been present for at least ??

A

half the time and the individual has not been without the symptoms for more than 2 months at a time.

  • Criteria for a major depressive, manic, or hypomanic episode have never been met*
  • The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
33
Q

Bipolar tx:

A

mood stabilizers
atypical antypsychotics
antidepressants

34
Q

Bipolar tx: mood stabilizers

A

lithium (Lithobid), valproic acid (Depakene), divalproex sodium (Depakote), carbamazepine (Tegretol) and lamotrigine (Lamictal).

35
Q

Bipolar tx: atypical antypsychotics

A

olanzapine (Zyprexa), risperidone (Risperdal),

quetiapine (Seroquel), aripiprazole (Abilify), ziprasidone (Geodon), lurasidone (Latuda) or asenapine (Saphris)

36
Q

Bipolar tx: antidepressants

A

help manage depression. Usually along with a mood stabilizer or antipsychotic.
-can sometimes trigger a manic episode!

CSI (75 decks)

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