Mood Disorders Flashcards
Feelings?
Compelling
‘Source of truth’
binding
Mood vs. affect
Mood: subjective (larger order experience -climate)
Affect: objective (moment by moment feelings - weather)
Depression Dx?
2+ weeks of: at least one of:
- Depressed mood
- Anhedonia (signature symptom
Depressed mood 3 description:
Quality
Reactivity
Diurnal pattern
2 types of depression:
- Neuro-vegetative (biological)
- psychomotor retardation - Cognitive affective symptoms
- guilt
- loss of self esteem and worthlessness
What more likely to have suicidal ideation?
- Severe depression
- Insomnia
- Worthlessness
- Guilt
- Phase of recovery - so apathetic when depressed, but when treating can increase motivation to complete suicide
What is a criteria of severe depression?
Psychotic symptoms
Psychotic symptoms in severe depression: 6 kinds of delusions:
Delusions: guilt, persecution, poverty, hyper contrasts, catastrophe, nihilism
Why psychotic depression important to Dx or know?
Treatment is different:
Antipsychotic
Antidepressants
ECT
How long will you be depressed with moderate depression if untreated?
9 months
Postpartum depression, how many and when?
10% women during
4-12 weeks
50% recurrence
Depression in older adults factors?
Loss
Organic
Somatic complains
Irritable more than sad
What neurological conditions associated with depression?
Parkinson’s
Stroke: frontal lobe
Orbits-frontal dementia
What meds can trigger depression?
Corticosteroids Mono amine depletion GABA-Ergic drugs: benzos, alcohol Chemo OC (rare) Interferon
Psychiatric co-morbidities include these 3 and need parallel treatment
Alcohol/drug abuse
Anxiety
Personality
What isn’t depression:
- Grief
- anxiety
- demoralization (loss of competence but still has hedonics)
- adjustment disorder
- delirium (hypo active)
- normal sadness
Genes and depression heritability?
40-70%
Depression only emotion?
- Brain structure changes
- Functional neurotransmitter changes
Interpersonal factors in childhood depression
- Parental loss + poor parenting
- chronic depressed mother
- Cumulative disadvantages
- Childhood sexual abuse
what is Protective for depression in childhood?
Good relationship
Higher IQ
Interpersonal factors in adult that is protective?
Married
Confiding in others
Environmental factors for depression?
Precipitating Loss Humiliation Entrapment Danger
What environmental factors protective for depression?
Employment/Financial, status
Fresh starts
social capital
How to treat mild/mod depression?
Psycho-social
- problem solving
- CBT (introduce alterity)
- exercise
- confiding other
- couple therapy
- lifestyle: sleep, diet, less alcohol)
What kinds of pharmacological treatments for depression?
SSRIs SNRIs Mirtazipine TCAs Lithium T3 SGAs
**How long to treat pharma for depression for?
6-12 weeks full dose
Maintain for 6-12 months post recovery in 1st episode.
If someone is better from 1st episode depression with pharma, how to do treat?
Treat for 6-12 months after at treatment dose.
ECT useful for?
Melancholic Psychotic Puerperal Bipolar or mania Prominent suicidality Poor oral intake
Risk factors for bipolar:
Genetic Head injury Organic CNS disease AIDS Season (spring/summer: mania) Circadian rhythm disruption Life events
Symptoms of mania? 1a and 1b?
1a: elevated mood
1b: irritable mood
Subjective less need for sleep Flight of ideas: thoughts moving too fast but still associated connections Talkativeness Distractibility Risky behavioural Increased sexual activity
What is bipolar I in spectrum disorder?
At least 1 episode of mania. +/- depressive
What is bipolar II in spectrum disorder?
Depressive episode + hypo-manic episode
What is cyclothymia?
Dysphoric + hypo mania
Ppl who are not psychotic when manic are what when depressed
Not psychotic
Mania Dx conventions?
Mania: >1week
Hypo mania: >2-4 days
Rapid cycling: >4episodes per year
Mixed state 1-2 weeks
Clinical pattern of bipolar:
Starts in Adolescence: brief, mild
- median duration 4.5-7 months
- kindling
- 2x depressive episodes of unipolar pts
Mania or depression
3x longer in depression than manic
Bipolar vs. depression, who gets more episodes of depression
Bipolar: 2x more likely to get depressive episode.
DDx for bipolar?
- Schizophrenia
- ORganic: orbito-frontal
- Drug induced psychosis: cocaine, cannabis etc.
How to treat bipolar?
- Mood stabilizers
- lithium
- SGAs-second Gen, anti
- antidepressants
- ECT
If suicidal bipolar, how to treat?
Clozapine and
Lithium
Primary indication for clozapine?
Treatment resistant schizophrenia
Dysthymia is?
Chronic low mood
Cyclothymia?
Mild mania
Mild depression
Hyperthymia?
Slightly happier than normal all the time.
What is an emotion
a Complex action: facial expression Postural Visceral Thoughts
