Mood Disorders Flashcards
What’s the lifetime risk of depression? Which populations are most at risk?
- 15-20% lifetime risk, 4% in the last month, 50% recurrent
- More common in women, men suicide more.
- More severe depression is more heritable
What are the DSM criteria for diagnosis of major depressive disorder?
- 5+ of the following have been present during the same two week period and represent a change from previous function. Must include one of bold symptoms
- Depressed mood most of the day, nearly every day
- Markedly diminished interest or pleasure in almost all activities almost all of the time (anhedonia)
- Significant unintentional weight loss (change by 5% in a month) or change in appetite
- Insomnia or hypersomnia nearly every day
- Psychomotor agitation or retardation nearly every day. Observed by others
- Fatigue or loss of energy nearly every day
- Feelings of worthlessness or excessive/inappropriate guilt nearly every day
- Diminished ability to think or concentrate/indecisiveness nearly every day
- Recurrent thoughts of death of suicidal ideation/attempt +/- plan
- Clinically significant distress or impairment in socio/occupational functioning
- Not due to GMC or better explained by other MH condition
- Never been manic or hypomanic
What are some of the neurobiological symptoms patients with major depressive disorder might experience?
- Insomnia and early morning awakening
- Anorexia and weight loss
- Psychomotor retardation
- Impaired concentration
- Working memory deficits
- Decreased libido
What are some of the cognitive symptoms a patient with major depressive disorder might experience?
- Anxiety, helplessness, worthlessness (dangerous symptom), social withdrawal, depersonalisation, guilt (cultural dimension to this), shame, rage, nihilism, hopelessness
- Suicidal ideation
- Linked factors: severity, insomnia, weight/appetite loss, worthlessness, hopelessness, guilt, thoughts of death, impulsion, aggression
In patients with major depressive disorder beginning treatment, which symptoms tend to resolve earliest? Why does this matter?
- On treatment, biological symptoms improve faster than cognitive symptoms. As amotivation passes, suicidal ideation may remain, and at this stage patients can be very dangerous to themselves
What proportion of mothers develop post-partum depression?
- 10% of mothers, 1/2 severe
Which medical conditions are most commonly associated with major depressive disorder? What drugs are associated with it?
- Hypothyroidism, MS, Cushing’s, HIV, paraneoplastic syndrome, stroke, basal ganglia diseases
- Propranolol, corticosteroids, GABAergics, chemotherapy, interferons
What are the key features distinguishing grief from depression?
- Less early morning awakening, diurnal variation, psychomotor retardation. Grief normally resolves in less than 3 months
What are some of the aspects you might consider with a patient to manage their depression?
- Education about illness and course, prognosis, treatment
- Lifestyle: exercise (sleep, diet, alcohol reduction)
- Psychotherapy
- Problem solving therapy
- CBT
- Interpersonal therapy
- Medication
- SSRI/SNRI/mirtazepine
- Agomelatine/moclobemide/reboxetine
- TCAs/mianserin/MAOIs
What are some risk factors for the development of bipolar disorder?
- Genetics, head injury, organic injury (older), AIDS, childbirth
What are the DSM criteria for a manic episode?
- 1+week of abnormally elevated/expansive/irritable mood and persistently increased goal-directed activity or energy
- 3+ of the following symptoms (4+ if mood is only irritable)
- Inflated self-esteem or grandiosity
- Decreased need for sleep
- More talkative than usual
- Flights of ideas or subjective experience that thoughts are racing
- Distractibility
- Increase in goal-directed activity or psychomotor agitation
- Excessive involvement in activities that have a high potential for painful consequences
- Mood disturbance is sufficiently severe to interfere with normal function, necessitate hospitalisation, or there are psychotic features
- Not due to a GMC or substance
What is the difference between a manic episode and a hypomanic episode?
- The disturbance in mood and function is observable by others BUT
- The episode is not severe enough to cause marked impairment in function or to require hospitalisation. No psychotic features
What is the difference between bipolar disorder 1 and 2?
- Bipolar I
- Criteria have been met for at least one manic episode
- Not better explained by another mental illness
- Bipolar II
- Criteria have been met for at least one hypomanic episode and at least one major depressive episode
- There has never been a manic episode
- Not better explained by another mental illness
- Depressive episode or the unpredictability caused by cycling causes impairment in function
What is cyclothymic disorder?
- 2 years with periods close to but not meeting MD and hypomanic criteria
- These symptoms have never been absent for > 2 months
- Criteria for MDE, hypomanic or manic episode never met
- Not better explained by another mental illness, GMC, and function is impaired
What proportion of patients with cancer may become depressed?
33%
