mood disorders

Question 1

what are the mood disorders

Answer 1

major depressive disorder
dysthymic disorder
adjustment disorder

Question 2

criteria for Major Depressive Disorder (MDD)

Answer 2

depressed mood + anhedonia w 5 or more associated symptoms almost every day for most of the days for 2 weeks

fatigue
insomnia or hypersonmia
feelings of guilt or worthlessness
recurring thoughts of death or suicide 
psychomotor agitation
significant weight change > 5% 
decreased concentration/indecisiveness 

somatic sx: constipation, headach, skin changes, chest or abdominal pain, cough, dyspnea

*sx cause clinical distress or impairment in social, occupational or other important areas of functions, ABSENCE OF MANI OR HYPOMANIA. FAMILY HISTORY

Question 3

pathophys of MDD

Answer 3

1. alteration in neurotransmitters-serotonin, norepinephrine, epinephrine, dopamine, acetylcholine
2. neuroendocrine dysregulation: adrenal, thyroid or growth hormone disorders
3. genetic factors

Question 4

management of MDD

Answer 4

1. psychotherapy : 1st line in mild to moderate depression (to help deal with stressors more effectively).
   15% of pts commit suicide (esp in 25-30 y/o men and women 40-50)
2. medications: SSRI’s first line medical tx, SNRIs, TCS etc
3. CBT: exposure and response prevention, psychoeducation, support groups. Electroconvulsive therapy in pts who fail to respond to medical therapy, previous response to ECT, or for rapid response in pts with severe symptoms

Question 5

mild chronic for of major depression: chronically depressed mood >2y in adults (>1y in children)

SEVERITY OF MOOD DOESN’T MEET CRITERIA FOR MDD

Answer 5

dysthymic disorder

Question 6

what is persistent depressive disorder

Answer 6

includes chronic major depressive disorder and dysthymic disorder

Question 7

this is an emotional reaction to an identifiable sterssor (ex job loss, physical illness) or an event that causes a DISPROPROTIONATE RESPONSE THAN WOULD NORMALLY BE EXPECTED c/n 2 months of stressors

Answer 7

adjustment disorders

Question 8

how long does it take for remission of sx with adjustment disorders?

Answer 8

remission of sx usually within 6 months

Question 9

differences between bipolar type I and bipolar type II

Answer 9

Bipolar Disorder (type I): 1 or more MANIC episode & occasional MAJOR DEPRESSIVE episodes

Bipolar Disorder (type II): HYPOMANIA + major depressive episode

Question 10

epidemiology of Bipolar type 1

Answer 10

men= women, 1% of population. new onset rare past age 50 yo

***family history strongest risk

Question 11

what is mania?

Answer 11

abnormal & persistently elevated, expansive or irritable mood @ least 1 week (or less if hospitalization required)

**marked impairment of social/occupational function

3 or more:

• Mood: euphoria, irritable, labile, or dysphoric
• Thinking: racing, disorganized, expansive or grandiose thoughts
• behavior: physical hyperactivity, pressured speech, decreased need for sleep, increased impulsivity & risk taking, increased goal directed activity

Question 12

what is the management of Bipolar type 1?

Answer 12

1: mood stabilizers: 2nd or 1st gen antipsychotics. may add SSRI for depressive sx
2: good sleep hygiene
3: therapy: cognitive, behavioral and interpersonal

Question 13

what is hypomania?

Answer 13

period of elevated, expansive or irritably mood @ least 4 days tha tis clearly different from the usual nondepressed mood. DOESN’T CAUSE MARKED IMPAIRMENT (no psychotic features)

3 or more:
MOOD: euphoria
THINKING: racing, disorganized, expansive or grandiose thoughts
BEHAVIOR: physical hyperactivity, pressured speech, decreased need for sleep, excessive involvement in pleasurable activities

Question 14

what is the management of bipolar type 2?

Answer 14

mania: lithium, valproate, 2nd gen antipsychotics
depression: lithium, valproate, carbamazepine, 2nd gen antipsychotics
mixed: atypical antipsychotics, valproate

Question 15

can cyclothymia have hypomania sx?

Answer 15

yes but they do not meet full criteria for hypomania