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Psychiatry First Aid > Mood Disorders > Flashcards

Mood Disorders Flashcards

1
Q

Define Mood Episode.

What are the 4 types?

A

Distinct period of time in which some abnormal mood is present:

  1. Major Depressive Episode
  2. Manic Episode
  3. Hypomanic Episode
  4. Mixed Episode
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2
Q

DSM 5 diagnostic criteria for Major depressive episode:

A

5+ of the following present for AT LEAST 2 weeks:

  • *At least #1 or #2 must be present (“SIGECAPS”)
    1. Depressed mood predominates
    2. Anhedonia
    3. Appetite/ weight changes
    4. Worthlessness/ Guilt
    5. Sleep disturbance (insomnia/ hypersomnia)
    6. Diminished concentration
    7. Psychomotor agitation/ retardation
    8. Fatigue/ Decreased energy
    9. SI
  • *Can’t be explained by meds/medical condition
  • *Significant distress social/ occupational impairment
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3
Q

DSM 5 diagnostic criteria for Manic Episode:

A

3+ of the following (4+ if mood is only irritable) for AT LEAST 1 WEEK:
DIGFAST

  1. Distractibility
  2. Inflated self esteem/ grandiosity
  3. ^ goal directed activity/ psychomotor agitation
  4. Decreased sleep
  5. Flight of ideas/ racing thoughts
  6. ^ Talkativeness/ pressured speech
  7. ^ indulging w/ consequences (shopping, sex, etc)
    * *Can’t be explained by meds/medical condition
    * *Significant distress social/ occupational impairment
    * *Up to 50% patients have comorbid psychosis
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4
Q

DIGFAST for mania:

A 
Distractibility 
Insomnia/ Impulsivity 
Grandiosity
Flight of ideas 
Activity/ Agitation 
Speech (pressured) 
Thoughtlessness
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5
Q

SIGECAPS for depression:

A 
Sleep disturbance 
Interest loss 
Guilt 
Energy decrease 
Concentration decrease 
Appetite changes 
Psychomotor retardation 
Suicidal ideation
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6
Q

DSM 5 Diagnostic criteria for Hypomanic Episode:

A

Same as manic episode, but only lasts AT LEAST 4 DAYS

  • *Does not cause marked functional impairment
  • *Does not require hospitalization
  • *Does not have psychotic features
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7
Q

DSM 5 Diagnostic criteria for Mixed Mood Episode:

What is the most predominant mood state in these patients?
How is the condition treated?

A
  1. Criteria met for manic or hypomanic episode
  2. 3+ sx of major depressive episode
  3. Duration of AT LEAST 1 WEEK
  • *Note that irritability is the most predominant mood state in these patients
  • *Can treat with AEDs like valproic acid
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8
Q

Patients with cerebrovascular disease/ stroke are at significant increase risk to develop which mood episode?

A

DEPRESSIVE

**Associated with poorer outcomes

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9
Q

4 Disease states that can cause manic mood episodes:

A
  • Metabolic disease (hyperthyroidism)
  • Neurological disease (MS, temporal lobe seizures)
  • Neoplasms
  • HIV infection
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10
Q

7 Disease states that can cause depressive mood episodes:

A
  • Cerebrovascular disease
  • Endocrinopathies (Cushings, DM, Ca, TH, etc)
  • Parkinson’s
  • Viral illness (mono)
  • Carcinoid syndrome
  • Cancer (pancreatic, lymphoma especially)
  • Collagen/ Vascular disease (SLE, etc)
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11
Q

Three substances/ meds you didn’t know could cause depression:

A
  • antihypertensives
  • diuretics
  • sulfonamides
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12
Q

Most common disorder leading to suicide?

A

MDD

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13
Q

DSM 5 criteria for Major Depressive Disorder:

A
  1. At lease 1 major depressive episode

2. NO Hx manic or hypomanic episodes

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14
Q

How does MDD commonly present?

  • Common sx
  • Common age of presentation
A
  • Vague somatic complaints like fatigue, HA, abdominal pain, muscle tension, etc.
  • Peak onset in 20’s; more common in women that men during reproductive age
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15
Q

Describe the sleep changes associated with MDD (4):

A
  • Multiple wakings
  • Initial and terminal insomnia (rarely hypersomnia)
  • REM shifted earlier in night (^^^ REM)
  • Decrease slow wave sleep
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16
Q

4 risk factors for MDD:

A
  • High cortisol (hypothalamic-pituitary-adrenal imbalance)
  • Abnormal TH axis
  • Adverse childhood experiences (especially death of parent before 11 yoa)
  • Genetics (first degree relatives 2-4x ^^^ likelihood)
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17
Q

Hamilton Depression Rating Scale:

What is it used for?

A

Measure depression severity and track effectiveness of therapies

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18
Q

PHQ-9 Depression Scale:

What is it used for?

A

Depression screening tool used in primary care setting

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19
Q 
Which antidepressant drug class is the most lethal in OD?
What are some ADRs associated with this drug class (5)
A

TCAs

  • Sedation
  • Weight gain
  • Orthostatic Hypotension
  • Anticholinergic effects
  • ^ QTc interval
20
Q

What are the most common ADRs associated with SSRIs?

3

A
  • GI
  • Sexual
  • Rebound anxiety
21
Q

When are MAOi’s indicated for use?
What are the 2 most important/ dangerous ADR?
What is the most COMMON ADR?

A
  • Refractory depression
    1. Hypertensive crisis with sympathomimetics or tyramine rich foods
    2. Serotonin syndrome when taken in combo with SSRI
  • # 1 ADR = orthostatic hypotension
22
Q

What are the clinical features of serotonin syndrome? (4)

A
  • ANS instability
  • Hyperthermia
  • Hyperreflexia
  • Seizures
23
Q

When are atypical antipsychotics used to treat depression? (2)

A
  • Adjunct to SSRI to treat MDD w psychotic features (1st line combo)
  • Resistant/ refractory MDD without psychotic features
24
Q

What are 3 possible adjunctive treatments used in tandem with antidepressants to treat refractory MDD?

A
  • Triiodothyronine (T3)
  • Levothyroxine (T4)
  • Lithium
25
Q

What are three indications for ETC?

A
  • Refractory MDD
  • Patients cant tolerate meds (preggos)
  • Rapid reduction in sx is necessary (immediate suicide risk)
26
Q

Describe the clinical presentation of a MDD with melancholic features (6)

A
  • Anhedonia
  • Early morning wakings
  • Depression WORSE IN MORNING
  • Psychomotor disturbance
  • Guilt
  • Anorexia

**Same for BP with melancholic features

27
Q

Describe MDD with Atypical Features (5):

A
  • Hypersomnia
  • Hyperphagia
  • Reactive mood
  • Leaden paralysis
  • Hypersensitivity to interpersonal rejection

**Same as BP with Atypical features

28
Q

Describe MDD with Mixed Features:

A
  • Manic/ hypomanic sx present during most days of MDE
    (^ mood, grandiosity, ^ E/ goal directed bx, etc…)

**Same as BP with mixed features

29
Q

Describe MDD with Catatonia:

**This type of MDD is especially responsive to what kind of therapy?

A
  • Cataplexy (immobility)
  • Purposeless mobility/ Bizarre posturing
  • Mutism or echolalia
  • *Great response to ECT
30
Q

Describe MDD with Psychotic Features:

A

Characterized by delusions or hallucinations
**Up to 24-53% of hospitalized geri’s with MDD have this

**Same as BP with psychotic features

31
Q

Describe MDD with Anxious Distress (5):

A
  • Keyed up/ Tense
  • Restless
  • Difficulty concentrating
  • Fear bad thing happening
  • Loss of control

**Same as BP with anxious/ distress features

32
Q

Peripartum onset MDD:

- When does it occur?

A

During pregnancy or within 4 weeks of delivery

**Same as peripartum BP

33
Q

Describe MDD with a Seasonal Pattern:

What is the specific term used to describe fall/ winter onset? To what type of therapy do these patients respond well?

A

Temporal relationship between MDD onset and time of year

SAD–Patients get this in fall/ winter and respond to light therapy
**Same as BP with seasonal pattern

34
Q

How long does normal bereavement last?

What should NOT be present in this normal, self limiting condition (3)?

A
  • May last months
  • NO psychosis
  • NO disorganization
  • NO SI
35
Q

DSM 5 Diagnostic criteria for Bipolar I Disorder:

  • What are two common features of this disease that are NOT required for dx?
  • Describe the genetic link?
A

Occurrence of ONE MANIC EPISODE:

  • May have euthimia, MDD, or hypomania between manic episodes, but this is NOT REQUIRED FOR Dx.
  • May possibly have psychotic features

**Has highest genetic link of all major psychiatric disorders

36
Q

Best treatment for a preggo having a manic episode?

A

ECT

37
Q

Which long term therapy for mania decreased Suicide risk?

A

Lithium

38
Q

What are the ADRs of lithium (10)?

A
  • **Low therapeutic index:
  • Weight gain
  • Tremor
  • GI upset
  • Fatigue
  • Cardiac arrhythmia
  • Seizures/ Coma
  • Hypothyroidism +/- goiter
  • Polyuria, Polydipsia –> Nephrogenic DI
  • Alopecia
  • Metallic Taste
39
Q

Define rapid cycling:

A

4+ mood episodes within one year (MDD, hypomania, or mania)

40
Q

What is the best treatment for Rapid cycling BP or BP with mixed features?

A

AEDs like valproic acid or carbamazapene act as mood stabilizers

41
Q

How are atypical antipsychotics used to treat BP disorder?

A

In tandem with mood stabilizer, they give greater and faster improvement

42
Q

DSM 5 criteria for Bipolar II Disorder (2):

**How do we treat the disease?

A
  1. 1+ Major depressive episode
  2. 1+ Hypomanic episode (note: hx of full manic episode will give you BP I)

**Tx is the same as BP I

43
Q

CHASES for Persistent Depressive Disorder:

A 
Concentration (poor) 
Hopelessness 
Appetite changes 
Sleep (insomnia/ hypersomnia)
Energy decrease/ fatigue 
Self-Esteem (poor)
44
Q

DSM 5 Criteria for Persistent Depressive Disorder (3):

Is the condition more common in men or women?

A
  1. Depressed mood most of the time for 2+ YEARS
    (ONLY 1 YEAR for KIDDOS or TEENS)
  2. 2+ of “CHASES”
  3. Patient is NEVER asx. for more than 2 mos at a time

**More common in women

45
Q

DSM 5 Criteria for Cyclothymic Disorder:

  • This condition commonly coexists with ____?
  • 1/3 patients with this condition develop___?
A
  1. Numerous periods with hypomanic sx over course of 2 years NEVER FULL BLOWN EPISODE
  2. Patient is NEVER asx. for more than 2 mos at a time
  3. No hx. MDE, hypomania, or manic episode
  • *Commonly coexists with borderline personality disorder
  • *1/3 patients develop BP I or BP II
46
Q

DSM 5 Criteria for Disruptive Mood Dysregulation Disorder (8):
**What is the age of dx?

A

Chronic, severe, persistent irritability during childhood/ adolescence:

  1. Recurrent outbursts disproportional to situation
  2. 3+ times per week; not congruent with dvlpmt.
  3. 1+ year duration; no longer than 3 mos w/o sx.
  4. Sx. in 2 settings (school, home)
  5. Sx started before 10 yoa
  6. Pt is bw 6-18 yoa
  7. No manic or hypomanic episode sx for longer than 1 day
  8. Not concurring w MDD or due to substance use

Psychiatry First Aid (3 decks)

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