Mood Disorders Flashcards
DSM-V Criteria for Major Depressive Disorder
A. 5 or more of the following symptoms occurring for at least 2 weeks and represent a change from previous functioning, with at least one symptoms has to be either depressed mood or anhedonia.
- Depressed mood (subjective or objective)
- Anhedonia (markedly diminished interest)
- Significant changes in weight and appetite
- Insomnia or Hypersomnia
- Psychomotor agitation or retardation
- Fatigue or loss of energy
- Feeling of worthlessness or excessive, inappropriate guilt (may be delusion)
- Diminished ability to think, concentrate, or indecisiveness
- Recurrent thoughts of death and/or suicidal ideation
B. Symptoms cause significant distress in social, occupational, and other important areas of functioning
C. Episode is not attributable to physiological effects of substance or other medical condition
D. Occurrence of MDE is not better explained by Schizoaffective disorder, Schizophrenia, Schizophreniform, Delusional Disorder, or other specified and non-specified Schizophrenia spectrum disorder
E. There has never been a manic or hypomanic episode
DSM-V Criteria for Manic Episode
A. Distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased goal-directed activity or energy, lasting at least 1 week and present most of the day, almost every day
B. During period of disturbance, at least 3 of the following have persisted (4 if the mood is only irritable) to a significant degree and represent a noticeable change from usual
- Grandiosity
- Sleep (decreased need)
- Talkative
- Pleasurable activities, painful consequences
- Activity (goal-directed)
- Ideas (flight of ideas)
- Distractibility
C. Mood disturbance is sufficiently severe to cause marked impairment in social or occupational functioning or to necessiate hospitalisation to prevent harm to self or others, or there are psychotic features
D. Episode not attributable to physiological effects of a substance or another medical condition
What is the definition of Bipolar I?
Bipolar disorder in which there is at least ONE MANIC episode (especially if it leads to hospitalisation or with psychotic symptoms)
Bipolar I Disorder is commonly associated with 1 MDE (but not required for diagnosis)
What is the definition of Bipolar II?
Bipolar disorder in which there is at least:
- 1 MDE
- 1 Hypomanic episode
- No manic episode
Bipolar II is NOT the less severe form of bipolar disorder (as compared to Bipolar I)
Bipolar II is a great masquerader and is often missed due to severity and chronicity of depressive episode, and low rates of recognition and reporting of hypomania
What is the mood disorder with the strongest genetic/familial relationship?
Bipolar disorder (60-65% of bipolar patients have family history of mood disorders, including and especially bipolar disorder)
Given history of UNIPOLAR MDE, what are the clinical features that can predict BIPOLAR diagnosis?
- Early age of onset <25 years old
- Increased number of MDE
- Anxiety disorders, especially panic
- Psychosis symptoms
- Post-partum onset
- Failure of antidepressants due to hypomanic symptoms
- Early impulsivity and aggression
- Substance abuse
- Cyclothymic temperament
DSM-V Criteria for Cyclothymia
A. Presence of numerous periods of hypomanic and depressive episodes for ≥2 months (but not meeting criteria for full hypomanic episode or MDE); and is never asymptomatic for at >2 years
B. Never have met criteria for MDE, mania, or hypomania
C. Symptoms are not due to direct physiological consequences of a substance or general medical condition
D. Symptoms cause significant distress and impairment in social, occupational, and other important areas of functioning
What are the treatment options for Bipolar disorder?
Non-pharmacological therapy:
- Psychoeducation
- Social support
- Ensure regular follow-ups
- Develop early warning system
- Develop emergency plan for mania
- Promote stable routine
- Supportive or psychodynamic PSYCHOTHERAPY, CBT, IPT/interpersonal social rhythm therapy, family therapy
Pharmacological therapy: multi-agent
- Treating mania: lithium, valproate, carbamazepine, SGA, ECT, benzodiazepine (for acute agitation)
- Preventing mania: lithium, valproate, carbamazepine, SGA, ECT
- Treating bipolar depression (4L): Lithium, Lamotrigine, Lurasidone, seroqueL (quetiapine is first line for bipolar II)
- Preventing depression: 4L, aripriprazole, valproate
- Mixed episode or rapid cycling: multi agent combinations of lithium/valproate + SGA (lurasidone, aripriprazole, olanzapine)
