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Psychopathology > Mood Disorders > Flashcards

Mood Disorders Flashcards

1
Q

criteria for major depressive disorder (general)

A

only major depressive episodes

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2
Q

bipolar disorder type 1 criteria

A

one or more manic episodes

-90% also have had mdd but not a requirement

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3
Q

bipolar type II criteria

A

major depressive episode + hypomanic episodes. NO manic.

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4
Q

requirement for Major depressive disorder? (time and symptoms) (SIC PAGES)

A 
symptoms every day for at least 2 weeks
.
depressive mood or anhedonia and 4/9 of the following: (SIC PAGES)
Sleep
Interest (anhedonia)
Concentration
Psychomotor agitation/retardation
Appetite
Guilt
Energy
Suicide
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5
Q

2 most important factors for differentiating between disorders?

A

time course and severity

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6
Q

anatomical location associated w/ depression (in brain)

A

hypothalamus

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7
Q

Melancholic depression is a subtype of depression. What characterizes it? treatment?

A
  • depressed mood and COMPLETE anhedonia
  • wake up early morning and mood worse in the morning
  • treatment: Histamine blockers.
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8
Q

Atypical depression is a subtype of depression. What characterizes it?

A
  • leaden paralysis

- oversensitive to perceived rejection

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9
Q

Psychotic depression is a subtype of depression. What characterizes it? treatment?

A
  • Hallucinations or delusions

- must give antidepressant AND antipsychotic. also possibly ECT

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10
Q

characteristics of catatonia.

must have disturbance in motor function + 3 other symtpoms

A
  • stupor
  • wavy flexibility
  • posture against gravity (catalepsy)
  • odd mannerisms
  • ocd like movements
  • agitation
  • negative
  • mute
  • repeats what you just said (echolalia)
  • copies your actions (echopraxia)
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11
Q

treatment of catatonic depression?

A

Benzodiazepines and/or ECT

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12
Q

you must treat anxious depression aggressively b/c theses patients have increased suicide risk. got it??

A

got it.

they have sense of impending doom btw

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13
Q

how to treat mixed featured depression? as in they have some manic/hypomanic symptoms but not enough to fit the bill.

A

mood stabilizer

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14
Q

true or false, you have increased risk of peripartum onset depression with increased # of preganancies

A

true bubba

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15
Q

criteria for adjustment disorder (w/ depressed mood)? (kinda vague)

A

basically milder depression, not enough to qualify as straight up MDD.
symptoms: marked distress, significant impairment. happens within 3 months of a major stressor and resolved within6 months. NO suicidal thoughts

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16
Q

Dysthymia/Persistent depressive disorder

time criteria?

A

low level depression for 2 years. depressed mood + 2 out of the 9 symptoms

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17
Q

Medical disorders and drugs that can contribute to depression? (9)

A
  1. endocrine disorders
  2. stroke (anterior left hemisphere)
  3. steroid meds
  4. antihypertensive meds
  5. alcohol
  6. amphetamines
  7. cocaine
  8. benzos/barbituates
  9. opiates
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18
Q

lifetime risk (%) of depression in men? women?

A

men: 10%
women: 20%

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19
Q

Rates of depression in medical populations

A

5-15% of population

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20
Q

what percent of people w/ MDD do not get treated

A

50%

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21
Q

risk factors for MDD (5)

A
  1. family history of depression or alcoholism
  2. female
  3. single
  4. old age
  5. parental loss before age 13.

Donna is a grandma who was never married. Her mother committed suicide when she was 10.

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22
Q

average age of onset of MDD?

A

40 years old

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23
Q

percentage of patients who do not recover from major depressive disorder and remain chronically depressed

A

10-20%

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24
Q

Percentage of patients with major depressive disorder who upon recovery go on to have more episodes of major depression

A

75-80%

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25
Q

Percentage of depressed patients who die from suicide

A

15% mortality rate

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26
Q

Highest risk time period of relapse into depression

A

6-12 months after recovery

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27
Q

3 risk factors for patients at highest risk for chronic impairment after MDD

A
  1. slow onset
  2. co morbid personality or medical issues
  3. co morbid dysthymid (persistent depressive) disorder
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28
Q

2 risk factors for patients at highest risk for relapse after MDD

A
  1. more previous episodes

2. older age

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29
Q

if someone is ill it’s hard to tell how much of their depression is appropriately from their illness, right? so tell me the criteria.

A
  1. anhedonia or mood nonreactivity
  2. worse mood in morning
  3. agitation or retardation *impaired concentration is NOT a criteria
  4. feeling worthlessness, excessive guilt, or suicidal thoughts
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30
Q

manic episode must last for at least 1 week. what are the required symptoms? DIG FAST

A
  • must have elevated mood and increased energy plus 3/7 of the following?
Distracted (and easily frustrated
Irresponsible. erratic behavior
Grandiosity and condescending
F = Flight of ideas
A = Activity increased with weight loss and increased libido
S = Sleep is decreased
T = Talkativeness

*bonus. Hallucinations in 50% of patients. (psychotic symptoms)

31
Q

Mania vs hypomania?

A

in mania: 4 symptoms for 1 week. impaired so usually hospitalization necessary. psychotic symptoms in 50%
.
in hypomania: 4 symptoms but only 4 days. not as impaired. no psychotic symptoms.

32
Q

what is cyclothymic disorder?

A

basically milder and chronic version of bipolar.

2 or more years. no normal mood for more than 2 months at a time

33
Q

requirement for rapid cycling bipolar?

A

4 or more episodes per year

34
Q

Medical conditions or meds/substances that -> Mania? (7)

A
  1. CNS stimulants (meth, cocaine)
  2. steroid meds (remember can cause depression too)
  3. antidepressants
  4. hyperthyroidism
  5. MS
  6. damage to right hemisphere
  7. temporal lobe seizures
35
Q

The risk of repeat episodes in a woman who has had one episode of post-partum depression with psychotic features

A

30-50%

36
Q

life time prevalence of bipolar type I and II? (genders are equal)

A

bipolar type 1: 1%

type 2: 0.5%

37
Q

if you have a family member w/ bipolar, for what and how much % are you at increased risk for?

A

risk increased for ALL mood disorders.

you have a 25-50% rate of getting some type of mood disorder if immediate family member

38
Q

Usual age of onset of bipolar disorder

A

late adolescence - early 20s

39
Q

Percentage of bipolar patients with chronic residual symptoms

A

5-10%

40
Q

true or false: MDD tend to occur more than manic episodes

A

true bubz

41
Q

true or false: subsequent episodes in bpolar will increase in frequency and become less related to stress:

A

true mang

42
Q

rate of suicide in bipolar disorder

A

10%

43
Q

the amine theory of mood disorders says that drugs that deplete NTs can cause depression. what is a drug that does this?

A

Reserpine (antipsychotic and anti-HTN drug)

44
Q

if you disturb this part of the brain you get disturbance of sleep, libido, appetite, and energy.

A

hypothalamus. (area most implicated in MDD)

45
Q

frontal cortex dysfunctions results in these symtpoms

A

pessimism. guilt and worthlessness.

46
Q

limbic structures dysfunction results in these symptoms

A

depressed mood. anhedonia, reduced mood reactivity

47
Q

if you disturb this structre you will get stooped posture and mental and motor slowing

A

basal ganglia

48
Q

what 5 parts of brain seem to get abnormal blood flow in mood disorders?

A
  1. ***** cingulate gyrus, angerior region esp
  2. prefrontal cortical regions
  3. ventral striatum
  4. medial thalamus
  5. medial cerebellum
49
Q

what percent of depressed patients have altered function of hypothalamic pituitary adrenal (HPA) axis?

A

60% bubz

50
Q

what is DST and what % of patients do not have steroids suppress their cortisol production like in normal people?

A

DST: dexamethasone suppression test. give them that steroid and see if cortisol production decreases like it should. it doesnt in 60% of depressed pts

51
Q

what is CRF and is it high or low in depressed pts?

A

Corticotrophin releasing factor is elevated

52
Q

specific abnormalities in sleep patterns of depressed pts

A

less time in stage 3/4 (deep sleep that’s not REM)
so then less amt of time to get to first REM episode
decreased eye mvt in REM
decreased sleep maintenance (i.e. wakes up in night)

53
Q

does synching patients w/ better sleep cycles/circadian rhythms help their symtpoms

A

why yes it does

54
Q

what is sensitization

A

when youre rlly stressed your limbic system becomes sensitized (not desenitized as you might think) and you start overreacting to stress and then reacting even without stress. exaggurated ACTH -> cortisol

55
Q

The effect of elevated cortisol on hippocampal neurons

A

permanent loss of HIPPOCAMPAL NEURONS gg QQ

56
Q

how long does it take for pt to feel effects of antidepressant

A

4-6 weeks

57
Q

The percentage of patients who respond to the first antidepressant

A

60-70%

58
Q

Which depressed patients should be given an antidepressant trial

A

so impaired that they can’t engage in psychotherapy
suicidal
any pt with melancholic or psychotic depression symptoms

59
Q

3 mechanisms of antidepressants upping 5HT and NE

A
  1. block reuptake
  2. decrease density of autoreceptors (like alpha-2)
  3. presynaptic excitatory effect to increase release
60
Q

symptoms of blocked cholinergic channels? (think opposite of dumBels)

A 
dry mouth
memory impairment
constipation
hard time peeing
blurred near vision
increases morbidity/mortality
61
Q

symptoms of blocked histamine channels

A

sedation

weight gain

62
Q

symptoms of 5HT overstimulation

A

5HT2: sex problems, agitation, insomnia
5HT3: nausea, diarrhea

63
Q

Blocked α-1 Adrenergic side effect

A

orthostatic hypotension (don’t give to elderly, fragile people)

64
Q

mechanism of SSRIs

A

inhibit cytochrom P450

tend to cause serotonin side effects

65
Q

dual mechanism inhibitors side effects

A

weight gain and sedation, nausea and anxiety

66
Q

do not give TCA to who and why?

A

people w/ heart problems bc it slows cardiac conduction.

also people with chronic suicide tendencies.

67
Q

danger of MAOIs?

A
  1. hypertensive crisis (esp if you eat Tyramine -> too much NE)
  2. hypermetabolic crisis (serotonin syndrome)
68
Q

what drug should you never give to bulimics and also is the only drug to target dopamine?

A

Bupropion (clean dual)

69
Q

Which MAOI used in depression is reversible

A

Selegiline patch

70
Q

How long it takes the irreversible MAOI effects to “wear off” and why it takes so long

A

2 weeks bc it’s irreversible so that’s how long it takes your body to make new MAOs

71
Q

over-the-counter medications and street drugs that can cause a hypertensive crisis while on MAOIs

A

cold medications

stimulants and ecstacy

72
Q

what ion channel is affected by many anticonvulsant mood stabilizers?

A

voltage sensitive sodium channel

73
Q

what is lithium used for and what is special about it? what 2nd messenger pathway does it affect?

A
  • type of mood stabilizing drug
  • shown to reduce suicide risk
  • Phosphatidylinositol (PI)
74
Q

whats dangerous about lithium?

A

narrow therapeutic window. blood levels must be moinitered closely. hemodialysis if lithium toxicity happens

Psychopathology (5 decks)

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