Mood disorders Flashcards
What are the mood disorders?
Major depressive disorder
Bipolar I, Bipolar II
Persistent depressive disorder
Cyclothymic disorder
Symptoms of major depression
SIG E CAPS
Sleep (+/-)
Interest
Guilt
Energy
Concentration
Appetite (+/-)
Psychomotor (+/-)
Suicidal thoughts
Criteria for major depressive episode
At least 5 of the following symptoms for at least 2 weeks: Depressed mood most of the time Anhedonia Change in appetite or weight Feelings of worthlessness or guilt Insomnia or hypersomnia Diminished concentration Psychomotor agitation or retardation Fatigue or loss of energy Recurrent thoughts of death or suicide Not substance or medical related
What is a manic episode?
Distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased goal-directed activity or energy, lasting >1wk and including at least 3 of:
Distractibility
Inflated self-esteem or grandiosity
Increased goal-directed activity or psychomotor agitation
Decreased need for sleep
Flight of ideas or racing thoughts
More talkative than usual
Excessive involvement in pleasurable activities that have a high risk of negative consequences
What is a hypomanic episode?
Period of elevated, expansive, or irritable mood and increased goal-directed activity or energy lasting at least 4 days and meeting at least 3 manic symptoms. *NO marked impairment in social or occupational functioning, NO psychotic features
When to hospitalize for major depressive episode?
If patient is at risk for suicide, homicide, or unable to care for self
Main side effects of SSRIs?
Headache, GI upset, sexual dysfunction
Most lethal antidepressant in overdose?
TCAs due to cardiac arrhythmias (treat with NaHCO3)
Side effects of TCAs?
Sedation, weight gain, orthostatic hypotension, and anticholinergic effects
First line treatment for MDD with psychotic features?
Atypical antipsychotics
General features of serotonin syndrome
Autonomic instability, hyperthermia, hyperreflexia (+myoclonus), and seizures
Indications for ECT in MDD
Unresponsive to pharmacotherapy, cannot tolerate pharma, or if rapid reduction in symptoms is needed
Common side effects of ECT
Retrograde and anterograde amnesia
Headache
Nausea
Muscle soreness
“Atypical” features of MDD
Hypersomnia, hyperphagia, reactive mood, leaden paralysis, hypersensitivity to personal rejection
Criteria for bipolar II disorder
History of one or more major depressive episode
At least one hypomanic episode
PharmaTx for bipolar disorder
Lithium, valproate, carbamazepine, or atypical antipsychotics
Treatment for a pregnant woman with manic episode
ECT
Side effects of Li
Weight gain Tremor GI upset Fatigue Arrhythmias Seizures Hypothyroidism Leukocytosis Coma Polyuria Polydipsia Alopecia Metallic taste
Definition of rapid cycling
Ocurrence of 4 or more mood episodes in 1 year
Persistent depressive disorder (dysthymia)
“2 Ds”
2 years of depression
2 listed criteria
Never asymptomatic for >2 months
Criteria for dysthymia/PDD (need at least 2)
Poor concentration/difficulty with decisions Feelings of hopelessness Poor appetite or overeating Insomnia or hypersomnia Low energy or fatigue Low self-esteem
Treatment for persistent depressive disorder
Psychotherapy + pharmacotherapy
What is cyclothymic disorder?
Alternating periods of hypomania and periods with mild-to-moderate depressive symptoms
Criteria for cyclothymic disorder?
Numerous periods with hypomanic symptoms (but not a full hypomanic episode) and periods with depressive symptoms (but not a full MDE) for at least 2 years
Never symptom free for >2 months
No history of MDE, hypomanic or manic episode
Prognosis for cyclothymic disorder
1/3 of patients go on to diagnosis of bipolar (I or II)
Treatment for cyclothymic disorder
Mood stabilizers or atypical antipsychotics
What is premenstrual dysphoric disorder?
Mood lability, irritability, dysphoria, and anxiety that occur repeatedly before menstrual period
Criteria for premenstrual dysphoric disorder
- Timing in cycle makes sense
- At least 5 symptoms
- At least one of: affective lability, irritability/anger, depressed mood, tension/anxiety
- At least one of: anhedonia, concentration problems, anergia, appetite changes, sleep changes, feeling out of control, physical symptoms (breast pain, joint pain, bloating, weight gain)
- Symptoms cause impairment in functioning
Treatment for premenstrual dysphoric disorder
SSRIs
OCPs
GnRH agonists
Bilateral oophorectomy + hysterectomy (dang)
What is disruptive mood dysregulation disorder?
Chronic, severe, persistent irritability occuring in childhood and adolescence
Criteria for disruptive mood dysregulation disorder
SEvere recurrent verbal/physical outbursts out of proportion to situation
>3x/week, inconsistent with developmental level
Mood between outbursts is persistently irritable/angry most of the day, observable by others
Symptoms for at least 1 year
Symptoms in at least 2 settings
Symptoms before age 10
No manic/hypomanic episodes
Prognosis for disruptive mood dysregulation disorder
High rates of comorbid ODD, ADHD, mood disorders, anxiety disorders
Treatment of disruptive mood dysregulation disorder
Psychotherapy, stimulants, SSRIs, mood stabilizers, atypical antipsychotics
