Mood disorders

Question 1

What are the mood disorders?

Answer 1

Major depressive disorder
Bipolar I, Bipolar II
Persistent depressive disorder
Cyclothymic disorder

Question 2

Symptoms of major depression

Answer 2

SIG E CAPS
Sleep (+/-)
Interest
Guilt

Energy

Concentration
Appetite (+/-)
Psychomotor (+/-)
Suicidal thoughts

Question 3

Criteria for major depressive episode

Answer 3

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

Question 4

What is a manic episode?

Answer 4

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

Question 5

What is a hypomanic episode?

Answer 5

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

Question 6

When to hospitalize for major depressive episode?

Answer 6

If patient is at risk for suicide, homicide, or unable to care for self

Question 7

Main side effects of SSRIs?

Answer 7

Headache, GI upset, sexual dysfunction

Question 8

Most lethal antidepressant in overdose?

Answer 8

TCAs due to cardiac arrhythmias (treat with NaHCO3)

Question 9

Side effects of TCAs?

Answer 9

Sedation, weight gain, orthostatic hypotension, and anticholinergic effects

Question 10

First line treatment for MDD with psychotic features?

Answer 10

Atypical antipsychotics

Question 11

General features of serotonin syndrome

Answer 11

Autonomic instability, hyperthermia, hyperreflexia (+myoclonus), and seizures

Question 12

Indications for ECT in MDD

Answer 12

Unresponsive to pharmacotherapy, cannot tolerate pharma, or if rapid reduction in symptoms is needed

Question 13

Common side effects of ECT

Answer 13

Retrograde and anterograde amnesia
Headache
Nausea
Muscle soreness

Question 14

“Atypical” features of MDD

Answer 14

Hypersomnia, hyperphagia, reactive mood, leaden paralysis, hypersensitivity to personal rejection

Question 15

Criteria for bipolar II disorder

Answer 15

History of one or more major depressive episode

At least one hypomanic episode

Question 16

PharmaTx for bipolar disorder

Answer 16

Lithium, valproate, carbamazepine, or atypical antipsychotics

Question 17

Treatment for a pregnant woman with manic episode

Answer 17

ECT

Question 18

Side effects of Li

Answer 18

Weight gain
Tremor
GI upset
Fatigue
Arrhythmias
Seizures
Hypothyroidism
Leukocytosis
Coma
Polyuria
Polydipsia
Alopecia
Metallic taste

Question 19

Definition of rapid cycling

Answer 19

Ocurrence of 4 or more mood episodes in 1 year

Question 20

Persistent depressive disorder (dysthymia)

Answer 20

“2 Ds”
2 years of depression
2 listed criteria
Never asymptomatic for >2 months

Question 21

Criteria for dysthymia/PDD (need at least 2)

Answer 21

Poor concentration/difficulty with decisions
Feelings of hopelessness
Poor appetite or overeating
Insomnia or hypersomnia
Low energy or fatigue
Low self-esteem

Question 22

Treatment for persistent depressive disorder

Answer 22

Psychotherapy + pharmacotherapy

Question 23

What is cyclothymic disorder?

Answer 23

Alternating periods of hypomania and periods with mild-to-moderate depressive symptoms

Question 24

Criteria for cyclothymic disorder?

Answer 24

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

Question 25

Prognosis for cyclothymic disorder

Answer 25

1/3 of patients go on to diagnosis of bipolar (I or II)

Question 26

Treatment for cyclothymic disorder

Answer 26

Mood stabilizers or atypical antipsychotics

Question 27

What is premenstrual dysphoric disorder?

Answer 27

Mood lability, irritability, dysphoria, and anxiety that occur repeatedly before menstrual period

Question 28

Criteria for premenstrual dysphoric disorder

Answer 28

• 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

Question 29

Treatment for premenstrual dysphoric disorder

Answer 29

SSRIs
OCPs
GnRH agonists
Bilateral oophorectomy + hysterectomy (dang)

Question 30

What is disruptive mood dysregulation disorder?

Answer 30

Chronic, severe, persistent irritability occuring in childhood and adolescence

Question 31

Criteria for disruptive mood dysregulation disorder

Answer 31

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

Question 32

Prognosis for disruptive mood dysregulation disorder

Answer 32

High rates of comorbid ODD, ADHD, mood disorders, anxiety disorders

Question 33

Treatment of disruptive mood dysregulation disorder

Answer 33

Psychotherapy, stimulants, SSRIs, mood stabilizers, atypical antipsychotics