Mood Disorders Flashcards
Diagnostic criteria for a Major Depressive Episode
Persistent depressive mood, most of the day, almost everyday
Decreased interest and pleasure in activities
Loss of appetite and weight loss OR increased appetite and weight gain
Insomnia or hypersomnia, almost everyday
Psychomotor agitation or retardation
Tiredness or listlessness
Feeling of worthlessness, self-reproach, guilt feelings
Concentration impairment
Recurrent suicidal thoughts/gestures
What are the most important associated symptoms of depression (function shift)?
Loss of appetite Loss of weight Diurnal mood swing Terminal insomnia/early morning waking Decreased libido
Precipitating factors of a major depressive episode
Chronic medical illness
Alcohol/drug abuse
Psychosocial stressors (divorce, bereavement, etc.)
What is the biological treatment of MDD?
SSRI’s
- Fluoxetine 20-60mg
- Citalopram 10-40mg
- Escitalopram 5-20mg
- Sertraline 50-200mg
- Paroxetine 20mg
What is the Psychosocial treatment of MDD?
Psycho: CBT
- Crisis management
- Supportive psychotherapy
Social:
- Support groups (SADAG)
What are the side-effects of SSRIs?
Insomnia Nausea Loss of weight Headache Anxiety Sexual Dysfunction
Complications of MDD
Suicide
Substance abuse
Immunosuppression - Accompanying illness - Infection and malignancy
What are the indications for ECT for MDD?
Treatment resistant Major depressive illness with psychosis
Sever, immediate risk of suicide
Psychomotor stupor
Depressive episodes when patients stop eating/drinking till life threatening
Patient decision
Contraindication for antidepressants
What are the risks and side-effects of ECT for MDD?
Musculoskeletal injuries
Memory and other cognitive disturbances
Provide a DDx for MDD
Uncomplicated bereavement Adjustment disorder with depressive mood Schizophrenia Anxiety disorder Substance-induced depressive disorders Depression due to another medical condition
Mania vs. Hypomania
Mania: Distinct period of abnormal and persistently elevated, expansive, irritable moods that causes significant impairment in social and occupational functioning
Hypomania: A milder degree if mania that does not significantly impair social and occupational functioning
What is the difference between Bipolar I and Bipolar II?
Bipolar I: At least 1 previous manic episode
Bipolar II: At least 1 hypomanic episode, with 1 or more major depressive episode
Diagnostic criteria for a Manic episode
A distinct period of abnormally and persistently elevated expansive or irritable mood as well as marked increase in activity of energy levels
Symptoms
- Inflated self-esteem or grandiosity
- Decreased need for sleep
- More talkative than usual
- Flight of ideas or racing of thoughts
- Distractibility
- Increased goal directed activity
- Excessive involvement in activities or poor business decisions
Causes significant impairment in social and occupational functioning, to warrant hospitalization to protect the patient/community, or there are psychotic features
Symptoms are not due to substances or medical condition
Provide and DDx for a manic episode
Substance-induced manic disorder
Manic disorder due to medical condition – delirium with excitement, epilepsy
Schizophrenia
ADHD in children
What are the side-effects of Lithium
Tremor Polyuria and polydipsia GIT discomfort Muscle weakness Weight gain Acne / Exacerbation psoriasis Hypothyroidism and goitre ECG: T-wave flattening
