Mood Disorders

Question 1

What are the criteria for the diagnosis of major depression? (Sig E Caps)

Answer 1

S(adness)
I(nterest)
G(uilt)
E(nergy)
C(oncentration)
A(ppetite)
P(sychomotor agitation or retardation) 
S(uicidal thoughts)

Question 2

What are some risk factors for major depression?

Answer 2

• Premenopausal woman
• Alcohol
• Family History

Question 3

What is a possible biomarker of depression?

Answer 3

Cortisol - chronically elevated

Question 4

Monoamine Theory of Depression

Answer 4

Abnormalities within the monoamine systems causative of depression - often too low amounts of the one of these NTs:
◦ Serotonin
◦ Norepinephrine
◦ Dopamine

Question 5

Inflammatory Theory of Depression

Answer 5

Low levels of chronic inflammation from either active illness or persistent heightened level of corticosteroids from “stress” produce a toxic inflammatory milieu where neurodegeneration increases and neurogenesis is inhibited.

Question 6

What IL might be associated with depression?

Answer 6

IL-6 - also associated with increased risk of heart disease and Alzheimer’s

Question 7

Structural Theory of Depression

Answer 7

Depression is caused by abnormal changes in brain areas that can be identified premorbidly and are exacerbated in active illness - atrophy of the prefrontal cortex, amygdala, and hippocampus suggestive

Question 8

Network Hypothesis of Depression

Answer 8

It is not specifically an altered brain area that causes depression but aberrancies in the tracts between areas. Diffusion tension imagery has revealed white matter abnormalities in the tracts between the medial prefrontal cortex, amygdala, and hippocampus.

Question 9

What are some possible psychological causes of depression?

Answer 9

Loss, abandonment, lack of nurturing, emptiness, anger turned inward, developmental arrest at a dependent stage

Question 10

What are some possible environmental causes of depression?

Answer 10

Poverty, deaths, famine, wars, oppression, abuse, torture, drugs, learned helplessness, side effects of medications, chemical toxins, infectious diseases, medical conditions

Question 11

What is a typical infection that can cause a depressive disorder?

Answer 11

EBV - mononucleosis

Question 12

What are some medications that can induce a depressive disorder?

Answer 12

• Corticosteroids
• Oral contraceptives
• Antipsychotics
• Interferons
• Reserpine

Question 13

Persistent Depressive Disorder

Answer 13

2 years of duration – depressed mood for most of the day on more days than not- course tends to be non- remitting

Question 14

Premenstrual Dysphoric Disorder

Answer 14

In the majority of menstrual cycles at least 1 of the following need to be present during the final week before start of menstruation:

• Marked affective lability
• Marked irritability and anger or interpersonal conflicts
• Marked depressed mood, feelings, or hopelessness
• Marked anxiety, tension, and/ or feeling on edge

Question 15

Adjustment Disorder with Depressed Mood

Answer 15

Some signs of depression that cause clinical concern but with an acute stressor that occurred within 3 months of the onset of symptoms - should resolve within 6 months after the stressor.

Question 16

Bipolar I Disorder

Answer 16

To be diagnosed you must have experienced at least one Manic episode, although most commonly there will be episodes of Major Depression and other mood states in the history.

Question 17

Bipolar II Disorder

Answer 17

The patient must have experienced a Major Depressive Episode but in addition at least one period of time where they have symptoms of hypomania which is defined as a distinct period of abnormally and persistent elevated, expansive, or irritable mood and increased activity or energy lasting at least 4 days in a row for most of those days.

Question 18

If there is psychotic thinking present, which Bipolar disorder is diagnosed?

Answer 18

Bipolar I

Question 19

Cyclothymic Disorder

Answer 19

2 years of minimum of mood cycling but never enough criteria for Bipolar I or II or Major Depressive Disorder.

Question 20

Bipolar Unspecified

Answer 20

A diagnosis that encompasses many potential patients who have some symptoms of mania and hypomania at times but never enough to meet full criteria.

Question 21

What is unique about the demographics of bipolar disorder?

Answer 21

Bipolar is unique amongst psychiatric illness as the only illness more prevalent in higher socioeconomic brackets.

Question 22

Which gender attempts more suicides?

Answer 22

Females

Question 23

What gender is more successful with suicides?

Answer 23

Males

Question 24

What are the risk factors of suicide?

Answer 24

-􏰂 currently has a feasible plan in mind
􏰂- history of prior attempts
􏰂- psychosis
􏰂- high anxiety
􏰂- impulsivity
􏰂- presence of a mental disorder
􏰂- substance abuse