Mood Disorders

Question 1

What are the criteria for a major depressive episode?

Answer 1

must have at least five of the following symptoms for at least a 2-week period:

• depressed mood
• sleep disturbance
• loss of interest
• feelings of guilt or worthlessness
• loss of energy
• decreased concentration
• change in appetite
• psychomotor agitation or retardation
• suicidal ideation

Question 2

What are the criteria for a manic episode?

Answer 2

a period of abnormally and persistently elevated mood lasting at least one week or requiring hospitalization and including at least three of the following (with four if the mood is irritable):

• distractability
• insomnia
• grandiosity
• flight of ideas
• activity/agitation
• speech (pressured)
• thoughtlessness/impulsivity (excessive involvement in pleasurable activities)

Question 3

What is a mixed mood episode?

Answer 3

one that meets criteria for both a manic and a major depressive episode nearly every day for one week

Question 4

How does a hypomanic episode differ from a manic one?

Answer 4

• hypomanic also includes three of the characteristic symptoms but lasts at least four days, has no social or occupational impairment, does not require hospitalization, and has no psychotic features
• a manic episode is defined by having an impact on social or occupational functioning and may include hospitalization or psychotic features

Question 5

What are the diagnostic criteria for MDD?

Answer 5

at least one major depressive episode and no history of manic or hypomanic episodes

Question 6

What sleep disturbances are seen in those with MDD?

Answer 6

• most common is difficulty with sleep initiation and terminal insomnia
• may also have frequent awakenings
• they also tend to have REM shifted earlier in the night and less deep sleep

Question 7

What neurotransmitter changes have been implicated in depression?

Answer 7

a decrease in serotonin, norepinephrine, and dopamine

Question 8

What are the general guidelines and tools available for the treatment of MDD?

Answer 8

• predominately use SSRIs due to efficacy and tolerability followed by SNRIs and Wellbutrin
• TCAs and MAOIs may be necessary in atypical or refractory depression
• ECT has a role in patients unresponsive to pharmacotherapy, if patients are pregnant, or if rapid reduction of symptoms is necessary
• importantly, inclusion of psychotherapy enhances the efficacy of treatment regimens

Question 9

What are the side effects of ECT?

Answer 9

retrograde and anterograde amnesia, headaches, muscle soreness, and nausea are most common

Question 10

What is “atypical” MDD?

Answer 10

a form of MDD characterized by hypersomnia, hyperphagia, reactive mood, leaden paralysis, and hypersensitivity to interpersonal rejection

Question 11

What are the five stages of grief?

Answer 11

• denial
• anger
• bargaining
• depression
• acceptance

Question 12

Compare normal grief/bereavement with depression.

Answer 12

• normal bereavement may include illusions but should not include gross disorganization or suicidality
• normal grief is typically confined to two months with mild cognitive disorder lasting less than one year

Question 13

What is the appropriate treatment for normal bereavement?

Answer 13

may use benzodiazepines to aid sleep but little else is required

Question 14

What is rapid cycling mood disorder?

Answer 14

one defined by the occurrence of four or more mood episodes (manic, depressive, or mixed) in one year

Question 15

What are the diagnostic criteria for bipolar I and II?

Answer 15

• the occurrence of one manic or mixed episode is sufficient to diagnose bipolar I
• bipolar II requires a history of one or more major depressive episodes and at least one hypomanic episode

Question 16

What is the typical pharmacotherapy for bipolar disorder?

Answer 16

• mood stabilizers like lithium, the anticonvulsants carbamazepine or valproate, and atypical antipsychotics
• ECT also plays a role in treating refractory of life-threatening acute mania

Question 17

What are the diagnostic criteria for dysthymic disorder?

Answer 17

> depressed mood for the majority of time most days for at least two years (1 year in children/adolescents) and without being symptom free for more than 2 months at a time
> no major depressive episodes
> at least two of the following:
- poor concentration
- feelings of hopelessness
- poor appetite or overeating
- sleep disturbance
- low energy
- low self-esteem
> think "rule of 2's"

Question 18

What is the preferred treatment for dysthymic disorder?

Answer 18

• cognitive therapy and insight-oriented psychotherapy are most effective
• antidepressants as adjuncts

Question 19

What are the criteria for cyclothymic disorder?

Answer 19

• numerous periods with hypomanic symptoms and periods with depressive symptoms for at least two years
• the person must never have been symptom free for more than 2 months during this time

Question 20

How is cyclothymic disorder treated?

Answer 20

with mood stabilizers like bipolar I and II

Question 21

What is minor depressive disorder?

Answer 21

defined by 2-4 depressive symptoms that do not meet the full criteria for a depressive episode and which are interspersed with euthymic periods unlike dysthymic disorder

Question 22

Describe seasonal affective disorder.

Answer 22

• a modifier to any mood disorder and not a true disorder in and of itself
• defined by at least two consecutive years of two major depressive episodes during the same season
• the typical tried is irritability, carbohydrate craving, and hypersomnia

Question 23

For what mood disorder is light therapy often beneficial?

Answer 23

for fall-onset seasonal affective disorder

Question 24

What are the criteria for adjustment disorder?

Answer 24

• development of emotional or behavioral symptoms within 3 months following a stressful life event which resolve within 6 months of the stressor ending
• the symptoms produced must either cause severe distress or impaired functioning

Question 25

How is adjustment disorder best treated?

Answer 25

with supportive psychotherapy or group therapy

Question 26

In general terms, what are the following:

• MDD
• Bipolar I
• Bipolar II
• dysthymic disorder
• cyclothymic disorder
• minor depressive disorder

Answer 26

• MDD: one major depressive episode and no mania
• Bipolar I: one manic episode
• Bipolar II: at least one hypomanic and one major depressive episode
• dysthymic disorder: a chronic, mild depression
• cyclothymic disorder: alternating periods of hypomania and mild-to-moderate depressive symptoms

Question 27

What is the general treatment strategy for mood disorders?

Answer 27

• depressive disorders are treated with SSRIs, SNRIs, and wellbutrin followed by TCAs and MAOIs
• disorders with mania are treated with mood stabilizers like lithium, carbamazepine, valproate, and atypical antipsychotics
• ECT is used for acute, life-threatening situations and pregnancy when pharmacotherapy isn’t an option