Mood Disorders Flashcards
_______% of patients with a mood disorder have a first-degree relative with a mood disorder
10-25
_____% of patients with bipolar disorder have a first-degree relative with a mood disorder
50%
________ is a NT involved in pathogenesis of depression in that there is down regulation of beta receptors leading to abnormal noradrenergic function
Norepinephrine
_______ is a NT that is decreased in depression, but increased in mania
Dopamine
______ is an inhibitory NT that is the site of action for anxiolytic agents like benzodiazepines
GABA
_____ is an excitatory NT involved in dementia; its _____ receptor is involved in current antidepressant studies
Glutamate; NMDA
What are some life and environmental stress factors that contribute to development of mood disorders?
Death of a parent before age 11
Death of a spouse or child
Unemployment
[note that these types of events often precede first mood episode rather than subsequent episodes]
A major depressive episode requires at least _____ criteria for a _________ period with at least either (1) ______ mood or (2) loss of __________
5; 2 week; depressed; interest or pleasure
List items included in diagnostic criteria for major depressive disorder
Depressed mood + [SIG E CAPS]
Sleep disturbance
loss of Interest (anhedonia)
Guilt or feelings of worthlessness
Energy loss and fatigue
Concentration problems
Appetite/weight changes
Psychomotor retardation or agitation
Suicidal ideation
A manic episode is defined as abnormally and persistently elevated, expansive, or irritable mood lasting at least _______ with at least _____ criteria
1 week; 3
Diagnosis of a manic episode requires hospitalization or marked functional impairment of at least 3 criteria. What are the criteria?
[DIG FAST]
Distractibility
Impulsivity/Indiscretion (hedonistic)
Grandiosity
Flight of ideas
psychomotor Agitation/goal-directed Activity
decreased need for Sleep
Talkativeness or pressured speech
______ _____ = similar to manic episode but is less severe; episodes only need to last ______ and must not include psychotic features; _____(are/are not) associated with social/occupational impairment
Hypomanic episode; 4 days; are not
The diagnosis of major depressive disorder requires the presence of ____ or more major depressive episodes and the ABSENCE of any _____, _____, or _____ episodes
One; manic; hypomanic; mixed
T/F: treatment of bereavement usually does not include antidepressants
True
Treatment for major depressive disorder
CBT and SSRIs are first-line
Other options: TCAs, MAOIs, trazodone, buproprion, SNRIs, and mirtazapine
Hospitalization
ECT used for treatment-resistant depression; newer option is Transcranial Magnetic Stim, but is expensive and time consuming
Treatment option for MDD that produces dissociative anesthesia as an NMDA antagonist; results in 50% reduction in suicidal thoughts in 24 hours
Ketamine
Depressed mood for most of the day (at least 2 years in duration for adults and 1 year for children) that has not been severe enough to meet criteria for major depressive episode; during the 2 years, cannot be w/o sx for >2 mo at a time
Persistent depressive disorder (Dysthymia)
Persistent depressive disorder (dysthymia) requires continuous symptoms for at least _____ for adults and ______ for children
2 years; 1 year
Treatment for persistent depressive/dysthymic disorder
Can be more difficult to treat
Pharmacology: SSRIs, SNRIs, MAOIs
CBT
Formerly known as seasonal affective disorder. Lasting >2 years with >2 major depressive episodes associated with seasonal pattern and absence of nonseasonal depressive episodes. Atypical symptoms common (hypersomnia, hyperphagia, leaden paralysis)
MDD with seasonal pattern
Mood instability with anxiety, depression, and irritability occurring the week before menses and consistent pattern over the year
Premenstrual dysphoric disorder (PMDD)
Treatment for PMDD
Exercise, diet, relaxation therapy
SSRIs may be used — Sertraline, fluoxetine, paroxetine. Treat during cycle or 2 weeks preceding menses
Must have at least one manic or mixed episode for diagnosis, but a major depressive episode is not required for diagnosis
Bipolar I
Which has worse px, bipolar I or MDD?
Bipolar I
Which is more prevalent, bipolar I or bipolar II?
Bipolar II
Define bipolar II
At least one major depressive episode and one hypomanic episode in the absence of any manic or mixed episodes
Treatment for bipolar disorders
Mood stabilizers are 1st line choice — lithium, valproic acid, or carbamazepine
Other options include Lamotrigine (for bipolar with depression) or second-generation antipsychotics (olanzapine, risperidone, ziprasidone, aripiprazole, quetiapine, lurasidone, cariprazine, asenapine)
Mood disorder characterized as dysthymic disorder with intermittent hypomanic periods; occurs in patient experiences repeated episodes of hypomania and depression over the last 2 years, but not severe enough to meet criteria for MDD
Cyclothymic disorder
Treatment for cyclothymic disorder
Mood-stabilizing drugs and supportive psychotherapy
[Antidepressants frequently precipitate manic symptoms]
Psychological and somatic symptoms of anxiety disorders
Psychological — apprehension/worry, sense of doom or panic, hypervigilence, difficulty concentrating, derealization (world seems strange)
Somatic — HA, dizziness, lightheaded, palpitations, lump in throat, restless, SOB, dry mouth, sweating
Diagnostic categories of anxiety
Separation anxiety disorder
Panic disorder
Agoraphobia
GAD
OCD
Specific phobias/social phobias
PTSD
2 major criteria for panic disorder
- Recurrent unexpected panic attacks
- At least one attack followed by 1+ month of at least one of the following: persistent concern about additional attacks, worry about implications of attack or its consequences, significant change in behavior related to the attacks
T/F: diagnosis of panic disorder requires the absence of agoraphobia
False — panic disorder occurs in the presence or absence of agoraphobia
A panic attack is a discrete period of intense fear or discomfort, in which ____ or more criteria develop abruptly and reach a peak within ____ minutes and usually last _______.
4; 10; <25 mins
A panic attack is a discrete period of intense fear or discomfort, in which 4 or more criteria develop abruptly and reach a peak within 10 minutes and usually last <25 mins.
What are the criteria?
Palpitations Sweating Trembling/shaking Sensation of SOB Chest pain Dizzy/unsteady/lightheaded Fear of losing control/going crazy/dying Paresthesias Chills or hot flashes
_____ are 2-3x more likely to be affected by panic disorder and the average age of presentation is 25 y/o. There is a strong genetic component in that ____% of all pts have at least one affected relative
Women; 50%
Anxiety about being in situations from which escape might be difficult or embarrassing or for which help may not be available in the event of panic
Agoraphobia
A persistent fear of one or more social or performance situations in which the person is exposed to unfamiliar people or a possible scrutiny by others; the individual fears that he or she will will act in a way (or show anxiety symptoms) that will be embarrassing and humiliating; typically lasts 6+ months
Social phobia (social anxiety disorder)
GAD consists of excessive, difficult-to-control anxiety and worry (apprehensive expectation), lasting for most of the day about a number of events or activities.
The anxiety and worry are associated with at least _____ criteria persisting for more days than not for at least ________
3; 6 months
The anxiety and worry of GAD are associated with at least 3 criteria persisting for more days than not for at least 6 months.
What are the criteria?
Restlesness or feeling on edge
Easily fatigued
Difficulty concentrating
Irritability
Muscle tension
Sleep disturbance
What is the difference between obsessions and compulsions?
Obsessions = recurrent and persistent thoughts, impulses, or images experienced as intrusive and inappropriate and causing marked anxiety or distress; recognized as a product of ones own mind
Compulsions = repetitive behaviors or mental acts that the person feels drive to perform; aimed at preventing or reducing distress or preventing some dreaded event/situation
T/F: Hoarding disorder, trichotillomania (hair pulling), and excoriation disorder (skin picking) are related to OCDq
True
What is the major difference between OCD and obsessive-compulsive personality disorder?
OCD — they know their compulsions and obsessions are not reasonable (most of the time)
OCPD — they don’t perceive they have a problem
What are some types of obsessions seen in OCD?
Contamination — fear of dirt, germs, illness, etc
Safety/harm — e.g., being responsible for a fire
Unwanted acts of aggression (e.g., unwanted impulse to harm a loved one)
Unacceptable sexual or religious thoughts
Need for symmetry or exactness
What are some types of compulsions seen in OCD?
Excessive cleaning
Checking, ordering, and arranging rituals
Counting; repeating routine activities
Some are performed as unobservable mental rituals
Pts with PTSD persistently re-experience traumatic event, persistently avoid stimuli associated with the trauma, show persistent symptoms of increased arousal such as difficulty sleeping, irritability, difficulty concentrating, and hypervigilence. They also show negative cognitions — what are some examples?
Persistent and distorted sense of blame of self or others
Estrangement from others
Markedly diminished interest in activities
Inability to remember key aspects of event
PTSD criteria include duration of disturbance/symptoms is more than ________; clinically significant distress that impairs function
1 month
Treatment for PTSD
SSRIs
Cognitive processing therapy
T/F: benzodiazepines are often helpful for PTSD pts who experience panic symptoms
False — PTSD pts have an increased risk of substance abuse, so addictive meds should be avoided
Iatrophobia
Fear of doctors
Acrophobia
Fear of heights
Psychotherapy options for anxiety include supportive therapy, psychodynamic psychotherapy, and CBT.
What are some psychopharmacology options?
SSRIs SNRIs TCAs MAOIs Buspirone Benzodiazepines Antispychotics
