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BSP Exam II > Mood Disorders > Flashcards

Mood Disorders Flashcards

1
Q

_______% of patients with a mood disorder have a first-degree relative with a mood disorder

A

10-25

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2
Q

_____% of patients with bipolar disorder have a first-degree relative with a mood disorder

A

50%

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3
Q

________ is a NT involved in pathogenesis of depression in that there is down regulation of beta receptors leading to abnormal noradrenergic function

A

Norepinephrine

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4
Q

_______ is a NT that is decreased in depression, but increased in mania

A

Dopamine

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5
Q

______ is an inhibitory NT that is the site of action for anxiolytic agents like benzodiazepines

A

GABA

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6
Q

_____ is an excitatory NT involved in dementia; its _____ receptor is involved in current antidepressant studies

A

Glutamate; NMDA

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7
Q

What are some life and environmental stress factors that contribute to development of mood disorders?

A

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]

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8
Q

A major depressive episode requires at least _____ criteria for a _________ period with at least either (1) ______ mood or (2) loss of __________

A

5; 2 week; depressed; interest or pleasure

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9
Q

List items included in diagnostic criteria for major depressive disorder

A

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

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10
Q

A manic episode is defined as abnormally and persistently elevated, expansive, or irritable mood lasting at least _______ with at least _____ criteria

A

1 week; 3

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11
Q

Diagnosis of a manic episode requires hospitalization or marked functional impairment of at least 3 criteria. What are the criteria?

A

[DIG FAST]

Distractibility
Impulsivity/Indiscretion (hedonistic)
Grandiosity

Flight of ideas
psychomotor Agitation/goal-directed Activity
decreased need for Sleep
Talkativeness or pressured speech

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12
Q

______ _____ = 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

A

Hypomanic episode; 4 days; are not

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13
Q

The diagnosis of major depressive disorder requires the presence of ____ or more major depressive episodes and the ABSENCE of any _____, _____, or _____ episodes

A

One; manic; hypomanic; mixed

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14
Q

T/F: treatment of bereavement usually does not include antidepressants

A

True

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15
Q

Treatment for major depressive disorder

A

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

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16
Q

Treatment option for MDD that produces dissociative anesthesia as an NMDA antagonist; results in 50% reduction in suicidal thoughts in 24 hours

A

Ketamine

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17
Q

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

A

Persistent depressive disorder (Dysthymia)

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18
Q

Persistent depressive disorder (dysthymia) requires continuous symptoms for at least _____ for adults and ______ for children

A

2 years; 1 year

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19
Q

Treatment for persistent depressive/dysthymic disorder

A

Can be more difficult to treat

Pharmacology: SSRIs, SNRIs, MAOIs

CBT

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20
Q

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)

A

MDD with seasonal pattern

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21
Q

Mood instability with anxiety, depression, and irritability occurring the week before menses and consistent pattern over the year

A

Premenstrual dysphoric disorder (PMDD)

22
Q

Treatment for PMDD

A

Exercise, diet, relaxation therapy

SSRIs may be used — Sertraline, fluoxetine, paroxetine. Treat during cycle or 2 weeks preceding menses

23
Q

Must have at least one manic or mixed episode for diagnosis, but a major depressive episode is not required for diagnosis

A

Bipolar I

24
Q

Which has worse px, bipolar I or MDD?

A

Bipolar I

25
Q

Which is more prevalent, bipolar I or bipolar II?

A

Bipolar II

26
Q

Define bipolar II

A

At least one major depressive episode and one hypomanic episode in the absence of any manic or mixed episodes

27
Q

Treatment for bipolar disorders

A

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)

28
Q

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

A

Cyclothymic disorder

29
Q

Treatment for cyclothymic disorder

A

Mood-stabilizing drugs and supportive psychotherapy

[Antidepressants frequently precipitate manic symptoms]

30
Q

Psychological and somatic symptoms of anxiety disorders

A

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

31
Q

Diagnostic categories of anxiety

A

Separation anxiety disorder

Panic disorder

Agoraphobia

GAD

OCD

Specific phobias/social phobias

PTSD

32
Q

2 major criteria for panic disorder

A
  1. Recurrent unexpected panic attacks
  2. 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
33
Q

T/F: diagnosis of panic disorder requires the absence of agoraphobia

A

False — panic disorder occurs in the presence or absence of agoraphobia

34
Q

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 _______.

A

4; 10; <25 mins

35
Q

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?

A 
Palpitations
Sweating
Trembling/shaking
Sensation of SOB
Chest pain
Dizzy/unsteady/lightheaded
Fear of losing control/going crazy/dying
Paresthesias
Chills or hot flashes
36
Q

_____ 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

A

Women; 50%

37
Q

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

A

Agoraphobia

38
Q

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

A

Social phobia (social anxiety disorder)

39
Q

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 ________

A

3; 6 months

40
Q

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?

A

Restlesness or feeling on edge

Easily fatigued

Difficulty concentrating

Irritability

Muscle tension

Sleep disturbance

41
Q

What is the difference between obsessions and compulsions?

A

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

42
Q

T/F: Hoarding disorder, trichotillomania (hair pulling), and excoriation disorder (skin picking) are related to OCDq

A

True

43
Q

What is the major difference between OCD and obsessive-compulsive personality disorder?

A

OCD — they know their compulsions and obsessions are not reasonable (most of the time)

OCPD — they don’t perceive they have a problem

44
Q

What are some types of obsessions seen in OCD?

A

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

45
Q

What are some types of compulsions seen in OCD?

A

Excessive cleaning

Checking, ordering, and arranging rituals

Counting; repeating routine activities

Some are performed as unobservable mental rituals

46
Q

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?

A

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

47
Q

PTSD criteria include duration of disturbance/symptoms is more than ________; clinically significant distress that impairs function

A

1 month

48
Q

Treatment for PTSD

A

SSRIs

Cognitive processing therapy

49
Q

T/F: benzodiazepines are often helpful for PTSD pts who experience panic symptoms

A

False — PTSD pts have an increased risk of substance abuse, so addictive meds should be avoided

50
Q

Iatrophobia

A

Fear of doctors

51
Q

Acrophobia

A

Fear of heights

52
Q

Psychotherapy options for anxiety include supportive therapy, psychodynamic psychotherapy, and CBT.

What are some psychopharmacology options?

A 
SSRIs
SNRIs
TCAs
MAOIs
Buspirone
Benzodiazepines
Antispychotics

BSP Exam II (10 decks)

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