Mood Disorders Flashcards
Mood disorders encompass what two main types of disorders?
depressive and bipolar
what are the five main mood disorders?
1) . major depressive disorder
2) . persistent depressive disorder
3) . premenstrual dysphoric disorder
4) . bipolar disorder (I, II, cyclothymic disorder)
5) . adjustment disorder
Likelihood of recurrence of depression after one episode is ___%. How about after two? three?
50%, 70%, 90%
what is the cause of depression?
Complex psychobiological syndrome, with neurochemical (serotonin, norepineprine, dopamine), genetic, psychosocial factors playing parts
what are the four types of symptoms in depression?
cognitive, affective, behavioral, physiological
what are some affective symptoms of depression? (4)
angry, irritable, down, flat
what are some cognitive symptoms of depression? (5)
cognitive triad: self, outside world, future self criticism loss of self worth ruminating thoughts hard to focus
what are some behavioral symptoms of depression? (4)
isolation, poor hygiene, libido decreases, develop bad habits
what are some physiological symptoms of depression?
change in weight/appetite (inc or dec), muscle aches, chronic pain, digestion slows, headaches
what is anhedonia?
you don’t enjoy the things you normally would
difference between MDD, single episode and MDD, recurrent?
presence of a single MD episode VS 2 or more MDEs AT LEAST 2 months apart
what are six specifiers for MDD?
with peripartum onset, with seasonal pattern, with psychotic features, atypical depression, catatonic depression, melancholia
MDD criteria (5)
1) . 5 or more present during 2 week period (must have 1 or 2)- SIGECAPS
- depressed mood most of the day, nearly every day
- diminished interest
- significant weight loss or gain
- insomnia or hypersomnia
- agitation or retardation
- fatigue
- feelings of worthlessness
- diminished ability to concentrate
- recurrent thoughts of death
2) . impairment in functioning
3) . not due to a substance or medical condition
4) . not better accounted for by schizoaffective DO
5) . never had a manic episode, mixed episode or hypomanic episode
Persistent Depressive Disorder (compared to MDD)
PDD = depressed mood for most of the day, more days than not for AT LEAST 2 YEARS (1 yr for children/adolescents)
***presence of 2 or more: poor appetite/overeating, low energy, insomnia/hypersomnia, low self esteem, poor concentration, feelings of hopelessness
AND never without symptoms for more than 2 months
what did PDD used to be called?
dysthymia
criteria for premenstrual dysphoric disorder (6)
1). at least 5 symptoms present in the final week before menses onset (start to improve with menses onset), minimal or absent in week postmenses
*Physical, emotional, behav
2). one or more: lability (rapidly changing emotions), irritability/anger, depressed mood, anxiety, tension
3). one or more: decreased interest, difficulty in concentration, lethargy, change in appetite, hypersomnia/insomnia, overwhelmed, physical symptoms
1-3# MUST BEEN MET FOR MOST CYCLE IN PRECEDING YR
4). impairment in functioning
5). not exacerbation of another disorder
6). not caused by substance or other medical condition
what are two screenings for depression?
Beck depression inventory and PHQ-9
what two aspects of depression should you focus on when asking a patient if they’re depressed?
sleep and anhedonia
treatment for depression is __-__% effective
70-90%
Med treatment for MDD and Persistent depressive Disorder
SSRI 1st line- also help with anxiety
Maybe SNRIs, Wellbutrin, Remeron, serzone, Effexor
Maybe TCAs
what therapy is most effective for treating depression?
CBT- addresses irrational thoughts, increases enjoyable activities, works on problem solving skills, need to be combined with antidepressants
when is ECT used to treat depression?
if medication or other therapy hasn’t worked (TC RESISTANT DEPRESSION), may have short term memory loss tho
what is vagus nerve stimulation? when is it used?
used for treatment resistant depression; surgical implantation of a nerve stimulator wrapped around the left vagus nerve
what is the most over diagnosed psych disorder?
bipolar
bipolar disorder: onset, prognosis, genetics
20-30 years (early onset coincides with more psychotic features), poor prognosis with psychotic symptoms; first degree relatives have increased incidence of inheriting (monozygotic twin rate is 75%)
Manic episode criteria (4)
1) . period of abnormality and persistently elevated or irritable mood, goal directed activity (LASTING AT LEAST ONE WEEK)
2) . 3 or more, notable change from previous behavior: inflated self esteem, decreased need for sleep, more talkative, flight of ideas, distractibility, inc in goal directed activity, involvement in activities that have high potential for painful consequences
3) . marked impairment in functioning or relationships, need hospitalization, or psychotic features are present
4) . not due to substance or medical condition
criteria for hypomanic episode (3)
same as manic episode EXCEPT:
- present for at least 4 DAYS
- must be a change from usual behavior
- NOT severe enough to cause marked impairment in functioning
3 criteria for bipolar I
- must have at least one manic episode
- MAY have MD episode
- may have hypomanic episodes
one criterion for bipolar II
recurrent major depressive episodes with hypomanic episodes (HAS NEVER HAD a manic episode)
what is cyclothymic disorder?
chronic, fluctuating mood disturbance with numerous periods of hypomanic symptoms and periods of depressive symptoms that are distinct from each other.
criteria for cyclothymic disorder (3)
hypomanic symptoms (don’t meet criteria for hypomanic episode) AND depressive symptoms (but don’t meet criteria for MDE) for AT LEAST 2 YEARS
- never met manic criteria either
- not symptom free for greater than 2 months
4 common specifiers for cyclothymic disorder
1) . rapid cycling- at least 4 mood episodes in previous 12 months meet criteria for MD, manic or hypomanic episode
2) . with psychotic features: delusions/hallucinations
3) . with anxious distress
4) . with seasonal pattern
treatment for bipolar: meds and therapy
1) . meds: mood stabilizers (lithium FIRST LINE)
2) . anticonvulsants- Depakote or carbamazepine (if pt doesn’t respond to stabilizers)
3) . 2nd gen antipsychotics if psychotic symptoms present
4) . therapy- CBT, family
what are the three characteristics of atypical depression? how do you tx this?
mood reactivity
appetite increase/weight gain
hypersomnia
tx: MAOIs
what is seasonal depression?
depression symptoms at the same time each year
what is catatonic depression?
motor immobility, stupor and extreme withdrawal
what is melancholia?
anhedonia, lack of mood reactivity, severe weight loss/loss of appetite, excessive guilt, sleep disturbance
what does DIGFAST mean?
acronym for bipolar sxs D- distractibility I - Irresponsibility G- Grandiosity F- Flight of Ideas A- Activity increase S- Sleep Deficit T- Talkative
how to treat acute mania?
antipsychotics: Risperidone > Olanzapine > Haldol
OR mood stabilizers (lithium or Depakote)
what happens if you use antidepressant monotherapy in a patient with bipolar disorder?
it could precipitate a manic episode
how to treat premenstrual dysphoric disorder?
SSRIs for emotional symptoms with dysfunction
***oral contraceptives for pts who do not want to take SSRIs
what is adjustment disorder?
maladaptive emotional or behavioral reaction to an identifiable stressor (I.e. job loss, physical illness, divorce) that causes a disproportionate response THAN would normally be expected WITHIN THREE MONTHS of the stressor
- usually RESOLVES WITHIN 6 MONTHS
criteria for adjustment disorder
1) . one or both:
- marked distress out of proportion to the severity of the stressor
- impairment in functioning
2) . may manifest as depressed mood, anxiety, or conduct disturbance
tx for adjustment disorder
PSYCHOTHERAPY 1st
- meds in select cases
adjustment DO specifiers (6)
1) . with depressed mood
2) . with anxiety
3) . with mixed anxiety and depressed mood
4) . with disturbance of conduct
5) . with mixed disturbance of emotions and conduct
6) . unspecified
what is a mixed episode?
meeting criteria for both major depressive and manic episodes nearly every day for at least a week
