Mood Disorders Flashcards
What defines major depressive disorder
one or more depressive episodes within the same 2 weeks
with 5 or more symptoms
What separates major depressive disorder from persistent depressive disorder?
Persistent depressive disorder lasts for at least 2 years with asymptomatic periods not exceeding 2 months
Define Mania
abnormally elevated, expansive or irritable mood, lasting at least 1 week plus 3 of 7 characteristic symptoms
what is hypomania
elevated mood, but not accompanied by psychotic symptoms, lasting for at least 4 days.
Patients are usually productive during hypomanic episodes as contrasted with mania
describe symptoms seen in mania
talking fast
slurred speech
decreased need for sleep
psychomotor agitation
flight of ideas
disinhibition and irresponsibility
grandiosity
easily distractable
aytpical features of depression
weight gain
hypersomnia
responsive to life situations, but devastated at the slightest rejection
feeing that extremities are weighing them down
compare and contrast depression vs bereavement
treatment for Major depressive disorder
SSRIs
MAOI
TCAs
SNRI
Esketamine
CBT
Electroconvulsive therapy
Treatments for mania
Valproate
Carbamazepine
Lamotrigine
Lithium
Antipsychotics
Etiology of Depressive Disorders
most mood disorders run in the family, but unclear if there is genetic transmission
people can experience loss of disappointment at any point in life
consistently negative environments can cause an increase in cortisol
decreased norepi
Lifetime prevalence of major depressive disorder and persistend depresive disorder
MDD: 17%
dysthymia: 2-3%
Prevalence of depressive disorders between genders
women> men
(2:1)
Epidemiology for bipolar disorder
2% (bipolar 1 & 2 combined)
women> men (3:2)
what is psychosis
- The group of symptoms that characterizes the most severe mental illness (schizophrenia, mania) and involve impairments in the ability to make judgments about boundaries between reality and fiction
- Group of symptoms that are common in aforementioned disorders
what are delusions
an abnormality in content of thought. They are false beliefs that cannot be explained on the basis of the patient’s cultural background.
presentation of psychosis
Having delusions, hallucinations, bizarre behaviors, disorganized speech and inappropriate affect
Presentation of delusions
• Grandiose type- Possessing wealth or great beauty or having a special ability; having influential friends; being an important figure
• Nihilistic-Believing that one is dead or dying; believing that one does not exist or that the world does not exist
• Persecutory- Being persecuted by friends, neighbors, or spouse; being followed, monitored, or spied on by the government or other important organizations
• Somatic- Believing that one’s organs have stopped functioning or are rotting away; believing that the nose or another body part is terribly misshapen or disfigured
• Sexual- Believing that one’s sexual behavior is commonly known; that one is a prostitute, pedophile, or rapist; that masturbation has led to illness or insanity
• Religious- Believing that one has sinned against God, that one has a special relationship to God or some other deity, that one has a special religious mission, or that one is the Devil or is condemned to burn in Hell
• Mind reading
• People can hear their thoughts
• Thought insertion
• Thought withdrawal
disorders associated with psychosis and delusions
- Schizotypal personality disorder
- Delusional Disorder
- Brief Psychotic Disorder
- Schizophreniform Disorder
- Schizophrenia
- Schizoaffective
- Catatonic
Schizotypal personality disorder
Diagnostic criteria and treatment
definition: characterized by a pattern of peculiar behavior, odd speech and thinking, and unusual perceptual experiences
features: Schizotypal patients are frequently socially isolated and have “magical” beliefs, mild paranoia, inappropriate or constricted affect, and social anxiety
treatment: Second-generation Antipsychotics- well tolerated and may help reduce the intense anxiety, paranoia, and unusual perceptual experiences
Delusional disorder
Diagnostic criteria and treatment:
Criteria: one or more delusions lasting at least a month without impaired functioning
treatment: Any antipsychotic can be used: high potency antipsychotics(haloperidol), Second-generation antipsychotics (risperidone), pimozide, SSRI
Group therapy- patients are suspicious and tend to misinterpret situations that can arise during the course of therapy
Schizophreniform disorder
Criteria:
treatment:
Criteria: used for patients who present with symptoms typical of schizophrenia but have been ill for less than 6 months
treatment: (same as acute schizophrenia): high potency antipsychotics, second-generation antipsychotics, then clozapine.
Schizoaffective disorder
criteria:
treatment:
Criteria: an uninterrupted period of illness during which there is a major mood episode concurrent with concurrent symptoms of schizophrenia and delusions/ hallucinations for 2 or more weeks in the absence of a major episode
treatment: Second-generation antipsychotics
Paliperidone
Mood stabilizers
what is catatonia
A state of abnormal behavior and movement, often including catalepsy (immobility), purposeless motor activity, strange postures, negativism, and mutism.
Schizophrenia
Diagnostic criteria
Treatment
Associated conditions
Criteria:
2 or more schizophrenic symptoms for a significant portion of time during a 1 month period, with at least 1 being delusions, hallucinations or disorganized speech. Also includes a decreased level of functioning since onset and has been contiguous for at least 6 months
Treatment:
Acute: high potency antipsychotics, second-generation antipsychotics, then clozapine.
Benzos if anxiety is prominent
Lithium carbonate and First-line anticonvulsants to decrease impulsive/ aggressive behaviors, hyperactivity or mood swings
Antidepressants if depressive symptoms are prominent
Electroconvulsant therapy
Assertive Community treatment
Family therapy
Cognitive, Vocational and Psychosocial Rehabilitation
Social skills training
Halfway houses
Associated conditions:
Schizotypal personality disorder
Delusional disorder
Schizophreniform disorder
Schizophrenia
Schizoaffective disorder
Catatonia
Describe positive and negative symptoms of psychosis
Define obsession
obsessions are recurrent and persistent ideas, thoughts, impulses, or images that are experienced as intrusive and inappropriate and that cause marked anxiety or distress
What are compulsions?
. Compulsions are repetitive and intentional behaviors (or mental acts) performed in response to obsessions or according to certain rules that must be applied rigidly
clinical presentation of OCD
a person must have either obsessions or compulsions that cause marked anxiety or distress, are time-consuming (more than 1 hour daily), or significantly interfere with the person’s normal routine, occupational functioning, or usual social activities and relationships
what medications and therapies are considered for OCD treatement
Meds (SSRIs, Clomipramine (TCA), Venlafaxine)
Behavior therapy
Psychotherapy
Family Therapy
Disorders associated with OCD
• Obsessive-compulsive disorder
• Body dysmorphic disorder
• Hoarding disorder
• Trichotillomania (hair-pulling disorder)
Excoriation (skin-picking) disorder
characteristics of OCD vs:
- Obsessive-compulsive personality disorder
- generalized anxiety disorder
- hoarding disorder
- tic disorder
- body dysmorphic disorder
- Trichotillomania
etiology of trauma/ stress-related disorders
• Traumatic event severe enough to be outside the range of normal human experience
highest cases of acute stress disorder come from…
interpersonal traumatic events (~50%)
MVAs (~13%)
Lifetime prevalence of PTSD and what are the top causes by gender
9% lifetime prevalence
women: assault
men: combat
who are adjustment disorders usually seen in and who tends to develop them?
seen most in women, unmarried people and young people (~5-20% undergoing outpatient mental care)
~1/3 cancer patients develop these disorders
Treatment of Acute stress disorder
Cognitive Behavior therapy
Benzos-reduce agitation and sleep disturbance
Treatment of PTSD
First-Line: Psychotherapy with or without medication- cognitive behavior therapy
SSRI and SSNRI (when CBT is not available), Prazosin (nightmares), atypical psychotics (psychotic symptoms), Benzos (hyperarousal and anxiety)
Conditions associated with trauma and stress-related disorders
• Reactive attachment disorder
• Disinhibited social engagement disorder
• Posttraumatic stress disorder
• Acute stress disorder
Adjustment disorders
presentation of Disruptive, Impulse-Control and Conduct Disorders
impaired self control
treatment of disruptive, impulsive-control and conduct disorders
• Cognitive Behavior Therapy
• Conduct Disorder: CBT and psychostimulants in comorbid ADHD, antipsychotic meds or mood stabilizers in severe aggression
• Oppositional Defiant Disorder: Psychotherapy
Disruptive Mood Dysregulation Disorder: psychotherapy, stimulants, antidepressants and atypical antipsychotics to address irritability and mood problems
Disorders associated with Disruptive, Impulse-Control and Conduct Disorders
• Oppositional defiant disorder
• Intermittent explosive disorder
• Conduct disorder
• Antisocial personality disorder
• Pyromania
Kleptomania
compare and contrast
conduct disorder
oppositional defiant disorder
disruptive mood disorder
normal development
compare and contrast differentials for trauma and stress-related disorders
