Mood disorders

Question 1

Major depressive disorder

Answer 1

A minimum 5 symptoms for at least 2 weeks (at least one of the following two)

• Depressed mood- irritable in kids
• Loss of interest or pleasure

Additional depressive symptoms, 4 of the following:
Weight loss or gain, insomnia/hypersomnia, psychomotor retardation or agitation, fatigue or energy loss, worthlessness or guild, decreased concentration, death thoughts, suicidal thought, plans acts

> 5 symptoms in the same 2 week period:
SIGE CAPS
Sleep, Interest* (depressed mood/ loss of interest), Guilt, Energy, Concentration, Appetite, Psychomotor Retardation or agitation, Suicide

• must include Interest

Question 2

nosology (classifications of depression)

Answer 2

Reactive vs Endogenous
Psychotic vs Neurotic
Primary vs Secondary (due to cancer or HTN disorders)
Bipolar vs Unipolar
Agitated vs Retarded

Question 3

Screenig for Depression in primary care

Answer 3

US preventive services task force recommends screening for depression in practices able to then actively manage patients who screen positive

2 question depression screen: over the past 2 weeks have you felt down or hopeless, over the past 2 have you felt little interest in doing things

A yes to either question is a positive screen for depression

Or PHG9 5-9 (monitor), at 14 start giving meds

Question 4

Terminology of bipolar

Answer 4

manic depression
Hypomania (manic episodes are milder)
Bipolar 1 and 2 (1 manic episode in their life, hypomanic is bipolar 2)

Rapid cycling- short intervals between manic episodes
mixed-
Cyclothymic- the amplitude is low

Question 5

Diagnosing a manic epidsode

Answer 5

distinct period, at least one week
Abnormally and persistently elevated, expansive mood
Or irritable mood, and abnormally and persistently increased goal directed activity
sufficient severity

Minimum of 3, 4 if irritable: grandiosity, decreased need for sleep, hyperverbal or pressured speech, flight of ideas or racing thoughts, distractibility, increased goal directed activity, psychomotor agitataion, more pleasurable activity with painful consequences (infidelity, shopping sprees)

Question 6

Three stages of mania (stage 1) aka hypomania

Answer 6

Stage1: increase in psychomotor activity, rate of speech, labile mood, euphoric, expansiveness, grandiosity, coherent thoughts, tangential
increased sexual preoccupation, religiousness, spending, letter writing
Hight but not out of control

Question 7

Stage 2

Answer 7

increased pressured speech, psychomotor activity, increase dysphoric mood, depression, open hostility, anger, explosive, assaultive behavior, flight of ideas, preoccupations now frankly delusional

Question 8

Stage 3

Answer 8

Desperate, panic stricken state, frenzied, bizarre psychomotor activity, loose associations, bizarre, idiosyncratic delusions, hallucinations, disorientation, ideas of references