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Psychiatry > Mood Disorders > Flashcards

Mood Disorders Flashcards

1
Q

What is the classification of depressive disorders?

A

One or more depressive disorders without a history of manic or hypomanic episodes

  1. Major depressive disorder
  2. Persistent depressive disorder
  3. Premenstrual dysphoric disorder
  4. Disruptive mood days regulation disorder
  5. Substance/medication induced depressive disorder
  6. Depressive disorders due to another medical condition
  7. Other specified depressive disorders
  8. Unspecified depressive disorder
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2
Q

What are the common characteristics of depressive and manic disorders?

A
  1. Periodicity: acute episodes, single or recurrent

2. Return to Normal after the acute phase(return to previous level of functioning)

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3
Q

What is mood?

A

Mood is a persistent emotion that colours the attitude of an entire individual

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4
Q

What is a depressive episode?

A

It is a persistent depressed mood that lasts at least 2 weeks and can be accompanied by insomnia, weight loss and impaired concentration

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5
Q

What is euphoria?

A

It is an abnormally elevated mood

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6
Q

What is a manic episode?

A

It is an abnormally elevated mood with insomnia and hyperactivity

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7
Q

What is a mood disorder?

A

A pattern of mood episodes that can be characterized as manic episodes and/or depressive episodes

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8
Q

What are the different classifications of bipolar disorders?

A

Characterised by one or more manic disorders

  1. Bipolar 1 disorder
  2. Bipolar 2 disorder
  3. Cyclothymic disorder
  4. Substance/medication induced bipolar disorder
  5. bipolar and related disorder due to another medical condition
  6. Other specified bipolar and related disorder
  7. Unspecified bipolar and related disorder
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9
Q

What is the differential diagnosis for a manic episode?

A
  1. Substance induced manic disorder-amphetamine, alcohol
  2. Manic disorder due to another medical condition
  3. Attention deficit/hyperactivity disorder in children
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10
Q

What is a manic episode characterised by?

A
  1. A distinct period where the person has abnormally and persistently elevated, expansive and irritable mood that is marked with an increase in energy and activity levels
  2. The symptoms we can expect are:
    - decreased need for sleep(feels fine after 3 hours of sleep)
    - grandiosity or inflated mood
    - flight of ideas
    - Talkative and increased urge to talk
    - distractibility
    - increase in goal directed activity on social, sexual and professional levels
  3. The mood disorder is severe enough to warrant hospitalization or dysfunction in social or occupational functioning
  4. Symptoms are not due to substances or to another medical condition
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11
Q

What is hypomania?

A

Hypomania is a milder form of mania where there is no impairment in the occupational or social life of a patient but rather can be seen as increased creativity and productivity and can sometimes not be presented as a problem

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12
Q

What is the age of onset for mania?

A

Usually teens to early twenties and rarely after 50 years old

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13
Q

How long must the symptoms be present for before we can call it mania according to the DSMV?

A

Mania: 7 days
Hypomania: 4 days

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14
Q

What is the typical course of a manic episode?

A

Sudden onset worsening over a couple of days

A manic episode usually lasts days to months and is shorter than major depressive episodes

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15
Q

What are the associated characteristics of a manic episode?

A
  1. Impaired insight and refusal for treatment especially bipolar 1 disorder
  2. Labile mood
  3. Delusions and hallucinations like grandiosity
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16
Q

What is a complication of manic episodes?

A

Substance use

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17
Q

What are the possible consequences that could cause problems for the patient?

A

Criminal behavior and financial losses

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18
Q

What are the diagnostic criteria for major depressive episodes?

A
  1. Persistent depressed mood, most of the day, almost everyday
  2. Decreased interest and pleasure in activities
  3. Significant loss of weight or appetite or increased weight or appetite
  4. Insomnia or hypersomnia almost every day
  5. Tiredness, listelessness
  6. Concentration impairment
  7. Recurrent thoughts of death, suicidal ideas or gestures
  8. Feelings of unworthiness, guilty
  9. Psychomotor agitation
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19
Q

What are the associated characteristics of major depression?

A

-functional shift which are vegetative symptoms
The 5 cardinal symptoms of a functional shift include:
1. Loss of appetite
2. Loss of weight
3. Diurnal mood swings(patient feels worse in the morning)
4. Terminal insomnia
5. Decreased libido

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20
Q

What is the functional shift?

A

It represents the depression of the hypothalamic function

  • it provides us with specific symptoms with which an accurate diagnosis can be made
  • they can sometimes be reversed when someone has increased appetite, weight gain and hypersomnia
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21
Q

What is a rare occurrence in depressive episodes that points towards severe degree of depression?

A

Psychotic symptoms like Hallucinations and delusions

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22
Q

What is major depressive disorder?

A

It is a disorder characterised by recurrent major depressive episodes without mani and hypomanic episodes

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23
Q

What is becoming the most important cause of disability worldwide?

A

Major depressive disorder

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24
Q

Why is major depressive disorder more common in women?

A

Because of hormonal factors

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25
Q

What is the essential characteristics of major depressive disorder?

A

It is the persistent depressed mood and the inability to take pleasure in most or all activities for a period of 2 weeks

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26
Q

What is the course of major depressive disorder?

A
  • sometimes it is one episode and patients return to previous functioning
  • sometimes there’s rapid episodes in succession to one another
  • sometimes there are long periods of normal functioning between episodes
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27
Q

What is the mask of depression in children?

A
  • anxiety, uncertainty
  • social withdrawal
  • deterioration in performance at school
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28
Q

What is the mask of depression in elderly people?

A

-they can present similarly to Alzheimer’s where the patient is irritable, has impaired concentration and memory , m,ore quiet and withdrawn and more listless

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29
Q

What is somatisation?

A

This is when patients present with physical symptoms or hypochondriac preoccupation with specific symptoms

30
Q

What is Yuppie flu?

A

This is chronic fatigue where a patient needs antidepressant medication

31
Q

What are the possible masks of depression?

A
  1. Children
  2. Elderly
  3. Somatisation
  4. Agitation
  5. Chronic fatigue
32
Q

What is the most important cause of completed suicide?

A

Major depressive disorder

33
Q

What should be the approach to a suicidal patient?

A

Tact and empathy
Ask about the patients ability to enjoy life, thoughts on death etc.
Hospitalise the patient if the risk is great

34
Q

What is the average age of onset for MDD?

A

Late twenties

35
Q

What is the course of major depressive disorder?

A

It can occur for a period of days to weeks and if there is a stressor it can occur suddenly

36
Q

What are the complications of major depressive disorder?

A
  1. Suicide
  2. Substance use
  3. Infections
  4. Malignancy
  5. Cardiovascular
  6. Metabolic disorders
37
Q

What are the predisposing factors to getting major depressive disorder?

A
  1. Chronic mental illness
  2. Alcohol and drug abuse
  3. Psychosocial stressors-pregnancy, bereavement , divorce
38
Q

What is the aetiology of major depressive episodes?

A
  1. Biological
    - genetics
    - biochemical
    - endocrinological
  2. psychosocial
39
Q

What is the genetic cause of depression?

A

There is usually positive family history
Molecular genetic studies show a positive component however the exact chromosomes are unknown
-it is postulated that cumulative genetic process (oligogenetic) rendering with environmental factors contributes to the depression

40
Q

What is the biochemical association?

A

That there is a lack of serotonergic and noradrenaline in the limbo-hypothalamic areas

41
Q

What is the endocrinological association?

A

There is moderate hypercortisolaemia that escapes suppression with the dexamethasone suppression test
-recent studies show hypersecretion of the corticotrophin releasing hormone and reduced levels of brain derived neurotrophic factor

42
Q

What is the psychosocial association with depression?

A

Children that have lost a parent before 11 are predisposed to depression
The recent loss of a loved one also contributes as there is the interaction between genetic loading for depression sand environmental factors

43
Q

What is the differential diagnosis for major depressive disorder?

A
  1. Uncomplicated bereavement
  2. Adjustment disorder with depressed mood
  3. Schizophrenia
  4. Anxiety disorders
  5. Alcohol and other substance use disorders
  6. Viral infections, chronic pain, underlying malignancy
  7. Medication like anti-hypertensives, ARV’S
44
Q

What is bipolar disorder?

A

It is a disorder that is characterised by at least one manic episode

45
Q

What is bipolar 2 disorder?

A

Characterised by atlesast one hypomanic disorder with one or two major depressive episodes

46
Q

How does the manic episode typically present in a bipolar patient?

A

It is not usually the euphoric mania but rather irritability and dysphoric

47
Q

What makes the depressive episode in a BMD different to MDD?

A

They usually have atypical symptoms such as hypersomnia, increased appetite, psychomotor retardation and interpersonal sensitivity

48
Q

What is the aetiology of bipolar mood disorder?

A

Genetics
The chance of a child getting BMD is 27% with one parent and 50-70% with both parents
And monozygotic twins is 0,67 and dizygotic is 0.20

49
Q

What is rapid cycling?

A

This is when the patient presents with episodes occurring frequently with almost no normal or symptom free period in between

50
Q

What is cyclothymic disorder?

A

It is a chronic mood disorder of two years where the patient presents with frequent periods of hypomania and depressed mood that does not meet the criteria for a Major depressive episode or manic episode

51
Q

What is persistent depressive disorder?

A

A. It is characterised by long-standing chronic low grade depressive mood for for most of the day and more days than not for at least 2 years

B. Presenting with at least 2 symptoms:

  • decreased or increased appetite
  • insomnia/hypersomnia
  • tiredness/
  • reduced concentration
  • decreased self confidence
  • difficultly making decisions
  • feelings of helplessness

C. Never symptom free for longer than two months over the two years
D. No indication of a major depressive episode over the first two years
E. No previous manic or hypomanic episodes
F. Not superimposed on a psychotic condition
G. No indication of another medical condition or substance induced disorder that could cause or perpetuate the disoder

52
Q

In which cases would we treat major depressive disorder as an inpatient?

A
  1. Severe form of depression
  2. High risk of suicide
  3. Side effects of medication
  4. Poor support structure at home
  5. When electroconvulsivbe therapy is required
  6. If the patient suffers from psychiatric and medical conditions that need treatment
53
Q

How long do we usually hospitalise a patient?

A

A couple of days to a week

54
Q

When can we start to see improvement in major depressive disorder on treatment?

A

1-3 weeks later, sometimes more

55
Q

When can we treat a patient with just psychotherapy?

A

If it is mild MDD

56
Q

What are the advantages of using the new SSRI’S?

A
  1. They don’t cause cardiotoxicity
  2. Usually simple dosing like one tablet per day
  3. Less weight gain
  4. Decreased epilogenecity
57
Q

What are the problems with the new anti-depressants?

A
  1. The compounds are metabolized through Cytochrome P450 hepatic enzyme system and cause drug interactions
58
Q

What are the new antidepressants ?

A
  1. Selective serotonin reuptake inhibitors (SSRI’S) fluoxetine 20mg
  2. Serotenigeric norepinephrine reuptakwe inhibitors (SNRI’S) vanlafaxine 75-300mg
  3. Melatonergic and monoaminergic antidepressants- agomelatine 25-50mg
  4. Noradrenergic and specific serotonergic antidepressants (NaSSA) Mirtazapine 15-30mg per day
  5. Reversible inhibitors of monoamine oxidase A (RIMA) 300-600mg per day
59
Q

What are the anticholinergic side effects that were associated with the older antidepressants?

A
  1. Dry mouth
  2. Sexual dysfunction
  3. Hand tremor
  4. Tachycardia
  5. Constipation
  6. Sleepiness
  7. Excessive sweating
60
Q

What are the psychotherapy options for the treatment of major depressive disorder?

A
  1. Supportive psychotherapy:
    This helps to develop defence mechanisms snd stress tolerance and stress tolerance in times of stress and illness
  2. Crisis management: the increased motivation , insight and change that occurs after crisis experiences helps the patient make necessary adjustments to return to emotional equilibrium
  3. Cognitive behavioral therapy
61
Q

When would you consider giving the patient electroconvulsive therapy?

A
  1. If the patients suffers from severe major depression
  2. If the patient has depression resistant to medication
  3. Severe and immediate risk for suicide
  4. If the patient has stopped eating an drinking as a result of the depression and it endangers the patients life
  5. If the patient chooses to
  6. Psychomotor stupor
62
Q

What are the risks for doing electroconvulsive therapy?

A
  1. Musculosceletal injury-very rare

2. Memory disturbance usually a few weeks.

63
Q

What are the pharmacological agents we use in bipolar mood disorder?

A

We need mood stabilizers:

  1. Lithium
  2. Anticonvulsant meds- carbamezipine, sodium valproate, lamotrigine
  3. Anti-psychotic meds- olanzipine
64
Q

What is the daily dose of lithium?

A

750-1500mg per day

65
Q

What is the therapeutic dose of lithium in blood?

A

0,6 and 1,2 mmol per litre

66
Q

What are the symptoms that become evident when we reach toxicity of lithium?

A
  1. Tremor
  2. Abdominal pain
  3. Nause and vomiting
  4. Diarrhea
  5. Hyperreflexia
  6. Ataxia
  7. Coma
  8. Death
67
Q

What are the the N things to know about sodium valproate?

A

It is an alternative to lithium and can be given as a loading dose of 30 mg/kg/day for the first two days

  • it has a wide therapeutic index
  • it is used in patients with mixed pictures(rapid cycling), substance abuse or head injury patients
  • you need to do liver function tests every 6 months because of hepatotoxicity
68
Q

What is the gold standard of bipolar mood disorder treatment?

A

Lithium

69
Q

What can you give to a acute manic patient to manage the episode?

A

We give second generation anticonvulsants or benzos such as lorazepam and(2-4mg) IV or IM every 6 hours or you can give haloperidol (2-5mg)IV or IM

70
Q

What do we do with a manic patient?

A

The patient usually needs to be hospitalized for a few days to a few weeks in a psychiatric hospital
-they are usually involuntary patients and we usually follow them up as out patients as we treat them with mood stabilizers

71
Q

How do we treat depressive episodes of BMD?

A

We need to use both mood stabilizers and antidepressants to prevent rapid cycling
-the best treatment is lamotrigine, lithium, aripraprozole and a combination of olanzipine and fluoxetine

Psychiatry (17 decks)

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