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5. HDS Neuro Psych > Mood Disorders > Flashcards

Mood Disorders Flashcards

1
Q

Mood Disorders

A
  • Bipolar and Related Disorders
  • Depressive Disorders
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2
Q

Bipolar and Related Disorders

A
  • Bipolar I Disorder
  • Bipolar II Disorder
  • Cyclothymic Disorder
  • Substance / Medication Induced Bipolar and Related Disorders
  • Bipolar and Related Disorder due another Medical Condition
  • Other Specified Bipolar and Related Disorders
  • Unspecified Bipolar and Related Disorders
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3
Q

DSM 5:

Depressive Disorders

A
  • Major Depressive Disorder
  • Persistent Depressive Disorder (Dysthymia)
  • Disruptive Mood Dysregulation Disorder
  • Premenstrual Dysphoric Disorder
  • Substance induced Depression
  • Depression due to another medical condition
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4
Q

Bipolar Disorders

vs

Depressive Disorders

A

Bipolar Disorder ⇒ Manic Episodes (with or without Depressive Episodes) OR Hypomanic Episodes + Depressive Episodes

Major Depression ⇒ only depressive episodes

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5
Q

Bipolar Disorder

Overview

A

Patients with Bipolar Disorder have:

A single or recurrent manic episodes with or without depressive episodes

or

Hypomanic episodes with depression

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6
Q

Manic Episode

A
  1. Distinct period of abnormally & persistent elevated, expansive or irritable mood AND abnormally and persistently increased goal directed activity or energy for 1 week
  2. During this period, 3 or more of the following (4 if irritable mood)
    • Inflated self-esteem or grandiosity
    • Decreased need for sleep
    • More talkative / Pressure of speech
    • Flight of ideas / subjective feeling of racing thoughts
    • Distractibility
    • Psychomotor agitation
    • Excessive involvement in activities which have a high potential for painful consequences
  3. Mood disturbance sufficiently severe to cause impairment in social occupational functioning or to need hospitalization
  4. Not due to substance abuse or medical condition
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7
Q

Manic Episode

DIGFAST

A

DIGFAST

  • Distractibility and easy frustration
  • Irresponsibility and erratic uninhibited behavior
  • Grandiosity
  • Flight of ideas
  • Activity increased with weight loss and increased libido Sleep is decreased
  • Talkativeness
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8
Q

Hypomanic Episode

A
  1. Distinct period of abnormally & persistent elevated, expansive or irritable mood AND abnormally and persistently increased goal directed activity or energy for 4 DAYS
  2. During this period 3 or more of the following (4 if irritable mood)
    • Inflated self-esteem or grandiosity
    • Decreased need for sleep
    • More talkative / Pressure of speech
    • Flight of ideas / subjective feeling of racing thoughts
    • Distractibility
    • Psychomotor agitation
  3. Excessive involvement in activities which have a high potential for painful consequences
  4. The episode is associated with unequivocal changes in functioning that is uncharacteristic
  5. The disturbance is mood and change in functioning is observable by others
  6. The episode is not severe enough to cause marked impairment in functioning or need hospitalization
    • If there are psychotic features, then by definition the episode is manic
  7. Not due to substance abuse or medical condition
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9
Q

Mania vs Hypomania

A
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10
Q

Depressive Episode

A
  1. Five (or more) of the following sx have been present during the same 2‐week period and represent a change from previous functioning
    At least one of the symptoms is either depressed mood or loss of interest or pleasure
    • Depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g., feels sad, empty, hopeless) or observation made by others (e.g., appears tearful). (Note: In children and adolescents, can be irritable mood.)
    • Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (as indicated by either subjective account or observation).
    • Significant weight loss when not dieting or weight gain (e.g., a change of more than 5% of body weight in a month), or decrease or increase in appetite nearly every day. (Note: In children, consider failure to make expected weight gain.)
    • Insomnia or hypersomnia nearly every day.
    • Psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings of restlessness or being slowed down).
    • Fatigue or loss of energy nearly every day.
    • Feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self‐reproach or guilt about being sick).
    • Diminished ability to think or concentrate, or indecisiveness, nearly every day (either by subjective account or as observed by others).
    • Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide.
  2. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
  3. The episode is not attributable to the physiological effects of a substance or to another medical condition.
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11
Q

Depressive Episode

SIGECAPS

A

Depressed mood or Anhedonia plus:

SIGECAPS

  • Sleep
  • Interest
  • Guilt
  • Energy
  • Concentration
  • Appetite
  • Psychomotor
  • Suicidal
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12
Q

Bipolar I

A

“The classic Manic‐Depressive Psychosis”

  • The patient has had at least one manic episode
  • There may or may not be a history of a major depressive episode
    • Vast majority of individuals who meet the criteria for a manic episode will experience a depressive episode in their lifetime
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13
Q

Bipolar II

A

Characterized by recurring mood episodes consisting of:

At least one hypomanic episode

One or more depressive episode

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14
Q

Bipolar Disorder

Course Specifiers

A
  • Rapid Cycling
  • Mixed features
  • Melancholia
  • Atypical features
  • Mood congruent / incongruent psychotic features
  • Catatonia
  • Peripartum Onset
  • Seasonal Pattern
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15
Q

Rapid Cycling

A

Can be seen in Bipolar I and II

4 or more episodes in the last 12 months which have

met the criteria for mania, hypomania or depressive episode

and are demarcated by full or partial remission

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16
Q

Mixed Features

A

Mania or Hypomania, with mixed features: The criteria for mania and hypomania are present plus there are depressive symptoms

Depressive episode with mixed features: Full criteria for a major depressive episode with manic or hypomanic symptoms

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17
Q

Melancholia

A
  • Loss of pleasure – Very marked anhedonia
  • Lack of reactivity
    • Does not feel better even temporarily if something good happens
  • Distinct quality of mood
  • Mood worse in the morning
  • Early morning awakening (at least 2 hours)
  • Marked retardation or agitation
  • Weight loss
  • Excessive or inappropriate guilt
18
Q

Atypical Features

A
  • Mood reactivity
  • Weight gain or increased appetite
  • Hypersomnia
  • Leaden paralysis
  • Long standing pattern of interpersonal rejection sensitivity
19
Q

Seasonal Pattern

A
  • There is a regular relationship between a mood episode and season
  • Not related to psychosocial stressors (anniversaries, unemployment…)
  • More likely in Bipolar II than in Bipolar I
  • Winter type seasonal pattern is related to latitude (Higher), Age (younger) and Sex (females)
20
Q

Mood Congruent / Incongruent

Psychotic Features

A
  • Delusions and Hallucinations can be present at any time during a mood episode
  • Psychotic features can be mood congruent or incongruent
    • Mood Congruent: Delusions and hallucinations are consistent with the mood.
      • E.g. Grandiose delusions during a manic episode or delusions of guilt during a depressive episode
    • Mood Incongruent: The content of the delusions is not consistent with the polarity of the episode
21
Q

Peripartum Onset

A
  • Onset of symptoms occurs during pregnancy or in the 4 weeks following delivery
  • Prevalence 3‐6%
  • 50% of “post-partum depression” actually begins during pregnancy
  • Psychotic symptoms may be present
22
Q

Cyclothymic Disorder

A
  • Duration of symptoms 2 yrs
    • 1 yr in children
  • Numerous hypomanic symptoms and depressive symptoms that do not meet the criteria for a hypomanic episode or depressive episode
  • Mood symptoms have been present for at least half the time in the 2-year period
23
Q

Major Depressive Disorder

A
  • Meets criteria for a Major Depressive Episode
  • There has never been a manic or hypomanic episode
  • Not due to substance abuse or another medical condition
24
Q

Depression vs. Grief

A
  • Responses to a significant loss may include the feelings of intense sadness, rumination about the loss, insomnia, poor appetite, and weight loss noted in Criterion A, which may resemble a depressive episode
    • Ex. bereavement, financial ruin, losses from a natural disaster, a serious medical illness or disability
  • Although such sx may be understandable or considered appropriate to the loss, the presence of a major depressive episode in addition to the normal response to a significant loss should also be carefully considered
  • This decision inevitably requires the exercise of clinical judgment based on the individual’s hx and the cultural norms for the expression of distress in the context of loss
25
Grief / Bereavement
* Predominant feeling of **emptiness and loss** * **Dysphoria** tends to _decrease_ over days / weeks * “Pangs of grief” – depression in **waves** * Grief often accompanied by **positive emotions and humor** * **Self-esteem maintained** (worthlessness in MDD)
26
Persistent Depressive Disorder | (Dysthymia)
* **Depressed mood** _on most days_ for **2 years** * 2 or more of the following: * Poor appetite or Overeating * Insomnia or Hypersomnia * Low energy * Low self esteem * Poor concentration * Hopelessness * Criteria for Major Depressive Disorder **may** also be present
27
Disruptive Mood Regulation Disorder
* **Severe recurrent temper outburst** manifested as verbal rages and physical aggression * “Temper tantrums” * Outbursts are **inconsistent with developmental level** * The onset is **before the age of 10 years** * The diagnosis is not made for the first time _before the age of 6 years_ or _after the age of 18 years_
28
Premenstrual Dysphoric Disorder
_Depressive sx present:_ * In majority of menstrual cycles * Start the final week before the onset of menses * improve within days of onset of menses * become minimal in the week post menses
29
Bipolar Epidemiology
* Lifetime prevalence of Bipolar Spectrum Disorder is around **2%** * **Similar across all geographical regions** * **Sex ratio is almost equal** * Age of Onset: * **Around 20 years for Bipolar I** * **Slightly later for Bipolar II** * 65% of all Bipolar patients will have their first mood episode **before the age of 25** * Rare for a mood disorder to start in the fourth or fifth decade * The strongest established risk factor for BPD is a **family history of BPD** * Also is an increased family history of depression * Socioeconomic status: ? * **Suicide risk is 15x** that of the general population
30
Major depressive Disorder (MDD) Epidemiology
* Prevalence: **7% in individuals 18‐29** and **three times higher in 60+** * **Females \> Males** by a factor of 1.5 – 3x * Course is very variable * 40% start improving within 3 months and 80% by one year * **Suicide risk 15‐20%**
31
Mood Disorders Etiology
* **Biological Factors** * Neurotransmitters * Hormonal Dysregulation * Neuroanatomical Corelates * Genetics * **Psychological Factors** * **Social Factors**
32
Monoamine Hypothesis of Depression
* Suggests that **decreased levels of serotonin and norepinephrine** result in the symptoms of depression * **Most antidepressants increase levels of monoamines** * Medications that target the monoamines, cause an increase in the synaptic monoamines within hours of administration, but it takes weeks for symptoms to improve * It is suggested that **deficiency of NE and 5HT** leads to **upregulation of post synaptic receptors** * The improvement in depression as well as the time course is related to the **down regulation of these receptors**
33
Monoamines in Mania
* **Antidepressants** can **induce mania in patients with depression** * CSF levels of the **norepinephrine** metabolite 3‐methoxy‐4‐hydroxyphenylglycol [**MHPG**] are increased in Mania * Inconsistent results for metabolites of Serotonin and Dopamine in CSF
34
Hormonal Dysregulation
* **Elevated HPA activity** is the clearest link between stress and depression * **Hypercortisolemia** is found in a significant proportion of depressed patients * **Thyroid dysfunction and depression** * **Blunted TSH** response to TRH * **Steroids** and Mood disorder – both depression and mania
35
Neuroanatomical Correlates
_Four anatomical areas correlated with mood disturbance:_ ## Footnote 1. Prefrontal cortex 2. Anterior cingulate cortex 3. Hippocampus 4. Amygdala
36
Genetics
If _one parent has a mood disorde_r the **risk in children for a mood disorder is between 10‐25%** A _family history of bipolar disorder_ conveys a **greater risk for mood disorders in general**
37
Biological Factors
Sleep Studies: **Depression – Reduced REM latency, shift in REM sleep to first half** * Normal: * First REM after 90 mins * Dreams are mostly in 2nd half of the night * Depression: * First REM after 45-60 mins * Dreams shift to first half * Reduction in REM and stage 3 and 4 * Pt feels tired and not well rested
38
Psychological Factors
* **Long standing stress / Adverse childhood events** * **Personality**: No one particular type predisposes to depression. OCD, histrionic and borderline more at risk. * **Psychodynamic Theory**: * Disturbance in mother‐infant relationship in the oral phase. * Depression is linked to real or imagined loss. * Introjection of departed object. * Ambivalent feelings to the departed object with anger directed inwards. * Mania is seen as reaction against depression. * **Cognitive Theorist** emphasize cognitive distortions in persons susceptible to depression * **Learned helplessness**: depression linked to learned helplessness
39
Pharmacotherapy
* Treatment of Manic Episode * Treatment of Depression in Bipolar Disorder * Maintenance treatment of Bipolar Disorder * Treatment of Depression
40
Biological Treatments
* Electro Convulsive Therapy (ECT) * Transcranial Magnetic Stimulation (TMS) * Vagal Nerve Stimulation (VNS)
41
Psychotherapies
* **Cognitive behavioral therapy (CBT)** * **Short‐term**, **goal‐oriented** psychotherapy treatment that takes a **hands‐on, practical approach to problem‐solving**. * Its goal is to **change patterns of thinking or behavior** that are behind people's difficulties, and so change the way they feel. * **Interpersonal Psychotherapy (IPT)** * Based on the principle that **relationships and life events impact mood** and that the reverse is also true. * It is time **limited to 14‐16 sessions** * **Psychodynamic Oriented Psychotherapies**

5. HDS Neuro Psych (46 decks)

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