Mood Disorders Flashcards
What is the second most debilitating disease after heart disease?
Major depressive disorder
50% of patients with bipolar disorder have first-degree relative with
mood disorder
10-25% with mood disorder have relative with it too
Neurotransmitters implicated in depression
Norepinephrine (downregulates beta receptors; abnormal)
Dopamine (decreased)
Serotonin/5-HT (decreased)
GABA (decreased)
Glutamate (NMDA receptor involved?)
What NT is increased in mania?
dopamine
Why are SSRIs and anxiolytics/benzos good treatment for depression?
SSRIs make more serotonin available (decreased in depression)
benzos/anxiety meds act on GABA receptor to increase it (decreased in depression)
Factors that can lead to depression
psychosomatic medicine
often precedes first mood episode
death of parent before 11
death of spouse or child
unemployment
DSM criteria for major depressive episode
at least 5 for a 2 week period with at least 1 depressed mood or lost of interest/pleasure
–>weight loss or gain when not dieting, insomnia or hypersomnia, psychomotor agitation or retardation, fatigue, worthlessness or excessive guilt, diminished ability to concentrate, recurrent thoughts of death or suicide
all need to occur EVERY DAY
What does the diagnosis of major depressive disorder require?
presence of 1+ major depressive episodes and ABSENCE of mania, hypomanic, mixed episodes
Associated features of major depressive disorder
psychotic: hallucinations or delusions where they feel they cause everything bad in the world
anxious distress
melancholic (sleep only, don’t eat, absence of all pleasure)
catatonic (lay in bed and stare, if you move them they stay there–> life threatening)
peripartum onset (during or 4 weeks after)
Ddx for manic depressive disorder
substance/drug-induced
mood disorders from general medical condition (AKA psychosomatic, think hypothyroid or DM)
normal grief/bereavement
Describe normal grief/bereavement
up to 1-2 years
sx similar to major depressive disorder but shouldn’t have hallucinations/delusions, impairment of fxn and grief comes in waves (MDD more persistent)
tmt doesn’t include antidepressants
Denial–>Anger–>Bargaining–>Depression–>Acceptance
Treatment of MDD (major depressive disorder)
hospitalization
somatic therapies
–> TCA, MAO inhibitor, SSRIs, trazadone, bupropion, SNRIs, second generation antipsychotics for augmentation
Electroconvulsive therapy (ECT)
- ->used for tmt resistant depression; induces 30 second seizure with short-term memory loss so don’t remember procedure (long-term rare)
- ->safe and effective, can be used in pregnancy with 75-80% response
Transcranial Magnetic Stimulation
–>magnetic field stimulates neuronal pathways, 50% effective, done in doctor’s office
Ketamine
- ->off-label for tmt resistant depression, causes dissociative anesthesia (NMDA antagonist similar to PCP but less toxic)
- -> 50% reduction in SI in 24 hours, but only temporary so need infusion
Spravato (esketamine)
- -> FDA for tmt resistant depression
- -> can’t be taken at home, in nasal spray and rapid acting but hella expensive
Describe persistent depressive disorder (dysthymia)
essentially a chronic moderate depression
depressed mood for most of the day for 2 years in adults/ 1 year in children that hasn’t been severe enough to meet MDD criteria
during 2 years, can’t be without sx for more than 2 months–> must be continuous, no manic episodes
Tmt for dysthymia/persistent depression
more difficult to treat
pharm (SSRI, SNRI, MAO-)
CBT
Define depression with seasonal pattern
onset and remission of MDD at characteristic times of year (changes of season like fall into winter)
AKA seasonal affective disorder
sleep and eat more, fatigued
use light therapy for tmt
Define premenstrual dysphoric disorder (PMDD)
mood instability with anxiety, depression, irritability, sleep disturbances
week before menses, consistent pattern over the year
Treatment for PMDD (premenstrual)
exercise, diet, relaxation therapy
SSRIs during cycle or 2 weeks before menses (sertraline, fluoxetine)
What is a manic episode?
abnormally and persistently elevated, expansive, irritable mood
last at least 1 week with at least 3 of:
- -> inflated self-esteem or grandiosity
- -> decreased need for sleep
- -> more talkative (pushy or pressured)
- -> flight of ideas/racing thoughts
- -> distractibility
- -> increased goal-oriented behavior
- -> excessive involvement in pleasurable activities
marked impairment in work/social activities/relationships
can’t be caused by drugs or other medical condition
Describe a hypomanic episode
similar to manic but less severe and only lasts 4 days
enough to where people notice you aren’t acting normally
not psychotic (don’t think you can read minds, not Jesus, etc)
no social or occupational impairment
Define Bipolar I disorder
more severe
at least 1 manic or mixed (mania with depression)
Major depressive episode not required for dx but usually presents first
can by psychotic with delusions or hallucinations
worse prognosis than MDD (major depressive disorder)
–> die from SI and accidental from manic episodes
Define Bipolar II disorder
at least 1 major depressive episode and 1 hypomanic episode
no manic or mixed episodes
more prevalent than I
Treatment of bipolar disorders
first line: mood stabilizers
—> lithium or valproic acid
carbamazepine
second generation antipsychotics
lamotrigine for bipolar with depression
**Antidepressants can precipitate manic sx
Describe cyclothymic disorder
dysthymic disorder with intermittent hypomanic periods
over 2 years (1 kids)–> repeated episodes of hypomania and depression (not severe enough to meet criteria for MDD)
during 2 years, can’t have MDD, manic or mixed episodes
tmt: mood stabilizers, supportive psychotherapy
Psych sx with anxiety disorders
apprehension, worry
sense of doom or panic
hypervigilence
difficulty concentrating
derealization (world seems strange)
Somatic (physical) sx of anxiety disorders
headache, dizziness lightheaded palpitations lump in throat restless SOB dry mouth sweating
PE findings with anxiety disorders
sweating cool, clammy skin tachy flushing hyperreflexia, tremor fidgeting
Why should you be careful prescribing antidepressants to a bipolar patient?
can cause manic sx
Generalized anxiety (overview)
worry about ACTUAL circumstances, events or conflicts
often accompanies panic anxiety
sx fluctuate more than those of panic anxiety
Define panic disorder
recurrent unexpected panic attacks (come out of nowhere)
AND
at least one attack followed by 1 month of persistent concern about additional attacks, worry about implications of attack, significant change in behavior related to attacks
Define panic attack
discrete period of intense fear or discomfort
- -> palpitations, sweating, trembling or shaking, SOB, chest pain/discomfort, dizzy or unsteady, fear of losing control or going crazy/dying, paresthesia, chills or hot flashes
- ->feel like dying
peak in 10 minutes, last less than 25 minutes
Who is more likely to be affected by panic disorder
women (2-3x)
25 year old average
a/w lifetime SI
strong genetic component
Define agoraphobia
anxiety about being in situations that makes escape difficult
ex: in the middle row of theater, away from home, in airplane when have panic attack
associated with panic disorder
Define generalized anxiety disorder
excessive anxiety and worry (most of day, more days than not) for at least 6 months
difficult to control worry
a/w at least 3: restlessness, feeling on edge, easily fatigued, difficulty concentrating, irritability, muscle tension, sleep disturbance
Describe OCD
either obsessive or compulsive behavior
recognized they are unreasonable
marked distress, time consuming, interferes with functioning
Difference between OCD and OCPD
OCPD–> don’t perceive they have a problem
OCD–> know it’s not reasonable most of the time
Iatrophobia
fear of doctors
acrophobia
fear of heights
SIG E CAPS for depression
Sleep (lack of)
Interest (anhedonia)
Guilt
Energy (lack of)
Concentration (difficulty)
Appetite (decreased or increased)
Psychomotor (decreased)
Suicidal ideation
DIG FAST for mania
Distractibility
Inflated self-esteem or Impulsive
Grandiosity
Flight of ideas (racing)
Activity (increased) or Agitation
Speech (pressured)
Thoughtlessness
First line tmt for MDD
SSRIs:
bupropion
venlafaxine
mirtazapine
