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Mood Disorders Flashcards

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1
Q

What is the second most debilitating disease after heart disease?

A

Major depressive disorder

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2
Q

50% of patients with bipolar disorder have first-degree relative with

A

mood disorder

10-25% with mood disorder have relative with it too

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3
Q

Neurotransmitters implicated in depression

A

Norepinephrine (downregulates beta receptors; abnormal)

Dopamine (decreased)

Serotonin/5-HT (decreased)

GABA (decreased)

Glutamate (NMDA receptor involved?)

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4
Q

What NT is increased in mania?

A

dopamine

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5
Q

Why are SSRIs and anxiolytics/benzos good treatment for depression?

A

SSRIs make more serotonin available (decreased in depression)

benzos/anxiety meds act on GABA receptor to increase it (decreased in depression)

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6
Q

Factors that can lead to depression

A

psychosomatic medicine

often precedes first mood episode

death of parent before 11

death of spouse or child

unemployment

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7
Q

DSM criteria for major depressive episode

A

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

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8
Q

What does the diagnosis of major depressive disorder require?

A

presence of 1+ major depressive episodes and ABSENCE of mania, hypomanic, mixed episodes

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9
Q

Associated features of major depressive disorder

A

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)

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10
Q

Ddx for manic depressive disorder

A

substance/drug-induced

mood disorders from general medical condition (AKA psychosomatic, think hypothyroid or DM)

normal grief/bereavement

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11
Q

Describe normal grief/bereavement

A

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

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12
Q

Treatment of MDD (major depressive disorder)

A

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
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13
Q

Describe persistent depressive disorder (dysthymia)

A

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

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14
Q

Tmt for dysthymia/persistent depression

A

more difficult to treat

pharm (SSRI, SNRI, MAO-)

CBT

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15
Q

Define depression with seasonal pattern

A

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

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16
Q

Define premenstrual dysphoric disorder (PMDD)

A

mood instability with anxiety, depression, irritability, sleep disturbances

week before menses, consistent pattern over the year

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17
Q

Treatment for PMDD (premenstrual)

A

exercise, diet, relaxation therapy

SSRIs during cycle or 2 weeks before menses (sertraline, fluoxetine)

18
Q

What is a manic episode?

A

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

19
Q

Describe a hypomanic episode

A

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

20
Q

Define Bipolar I disorder

A

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

21
Q

Define Bipolar II disorder

A

at least 1 major depressive episode and 1 hypomanic episode

no manic or mixed episodes

more prevalent than I

22
Q

Treatment of bipolar disorders

A

first line: mood stabilizers
—> lithium or valproic acid

carbamazepine

second generation antipsychotics

lamotrigine for bipolar with depression

**Antidepressants can precipitate manic sx

23
Q

Describe cyclothymic disorder

A

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

24
Q

Psych sx with anxiety disorders

A

apprehension, worry

sense of doom or panic

hypervigilence

difficulty concentrating

derealization (world seems strange)

25
Q

Somatic (physical) sx of anxiety disorders

A 
headache, dizziness
lightheaded
palpitations
lump in throat
restless
SOB
dry mouth
sweating
26
Q

PE findings with anxiety disorders

A 
sweating
cool, clammy skin
tachy
flushing
hyperreflexia, tremor
fidgeting
27
Q

Why should you be careful prescribing antidepressants to a bipolar patient?

A

can cause manic sx

28
Q

Generalized anxiety (overview)

A

worry about ACTUAL circumstances, events or conflicts

often accompanies panic anxiety

sx fluctuate more than those of panic anxiety

29
Q

Define panic disorder

A

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

30
Q

Define panic attack

A

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

31
Q

Who is more likely to be affected by panic disorder

A

women (2-3x)

25 year old average

a/w lifetime SI

strong genetic component

32
Q

Define agoraphobia

A

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

33
Q

Define generalized anxiety disorder

A

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

34
Q

Describe OCD

A

either obsessive or compulsive behavior

recognized they are unreasonable

marked distress, time consuming, interferes with functioning

35
Q

Difference between OCD and OCPD

A

OCPD–> don’t perceive they have a problem

OCD–> know it’s not reasonable most of the time

36
Q

Iatrophobia

A

fear of doctors

37
Q

acrophobia

A

fear of heights

38
Q

SIG E CAPS for depression

A

Sleep (lack of)

Interest (anhedonia)

Guilt

Energy (lack of)

Concentration (difficulty)

Appetite (decreased or increased)

Psychomotor (decreased)

Suicidal ideation

39
Q

DIG FAST for mania

A

Distractibility

Inflated self-esteem or Impulsive

Grandiosity

Flight of ideas (racing)

Activity (increased) or Agitation

Speech (pressured)

Thoughtlessness

40
Q

First line tmt for MDD

A

SSRIs:

bupropion
venlafaxine
mirtazapine

Psych (12 decks)

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