mood disorders: bipolars, MDD, thymia

Question 1

major depressive episode DSM V Criteria

Answer 1

5+ following sx in 2 weeks (must include depressed mood or anhedonia)

1. depressed mood
2. Sleep: insomnia or hypersombia
3. Interest: anhedonia (loss of interest)
4. G: excessive guilt or worthlessness
5. E: fatigue or energy loss
6. C: diminished concentration
7. A: appetite changes (wt loss or gain)
8. P: pschomotor agitation or retardation
9. S: recurrent SI or death

cause distress/impairment

Question 2

manic episode criteria

Answer 2

need 3-4 in 1 week

1. D: Distractibility
2. I: insomnia / irritability/impulsive
3. G: inflated self esteem / grandiose
4. F: Flight of ideas or racing thoughts
5. A. increase in goal-directed activity or psychomotor agitation
6. S: more talkative or pressured speech
7. T: excessive involvement in high risk activity (gambling)

Question 3

hypomanic episode

Answer 3

distinct period of abnormally and persistently elevated, expansive or irritable mood and increased goal-directed activity or energy lasting 4+ days
3++ sx of DIGFAST
but NO marked impairment in functioning, no psychotic features

Question 4

medical causes of depresson

Answer 4

stroke, MI, DM, cushings, addisons, thyroid, calcemia, parkinsons, carcinoid, cancer

Question 5

medical causes of mania

Answer 5

hyperTH, seizures, neoplasms, HIV

Question 6

MDD

Answer 6

1+ major depressive episode

NO hx mania/hypomania

Question 7

MDD Tx

Answer 7

SSRIs, SNRI (venlafaxine or duloxetine), DNRI (wellbutrin)
alpha 2 antagonist: mirtazapine (remeron)
TCAs (OD risk and QTC prolongation)
MAOI: can cause HTN crisis
CBT
ECT

Question 8

Bipolar I DSM

Answer 8

episodes of mania and major depression, but must have mania, and euthymia or depression or hypomania in between

Question 9

Bipolar I tx

Answer 9

lithium: mood stabilizer, dec suicidal risk, side effects
anticonvulsants: carbamazepine (Tegretol) and valproate
atypicals: mono or adjunct therapy esp if psychosis
antidepressants + mood stabilizer
ECT

Question 10

dysthymia DSM

Answer 10

chronic depression
1. depressed mood most days for 2 years
2+ of
poor concentration
hopelessness, poor appetite/overeating
insomnia/hypersomia
low energy/fatigue
low self esteem
NEVER mania

Question 11

cyclothymia

Answer 11

hypomania and depressive sx
1. numerous hypomanic symptoms but never episode
2. depressive sx but NO MD episode
never sx free for > 2 months during 2 years
treat with mood stabilizer or antipsychs

Question 12

DMDD

Answer 12

disruptive mood dysregulation disorder
severe.recurrent verbal or physical outbursts
outburts >3x week and inconsistent with developmental
mood btw outburst is irritable/angry most of the day
sx 1+ year in 2 settings
started before age 10
no full criteria for mania/hypomania
behaviors dont occur in MDD
cannot coexist with ODD or CD
tx: SSRI, stimulant, mood stabilizer, antipsychs