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Psych Rotation > Mood disorders (Ch 4) > Flashcards

Mood disorders (Ch 4) Flashcards

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1
Q

Mood

A

one’s internal emotional state

external and internal stimuli can trigger moods

Normal to have wide range of moods and to have sense of control over one’s mood

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2
Q

Mood episode

A

distinct periods of time in which some abnormal mood is present.

Depression, mania, hypomania

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3
Q

Mood disorders

A

patterns of mood episodes, includes major depressive disorder (MDD), bipolar I disorder, bipolar II disorder, persistent depressive disorder, and cyclothymic disorder

may have psychotic features (delusions or hallucinations)

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4
Q

Major Depressive Episode DSM5 criteria

A

At least 5 of the following, must have either 1 or 2, for at least 2 week period

  1. Depressed mood most of the time
  2. Anhedonia (loss of interest in pleasurable activities)
  3. Change in appetite or weight (up or down)
  4. Feelings of worthlessness or excessive guilt
  5. Insomnia or hypersomnie
  6. Diminished concentration
  7. Psychomotor agitation or retardation (i.e. restlessness or slowness)
  8. Fatigue or loss of energy
  9. Recurrent thoughts of death or suicide
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5
Q

Manic Episode DSM5 criteria

A

Distinct period of abnormally and persistent elevated, expansive or irritable mood, and abnormally and persistently increased goal-directed activity or energy, lasting at least 1 week

Includes at least three of the following (four if mood is only irritable):

  1. distractibility
  2. Inflated self-esteem or grandiosity
  3. Increase in goal-directed activity (socially, at work, or sexually) or psychomotor agitation
  4. decreased need for sleep
  5. Flight of ideas or racing thoughts
  6. More talkative than usual or pressured speech (rapid and uninterruptible)
  7. Excessive involvement in pleasurable activities that have a high risk of negative consequences (e.g. shopping sprees, sexual indiscretions)

Greater than 50 percent of manic patients have psychotic symptoms

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6
Q

Symptoms of Mania

A 
"DIG FAST"
Distractibility
Insomnia/impulsive behavior
Grandiosity
Flight of ideas/racing thoughts
Activity/Agitation
Speech (pressured)
Thoughtlessness
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7
Q

Symptoms of major depression

A 
SIG E. CAPS
Sleep 
Interest
Guilt
Energy
Concentration
Appetite
Psychomotor activity
Suicidal ideation
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8
Q

Hypomanic episode

A

distinct period of abnormally and persistently elevated, expansive, or irritable mood, and abnormally and persistently increased goal directed activity or energy, lasting at least 4 consecutive days, that includes at least 3 symptoms listed for manic episode criteria (four if mood is only irritable)

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9
Q

Major Depressive Disorder (MDD) DSM5

A

At least one major depressive episode
No history of manic or hypomanic episode

Episodes of depressed mood associated with loss of interest in daily activities. May not acknowledge their depressed mood or may express vague, somatic complaints (fatigue, HA, abdominal pain, muscle tension, etc)

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10
Q

Sleep problems associated with MDD

A

Multiple awakenings
Initial and terminal insomnia (hard to fall asleep, early morning awakenings)
Hypersomnia (excessive sleepiness) is less common
Rapid eye movement (REM) sleep shifted earlier in the night and for greater duration with reduced stage 3 and 4 (slow wave) sleep

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11
Q

Causes of MDD

A

decreased CSF levels of 5-HIAA (serotonin metabolite) in depressed patients with impulsive and suicidal behavior

Increased sensitivity to b-adrenergic receptors

High cortisol - hyperactive H-P-A axis, fail to suppress cortisol levels with dexamethasone suppression test

Abnormal thyroid axis

GABA, glutamate, endogenous opiates may have a role

Psychosocial/life events - multiple adverse childhood experience risk factor for later developing MDD

Genetics - first degree relatives 2-4 x more like to have MDD

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12
Q

Selective serotonin reuptake inhibitors (SSRIs) side effects

A

HA, GI disturbance, sexual dysfunction, rebound anxiety

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13
Q

SNRI drugs

A

venlafaxine (Effexor)

Duloxetine (Cymbalta)

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14
Q

alpha2-adrenergic receptor antagonist drug

A

mirtazapine (Remeron)

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15
Q

Dopamine-norepinephrine reuptake inhibitor drug

A

bupropion (Wellbutrin)

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16
Q

TCAs

A

Most lethal in overdose due to cardiac arrhythmias

Side effects: sedation, wt gain, orthostatic hypotension, anticholinergic effects

Can aggravate prolonged QTc syndrome

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17
Q

Monoamine oxidase inhibitors (MAOIs)

A

for refractory depression

risk of hypertensive crisis when used with sympathomimetics or ingestion of tyramine-rich foods (wine, beer, aged cheeses, liver, smoked meats)

Risk of serotonin syndrome when used with SSRIs

Most common side effect - orthostatic hypotension

18
Q

Adjunct medications used to threat MDD

A

Atypical antipsychotics with antidepressants for MDD with psychotic features or resistant/refractory MDD w/o psychotic features

T3, levothyroxine (T4), lithium to augment antidepressants in refractory MDD

Methylphenidate in terminally ill

19
Q

Electroconvulsive Therapy (ECT)

A

For unresponsive or cannot tolerate (pregnant) to pharmacotherapy, need rapid reduction of sxs (immediate suicide risk, refusal to eat/drink, catatonia)

Premedicate with atropine -> general anesthesia (methohexital) -> muscle relaxant (succinylcholine)

Generalized seizure induced, should last 30-60 seconds, no longer than 90 seconds

Need 6-12 tx over 2-3 weeks

Retrograde and anterograde amnesia common - resolve w/in 6 months

Other transient side effects: HA, N, muscle soreness

20
Q

Melancholic features

A

more likely in severely ill inpatients, including those with psychotic features

Anhedonia, early morning awakenings, depression worse in the morning, psychomotor disturbance, excessive guilt, anorexia

21
Q

Atypical features

A

hypersomnia, hyperphagia, reactive mood, laden paralysis, hypersensitivity to interpersonal rejection

22
Q

Mixed features

A

Manic/hypomanic symptoms during majority days during MDE

elevated mood, grandiosity, talkativeness/pressured speech, flight of ideas/racing thoughts, increased energy/goal-directed activity, excessive involvement in dangerous activities, and decreased need for sleep

23
Q

Catatonia

A

catalepsy (immobility), purposeless motor activity, extreme negativism or mutism, bizarre postures, echolalia

Especially responsive to ECT

24
Q

Psychotic features

A

presence of delusions and/or hallucinations

24-53% of older, hospitalized patients with MDD

25
Q

Anxious distress

A

feeling keyed up/tense, restless, difficulty concentrating, fears something bad happening, feelings of loss of control

26
Q

Peripartum onset

A

Onset of MDD during pregnancy or 4 weeks following delivery

27
Q

Seasonal pattern

A

Temporal relationship between onset of MDD and particular time of year

Fall-onset SAD responds to light therapy

28
Q

Bereavement

A

reaction to a major loss, not a mental illness
only lasts for several months

Normal bereavement does not include gross psychotic symptoms, disorganization, or active suicidality

29
Q

Bipolar I disorder

A

episodes of mania and of major depression (not required for dx) - aka manic-depression

Between manic episode may be interspersed euthymia, major depressive episodes, or hypomanic episodes

Onset before 30, mean age 18

First degree relatives with bipolar are 10x more likely to develop the illness
Highest genetic link of all major psych disorders

Course chronic with relapses, as disease progresses, episodes more frequent

25-50% will attempt suicide, 10-15% succeed

30
Q

Pharmacotherapy for Bipolar I disorder

A

Lithium - mood stabilizer, partial reduction of mania. Long term use reduces suicide risk. Acute overdose can be fatal d/t its low therapeutic index

Anticonvulsants: carbamazepine and valproic acid - mood stabilizers. useful in rapid cycling bipolar disorder and those with mixed features

Atypical antipsychotics - risperidone, olanzapine, quetiapine, ziprasidone - effective as mono/adjunct therapy for acute mania

Antidepressants discouraged as mono therapy -> activating mania or hypomania

31
Q

Psychotherapy in Bipolar I disorder

A

may prolong remission once the acute mania episode has been controlled

32
Q

ECT for Bipolar I disorder

A

works well in manic episodes, may require up to 20 treatments

Effective for refractory or life-threatening acute mania or depression

33
Q

Bipolar II disorder

A

aka recurrent major depressive episodes with hypomania

Hx of one or more major depressive episodes and at least one hypomanic episode

Onset usually before 30

34
Q

Rapid cycling

A

at least four mood episodes (manic, hypomania, depressed) within 12 months

35
Q

Persistent Depressive Disorder (Dysthymia)

A

Chronic depression most of the time, may have discrete major depressive episodes

onset often in childhood, adolescence, and early adulthood

Early and insidious onset with a chronic course

Treatment with psychotherapy and pharmacotherapy
SSRIs, TCAs, MAOIs

36
Q

Persistent Depressive Disorder (Dysthymia) DSM5 criteria

A

Depressed mood for majority of time most days for at least 2 years (children or adolescents for at least 1 year)

At least two of the following: "CHASES"
poor CONCENTRATION or difficulty making decisions
feelings of HOPELESSNESS
poor APPETITE or overeating
inSOMNIA or hyperSOMNIA
low ENERGY or fatigue
low SELF-ESTEEM

During 2 year period, and not symptom free for more than 2 months at a time

37
Q

Cyclothymic Disorder

A

Alternating periods of hypomania and periods of mild-to-moderate depressive symptoms

May coexist with borderline personality disorder
Onset 15-25

Treat with antigenic agents (mood stabilizers or second gen antipsychotics) as used to treat bipolar disorder

38
Q

Cyclothymic Disorder DSM5 criteria

A

Numerous periods with hypomanic symptoms (but not full hypomanic episode) and periods of depressive symptoms (but not full MDE) for at least 2 years

Never have been symptoms free for more than 2 months during those 2 years

No history of major depressive episode, hypomania, or manic episode

39
Q

Premenstrual dysphoric disorder

A

Mood lability, irritability, dysphoria, and anxiety occur repeatedly during premenstrual phase of the cycle

May worsen prior to menopause but cease after menopause

SSRIs first line treatment - daily or during luteal phase only
OCPs may reduce symptoms
GnRH agonists have been used
Rare causes need Bilateral oophorectomy with hysterectomy to resolve sxs

40
Q

Premenstrual dysphoric disorder DSM 5 criteria

A

at least 5 symptoms are present: in the final week before menses, improve within a few days after menses, and are minimal/absent in week postmenses

At least one: affective lability, irritability/anger, depressed mood, anxiety/tension

At least one (total of at least 5 with above sxs): anhedonia, problems concentrating, anergia, appetite changes/food cravings, hypersomnia/insomnia, feeling overwhelmed/out of control, physical sxs (breast tenderness/swelling, joint/muscle pain, bloating, wt gain)

Sx cause clinically significant distress or impairment in functioning

41
Q

Disruptive Mood Dysregulation Disorder (DMDD)

A

Chronic, severe, persistent irritability occurring in childhood and adolescence

Very high rates of comorbidity, especially with ODD, ADHD, mood disorders, and anxiety disorders

Psychotherapy - parent management training for patient and family first line
Medications for comorbidities
Stimulants, SSRIs, mood stabilizers, second gen antipsychotics treat primary sxs of DMDD

42
Q

Disruptive Mood Dysregulation Disorder DSM5 criteria

A

Severe recurrent verbal and/or physical outburst out of proportion to situation

Outbursts 3 or more per week, inconsistent with developmental level

Mood between outburst persistently angry/irritable most of the day, nearly every day, and observed by others

Sxs for at least 1 year, no more than 3 months without sxs

Sxs start before age 10, dx made between 6-18

No episodes meeting full criteria of manic/hypomanic episode longer than 1 day

this disorder cannot coexist with oppositional defiant disorder, intermittent explosive disorder, or bipolar disorder

Psych Rotation (9 decks)

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