Mood Disorders - Depressive & Bipolar

Question 1

Disruptive Mood Dysregulation Disorder (DMDD)

Answer 1

Criteria:
A) severe recurrent temper outbursts manifested verbally or behaviorally that are out of proportion
B) inconsistent with developmental level
C) average 3x a week
D) mood between outbursts is irritable or angry most of the day
E) have been present for 12 or more months (no more than 3 months without sxs)
F) present in at least 2-3 settings
G) diagnosis should not be made before 6yrs or after 18
H) Onset is before 10 years

Question 2

Persistent Depressive Disorder (Dysthymia)

Answer 2

Criteria:
A) Depressed mood for most of the day, for at least 2 years (1 year for children)
B) Presence of 2 or more: change in appetite, change in sleep, change in energy, lows self-esteem, poor concentration, hopelessness, poor judgment
C) Never without symptoms for 2 months
D) Never had manic or hypomanic sxs

Question 3

Specifying Dysthymia

Answer 3

Onset: early (by 20) or late (after 21)
with pure dysthymic syndrome: doesn’t meet criteria for MDE
with persistent major depressive episode, with current episode: meets MDE now, but at times didn’t
with intermittent major depressive episodes, without current episodes: met MDE, but currently doesn’t

Question 4

Major Depressive Disorder (MDD)

Answer 4

Criteria:
A) 5 or more sxs present during the same 2 week period and present a CHANGE from previous functioning (at least 1 of the sxs is either depressed mood or loss of interest or pleasure) - weight change, appetite, sleep, agitation, worthlessness, inappropriate guilt, thoughts of death, diminished concentration, etc.
B) significant distress
C) never had manic or hypomanic episode

Question 5

Specifying MDD

Answer 5

Severity: mild, moderate, severe
With/out psychotic features
Remission: partial or full
With anxious distress
With melancholic features
With atypical feature
With seasonal patterns
With peripartum onset 
With catatonic features
With mixed features
With mood congruent psychotic features
With mood incongruent psychotic features

Question 6

Premenstrual Dysphoric Disorder (PDD)

Answer 6

Criteria:
A) in the majority of the menstrual cycles, at least 5 symptoms must be present, and must IMPROVE within a few days after the onset and become minimal in the week postmenses
B) one of more of the MOOD sxs: affective lability, irritability, depressed mood, anxiety, tension.
C) one or more of the BEHAVIOR/PHYSICAL sxs: decreased interest, difficulty concentrating, fatigue, change in sleep, change in appetite, overwhelmed, physical symptoms
D) significant distress
E) at least 2 symptomatic cycles

Question 7

Major Depressive Episode (MDE)

Answer 7

A) mood lower than normal
B) most of the day, every day for at least 2 weeks
C) at least 5 SXS: depressed mood, loss of pleasure, appetite, weight, sleep, fatigue, psychomotor retardation, agitated, low self-esteem, guilt, concentration, death wishes, suicidal ideas
D) distress and impair social life
E) no substance use or medical condition

Question 8

Manic Episode

Answer 8

A) mood is jolly, extreme cheerfulness, irritable, euphoria
B) minimum of 1 week
C) along with euphoria or irritability and increase in energy, at least 3 SXS: heightened self esteem, delusions, rested on little sleep, heightened activity, lost judgment, rapid speech, flight of ides, easily distracted
D) distress and impair social life
E) no substance use or medical condition

Question 9

Hypomanic Episode

Answer 9

A) mood is euphoric or irritable, without the driven quality in manic
B) minimum of 4 days
C) C) along with euphoria or irritability and increase in energy, at least 3 SXS: heightened self esteem, delusions, rested on little sleep, heightened activity, lost judgment, rapid speech, flight of ides, easily distracted
(NEVER PSYCHOTIC OR DELUSIONAL)
D) affects social life, but not to the point of hospitalization or psychosis
E) no substance or medical condition

Question 10

Bipolar Disorder I

Answer 10

Criteria:
A) at least one manic episode
(specify the same way as a major depressive disorder)

Question 11

Bipolar Disorder II

Answer 11

Criteria:
A) At least one hypomanic episode and one major depressive episode
B) Never had manic episode
(specify the same way as a MDD)

Question 12

Cyclothymic Disorder

Answer 12

A) for at least 2 years (1 in children) numerous periods with hypomanic and depressive symptoms that don’t meet the full criteria
B) During 2 years, sxs have been present for at least 1/2 the time
C) Criteria for a MDE, manic, and hypomanic episode have never been met

Question 13

Differential Diagnosis & Comorbidity for BP I & II

Answer 13

DD - MDD is the most challenging to differentiate. It could be MDD accompanied by hypomanic or manic symptoms. To distinguish, these sxs should NOT meet the full criteria.
Comorbidity is the most common with anxiety disorders, suicide and substance abuse.

Question 14

Treatment for Bipolar Disorders

Answer 14

1. drug treatment - refer to psychiatrists
2. relapse prevention therapy (e.g. WRAP)
3. mood stabilizer (lithium, valproate)
4. electroconvulsive therapy
5. manic - benzodiazepines, lithium, VPA, antipsychotic
6. depressive - antidepressant, buroproprion, SSRI

Question 15

Motivation for Suicide

Answer 15

• wanting to join loved one
• attention
• relieve the pain
• control when death will occur
• avoid or be punished for crime
• revenge

Question 16

Suicide Clues

Answer 16

• about 75% voice their intentions
• situational clues: loss of job, sudden death, terminal illness
• behavioral clues: buying a gun, previous attempt, planning funeral, personal and business affair in order, suicide note
• depressive symptoms: apathy, decrease in libido, no desire to socialize, loss of self-esteem
• verbal cures

Question 17

Suicide Assessment

Answer 17

I - intent
P - plan
M - method
S - specific time
ask specifically about these things