Mood Disorders - Hill Flashcards
How to diagnose a major depressive episode
2 weeks – 5+ of the following, including 1 of the first 2…
- Depressed mood for most of the day, almost every day
- Marked diminished interest/pleasure in anything
- Weight loss or weight gain
- Insomnia or hypersomnia
- Psychomotor agitation or retardation
- Fatigue or energy loss
- Worthlessness or excessive guilt
- Poor thinking or concentration
- Recurrent thoughts of death or suicide
SIG E CAPS (see first aid)
How to diagnose a manic episode
1+ week – 3+ of the following, w/ mood disturbance and high energy…
- Distractability (low concentration)
- Irresponsibility (pleasure w/o consequences)
- Grandiosity (high self esteem)
- Flight of ideas (racing thoughts)
- Activity/agitation
- Sleep less
- Talkative or pressured speech
DIG FAST (see first aid)
Major depressive episodes and manic episodes are both ___ for the patient
Very disturbing/distressing/impairing
Hypomanic episode
Less severe manic episode, 4+ days, no major impairment in social or occupational functioning, no psychosis, no need for hospitalization
Major depressive disorder - how to diagnose
Treatment?
Major depressive episodes lasting 6-12 months WITHOUT any manic, hypomanic, or mixed episodes
CBT, SSRIs
Dysthymic disorder - how to diagnose
Depressed mood (milder than major depressive episode) for at least 2 years, where breaks in symptoms are no longer than 2 months. Never met criteria for manic episode, hypomanic episode, or mixed episode.
CHASE – concentration loss, hopelessness, appetite loss, self-esteem loss, energy loss
Bipolar 1 disorder
1+ manic or mixed episode, with or without a hypomanic or depressive episode. Mood returns to normal between episodes.
Bipolar 2 disorder
1+ major depressive episode + 1+ hypomanic episode, WITHOUT any manic or mixed episodes
Treatment for bipolar disorders
Lithium
Valproic acid
Cyclothymic disorder
Treatment
Dysthymic disorder w/ intermittent REPEATED hypomanic and depressive (NOT major) periods. At least 2 years. No major depressive, manic, or mixed episodes
Lithium, Valproic acid; psychotherapy
What NOT to give to a bipolar or cyclothymic person? Why?
Antidepressants – can precipitate manic symptoms
Symptoms of anxiety (psych and somatic)
Psych: Apprehension, worry, sense of doom/panic, hypervigilence, difficulty concentrating, derealization
Somatic: Sympathetic symptoms
Anxiety
Inappropriate fear/worry + physical manifestations that are incongruent with the magnitude of the perceived stressor
Panic disorder - define
(1) Recurrent panic attacks
(2) 1+ month of concern, worry, or behavioral changes about additional attacks
Panic attack
Under 25 minutes, peaking in 10 minutes, 4+ of the following…
PANICS - palpitations, paresthesias, abdominal distress, nausea, intense fears of dying or losing control, chest pain, chills, choking, sweating, shaking, SOB
Generalized anxiety disorder
Excessive anxiety and worry for at least 6 months, most of the time, about a variety of events or activities. Symptoms include…
- Restlessness or feeling on edge
- Easily fatigued
- Difficulty concentrating
- Irritable
- Muscle tension
- Sleep disturbance
OCD
Obsessions = persistent, recurrent thoughts and impulses that are intrusive. Patient attempts to ignore them.
Compulsions = Repetitive behaviors or mental acts that try to prevent or reduce the distress OR prevent a dreaded event
Spends AT LEAST 1 hour per day doing them
How is OCD different that OC personality disorder?
OCD - ego-dystonic, patient finds it stressful
OC personality - ego-syntonic, more about order, perfectionism, values/beliefs
Main obsessions in OCD
Contamination, safety/harm, unwanted acts of aggression, unacceptable sexual/religious thought, symmetry/exactness
Main compulsions in OCD
Cleaning, checking/ordering/arranging, counting, repeating routine activities, mental rituals
PTSD - qualifications
What do they tend to do?
(1) Person experienced/witnessed the event
(2) Person’s response involved intense fear, helplessness, or horror
1+ month of…
- Persistently re-living it
- Persistently avoiding stimuli related to it
- Persistent hyper-vigilance and increased arousal
PTSD - treatment
SSRIs, CBT