Mood Disorders I and II Flashcards by Allison Zarnke

How common is major depression disorder?

Common:
8-10% of Men
15-20% of Women (lifetime prevalence)

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According to DSM 5, 5 of the 9 criteria for major depressive disorder must be present for 2 weeks and represent a change from previous functioning. What are the 9 criteria?

SIG E CAPS
S- Sleep disorders (too much or too little)
I- Interest- loss of interest/pleasure in daily activities
G- Guilt (feelings of worthlessness or excessive, inappropriate guilt)
E- Energy- lack of energy/fatigue
C- Concentration- indecisiveness/inability to concentrate
A- Appetite, changes in weight
P- Psychomotor, either agitation or retardation
S- Suicide: thoughts of suicide or death

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Which two of the 9 criteria for MDD must be present?

Depressed Mood

Loss of Interest/pleasure

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How does marital status affect depression rate?

Unmarried/divorced/widowed people are at higher risk for depression

Except in old men. Then it doesn’t make a difference

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How does income, profession, religion or geography affect rates of depression?

They have minimal impact

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Describe the triggers for onset of illness in MDD

Can either be a series of negative life events, or could be one catastrophic event

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Do most people have one occurrence of a MDD or is it a reoccurring problem?

For most people, MDD is a reoccurring chronic illness

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Name two physiologic findings that correlate with MDD.

Smaller hippocampus

Abnormal serotonin transport protein

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Name three classifications of triggering events for MDD

Biological (medicines, substances, disease)
Psychological
Environmental

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Differentiate relapse from reoccurance of MDD

Relapse: onset of symptoms while in remission

Recurrence: onset of symptoms following recovery from MDD

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What class of disease is MDD?

Neurodegenerative brain disorder

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What is one biologic marker we associate with the neurodegenerative process of MDD?

Chronic low levels increases of cortisol.

May be secondary to stress –> disruption in healthy neurogenesis and may add to neurodegeneration

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Why is the traditional theory of monoamine control of emotions not fully explanatory?

Antidepressants work by increasing the levels of serotonin, dopamine and norepinephrine.

At best, remission only occurs in 40% of patients, and only 65% respond to the medication. This indicates there is another process involved.

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What is the cytokine thought to be responsible for interruption of serotonin metabolism?

IL-6.

Produced as a part of a chronic inflammatory process

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Describe the structural theory of MDD

Depression is caused by abnormal changes in brain architecture.

Atrophy: hippocampus, amygdala, and prefrontal cortex

Enlargement: anterior cingulated cortex, and insula

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Describe the network hypothesis of MDD

White matter abnormalities in tracts between medial prefrontal cortex, amygdala and hippocampus

Depression is therefore a result of miscommunication and misinterpretation of various brain regions involved with interpreting emotions.

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How does length of a depressive episode correlate to success in treating it?

The longer the depressive episode lasts, the less likely it is to be treated successfully

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Name a typical example of a depressive disorder due to another medical condition

EBV causing mono

Once the infection is resolved, the depressive symptoms go away

List medications that can lead to a depressive disorder

Corticosteroids (cushings), oral contraceptives, antipsychotics, interferons, reserpine, isotretinoin (accutane), beta blockers, central acting anti-hypertensives, all psychoactive substances

Describe MDD with melancholic features

mood worse in the am, terminal insomnia, excessive guilt, marked weight loss, total lack of pleasure (anhedonia)

Describe MDD with atypical features

weight gain, over sensitive mood reactivity, oversleeping, leaden paralysis- feel like you can’t move arms/legs

Describe MDD with mood congruent psychotic features

about 10% of episodes

delusions and hallucinations with depressive content “I feel like I’m rotting inside, the devil is coming to get me”

What are the criteria for persistent depressive disorder?

2 years of duration –
Depressed mood for most of the day on more days than not- course tends to be nonremitting

Two of the following Six:
- poor appetite or overeating
- low energy or fatigue
- insomnia or hypersomnia
- low self-esteem
- poor concentration or difficult decision making
- feelings of hopelessness
Has never been free of symptoms for longer than 2 months, no signs of other significant mental disorder that would explain symptoms, can have Major Depressive Disorder on top of this disorder

What are the criteria for being diagnosed with bipolar I disorder?

You must have experienced at least one manic episode, although most commonly, there will be episodes of major depression and and other mood states during a history

What are the criteria for the diagnosis of Bipolar Disorder I?

A. A distinct period of abnormally and persistent elevated, expansive, or irritable mood present for most of the day for at least 1 week duration B. During the period of mood disturbance at least 3 of the following are present (if the mood is only irritable then 4 need to be present) 1. Inflated self esteem or grandiosity 2. Decreased need for sleep 3. More talkative than usual or pressure to keep talking 4. Flight of Ideas or subjective experience of racing thoughts 5. Distractibility 6. Increase in goal-directive activities or psychomotor agitation 7. Excessive involvement in pleasurable activities that have a high potential for painful consequences – buying, speeding, sexual indiscretions, foolish business ventures C. Marked impairment in functioning in job, social activities, or relationships with others or there are psychotic features D. Symptoms not caused by a substance or medical condition Psychosis leads to a diagnosis of bipolar disorder I

What are the three states of Bipolar Disorder? What percent of the time is spent in each state?

Depressive State: 40-45% of the time Hypomanic/manic phase; 5-10% Euthymic state: 45%

How is the intelligence of a person with bipolar disorder affected?

Decreased- functioning "less than baseline"

What is the lifespan of someone with bipolar disorder?

8-10 years less due to metabolic comorbidities, substance, abuse and suicide (10-15x risk)

How is biopolar disorder II defined?

The patient must have experienced a Major Depressive Episode but in addition at least one period of time where they have symptoms of hypomania y lasting at least 4 days in a row for most of those days. You need 3 or more of the same criteria as for a manic episode. There is no psychosis present. .

Define cyclothymic disorder

2 years minimum of mood cycling but never enough criteria for Bipolar I/II or MDD

Which disorder is more commonly seen in higher socioeconomic brackets?

Bipolar disorder

Define bipolar unspecified

– a diagnosis that encompasses many potential patients who have some symptoms of mania and hypomania at times but never enough to meet full criteria. Anyone with significant mood fluctuations and irritability that are not induced by substances may fall into this area. This diagnosis is largely speculative but may encompass 3-4%of the population who often are never diagnosed

What is the lifetime prevalence of bipolar I disorder?

0.6-0.8%

What is the lifetime prevalence of bipolar II disorder?

0.5-0.8%

is bipolar disorder more common in men or women?

Equal

When does bipolar disorder onset?

late teenage years

What is the heritability of bipolar disorder?

``` Highly heritable: 65-85% Concordant twins: 75-85% Discordant twins: 15-20% One parent with bipolar disorder: 10% Two parents with bipolar: 50% ```

What do we currently rely on for the diagnosis of bipolar disorder?

Clinical findings

List a few clinical findings that might suggest someone presenting with depression may be bipolar rather than have unipolar depression

Early age onset(before age 20) Psychotic Depression 1st episode of depression is postpartum especially if psychotic Rapid onset and offset of depressive symptoms Recurrent depression with more than 5 episodes Bipolar family history Seasonal Mood Disorder Atypical Depression Hypomania associated with antidepressants Repeated loss of efficacy of antidepressant over time Trait mood lability, hyperthymic temperament Depression with mixed mood states

Differentiate suicidal ideation from suicidal intent

Ideation: fleeting/persistent thoughts that the world may be better off without them Intent: Thoughts have moved to thinking about how you would actually kill yourself- looked on websites, ask others, secure the means to actually do it

What % of those with suicidal ideation plan an attempt?

34%

What % of those who plan an attempt actually try to commit suicide?

72%

What are the three top ways people commit suicide?

Firearms Suffocation (hanging) Poisoning