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Block 8 Week 1 Colt > Mood Disorders - Jacobs > Flashcards

Mood Disorders - Jacobs Flashcards

1
Q

What is the most common psychiatric illness?

A

depression

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2
Q

depression affects what percent of outpt and inpts?

A

outpatient: 10%
inpatient: 15%

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3
Q

What are the comorbidities associated with unipolar depression?

A

Substance use disorders, pathological gambling, personality disorders, anxiety

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4
Q

What is the lifetime prevalence of depression?

A

16.5%

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5
Q

Women are (blank) percent more likely to experience depression

A

70%

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6
Q

What is the annual prevalence of depression in adults in the US?

A

7%

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7
Q

What age group has the highest rate of depression?

A

40-59

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8
Q

What race has the highest rate of depression/

A

non-hispanic black

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9
Q

T/F: med students are more prone to depression than their peers

A

true

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10
Q

What percent of med students report moderate-severe depression?

A

14.3%

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11
Q

What is the correlation between marriage and depression amongst medical residents?

A

married residents have a lower rate of depression

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12
Q

When is depression most common in residency?

A

1st year

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13
Q

What percent of physicians know another physician who’s work has been compromised by depression?

A

43%

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14
Q

What are two unique issues that physicians face when dealing with depression?

A

avoiding treatment
and
self prescribing anti-depressants

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15
Q

Where is the largest burden of depression economically?

A

lost productivity in the workplace

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16
Q

By what fold has the cost of depression increased since 1990?

A

two fold

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17
Q

What are some normal responses to consider when screening for depression?

A

bereavement
normal reaction to stress or loss
adjustment disorder
cultural factors

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18
Q

What are the diagnostic criteria for a major depressive episode?

A
  1. two weeks or more of symtpoms
  2. 5/9 of SIGECAPS
  3. marked distress or functional impairment
  4. rule out medical and substance etiologies
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19
Q

What is SIGECAPS?

A

S – sleep disturbance (insomnia, hypersomnia)
I – interest reduced (reduced pleasure/enjoyment)
G – guilt and self-blame
E – energy loss and fatigue
C – concentration problems
A – appetite changes (increase or decrease)
P – psychomotor changes (retardation, agitation)
S – suicidal thoughts

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20
Q

What are some of the neurovegetative symptoms?

A 
Sleep disturbance
(initial, middle or terminal insomnia)
Appetite problems
(anorexia)
Loss of energy
(anergia)
Decreased libido
Psychomotor retardation/ agitation
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21
Q

What are some somatic symptoms associated with depression?

A 
nausea
constipation
headaches
back pain
shortness of breath*
chest pain*
*anxiety type symptoms
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22
Q

50% of the cases of depressive disorder onset in what age group?

A

20-50

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23
Q

when is the peak incidence of depression?

A

20s

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24
Q

what is the median age of onset of depression?

A

32

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25
Q

T/F: depression can occur in children and elderly

A

true

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26
Q

A single episode of a major depressive disorder may last for how long?

A

6-13 months

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27
Q

how quickly do you hope to see response in a MDE?

A

1-3 months

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28
Q

MDE treatment will respond quicker with what?

A

ECT

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29
Q

What percent of people that have had an MDE relapse?

A

70%

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30
Q

What percent of people with a repeat episode of MDE commit suicide?

A

15%

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31
Q

How do you classify a depression that has symptoms present but doesn’t meet full criteria?

A

Depression NOS

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32
Q

How long must you have symptoms to have persistent depressive disorder?

A

2 years

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33
Q

how long must a child have symptoms to have persistent depressive disorder?

A

1 year

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34
Q

What are the characteristics of persistent depressive disorder?

A

Milder, more fluctuating symptoms
Presence of at least 2 of the following:
CHAFSS: concentration, hopelessness, appetite, fatigue, sleep, self-esteem
Distress or impaired functioning

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35
Q

What is double depression?

A

dysthymic disorder and an MDE at the same time

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36
Q

What is the time course of premenstrual dysphoric disorder?

A

> 5 symptoms that start the week before menses and improve a few days at the onset of menses and are gone the week after menses

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37
Q

What are neurologic etiologies for depression?

A 
Parkinsons
Huntingtons
TBI
CVA
dementia
MS
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38
Q

What are metabolic etiologies for depression?

A

renal failure, Wilson’s, acute intermittent porphyria

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39
Q

What are GI etiologies for depression?

A

IBS, chronic pancreatitis, Crohn’s, cirrhosis, hepatic encephalopathy

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40
Q

What are some endocrine etiologies for depression?

A 
hypothyroidism
hyperthyroidism
Cushing's
Addison's
DM
parathyroid disease
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41
Q

What are some cardio etiologies for depression?

A

cardiomyopathies,

MI

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42
Q

What are some pulmonary etilogies for depression?

A

obstructive sleep apnea

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43
Q

what are the malignant etiologies that cause depression?

A

pancreatic carcinoma
brain tumors
paraneoplastic effects of lung cancer

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44
Q

What are the autoimmune etiologies of depression?

A

SLE
RA
fibromyalgia

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45
Q

What are the infectious causes of depression?

A

HIV

46
Q

what are some drugs that can cause depression?

A 
EtOH
benzos
opioids
hallucinogens including cannabis
withdrawal from stims 
THE PILL
steroids
antihypertensives like reserpine and beta blockers
47
Q

What is the disorder where you have severe temper tantrums? What is the mininum and maximum ages?

A

Disruptive mood dysregulation disorder; onset before 10, min. age 6, max age 18

48
Q

what is the mood like between temper tantrums?

A

persistently negative

49
Q

how long must a person have these crazy tantrums in order to have disruptive mood dysregulation?

A

12 months and cannot be symptom free for three months in that time

50
Q

How long should symptoms of grief clear?

A

after two months

51
Q

T/F: bereavement may induce an MDE

A

false!! AND THE DSMV DROPS THE 2 MONTH RULE

52
Q

what two things go into forming the learned helplessness model in someone?

A

exposure to uncontrollable negative stimuli plus attributional style

53
Q

What are the four theories on the etiologies of depression?

A
  1. learned helplessness
  2. cognitive theory
  3. genetics
  4. biology
54
Q

T/F: there is a strong familial pattern in depression

A

true

55
Q

First degree relatives have what greater risk of having depression?

A

2-5 times the risk

56
Q

What are the six important biogenic amines in depressoin?

A 
Dopamine
Epi
ACh
NorEpi
Histamine
Serotonin
57
Q

Where is NorEpi made?

A

locus ceruleus

58
Q

Where is serotonin made?

A

dorsal raphe nuclei in the pons

59
Q

Decreased CSF levels of 5HIAA are found in those that die of (blank) suicide

A

violent

60
Q

Where is dopamine made?

A
  1. VTA of the midbrain
  2. substantia nigra pars compacta
  3. arcuate nucleus
61
Q

The Indoleamine hypothesis thinks that there is a deficiency of (blank) that causes depressoin

A

5HT

62
Q

The Catecholemine hypothesis states that there is a deficiency in (blank or blank)

A

NE or DA

63
Q

The Cholinergic-adrenergic balance hypothesis states that depression occurs when what two molec’s are low compared to ACh?

A

NE and DA are low compared to ACh and mania occurs when NE and DA are too high compared to ACh

64
Q

The neuroendocrine model says that the hypothalamus hypersecretes (blank), resulting in elevated ACTH, which then triggers the adrenal cortex to release extra cortisol

A

CRF

65
Q

T/F: cortisol levels in unipolar and bipolar depression cannot be lowered with dexamethasone

A

true

66
Q

(blank) can lower cortisol levels in depressed patients and can be used in treatment-resistant depression

A

ketoconazole

67
Q

The infectious model says that the (blank) virus can cause depression and can be treated with amantadine

A

Borna virus

68
Q

What is the mood in a manic episode?

A

elevated, can be irritable, lasting at least one week

69
Q

What is the activity like in a manic episode?

A

increase in goal directed activity or energy lasting at least 1 week

70
Q

How many of the following symptoms must you have to be having a manic episode?

Grandiosity, decr need for sleep, pressured speech, flight of ideas/racing thoughts, distractibility, incr goal-directed activity or psychomotor agitation, risky behaviors

A

3, but 4 if you are just irritable

71
Q

T/F: a manic episode results in psychosis and a need for hospitalization

A

true, or at least there is a major functional impairment

72
Q

what must you rule out to Dx a manic episode?

A

medical or substance etiologies

73
Q

what is the average age of onset of bipolar 1?

A

20s and 30s

74
Q

T/F: the first episode of bipolar 1 can be manic or depressed

A

true

75
Q

how long do manic episodes last?

A

weeks to months

76
Q

T/F: rapid cycling of 4+ episodes in a year is common in bipolar 1

A

false

77
Q

The family history of someone with bipolar will be positive for (blank) 60% of the time

A

major mood disorder

78
Q

Which of the following disorders has the highest genetic component?
depression
bipolar 1
schizophrenia

A

bipolar 1

79
Q

what are some of the things on your DDx when thinking about bipolar 1?

A

drugs or medical problem
bipolar 2
schizoaffective disorder
cyclothymia

80
Q

What are the neoplastic causes of bipolar?

A

meningiomas, gliomas, and thalamic nets

81
Q

A stroke to what part of the brain can lead to bipolar?

A

thalamus

82
Q

T/F: head trauma and Wilson’s disease and MS can all cause bipolar

A

true

83
Q

Trauma to the right frontal lobe results in….

A

mania

84
Q

Trauma to the left frontal lobe results in…

A

depressoin

85
Q

Trauma to the medial frontal lobe results in..

A

apathy

86
Q

Trauma to the orbitofrontal lobe results in…

A

profanity, irritability, irresponsibility

87
Q

which drugs of abuse can induce bipolar?

A

LSD
METH
PCP

88
Q

what Rx meds can induce bipolar?

A 
steroids
L-dopa
thyroxine
captopril
Withdrawal from clonidine
89
Q

a hypomanic episode has (blank) days of increased mood with increased goal directed activity

A

4 days

90
Q

How many other symptoms must be present for a hypomanic episode?

A

3, but 4 if you’re just an irritable little shit

91
Q

T/F: hypomania comes with a change in functioning

A

true

92
Q

T/F: hypomanic episodes results in psychosis that requires hospitalization

A

false; not that severe

93
Q

What are the two characteristics of bipolar 2?

A

hypomanic episode and major depressive episode, no history of manic episodes

94
Q

T/F: a manic episode results in impairment of functioning

A

true

95
Q

T/F: a hypomanic episode results in an impairment of functioning

A

false; just a change

96
Q

T/F: hypomanic episodes show signs of psychosis

A

false

97
Q

T/F: bipolar 1 may present without MDE

A

true

98
Q

T/F: bipolar 2 neeeds at least one MDE and no history of manic episodes

A

true

99
Q

What are the criteria for mania/depression for bipolar 1?

A

manic episodes with or without MDE

100
Q

what are the critera for mania/depression in bipolar 2?

A

at least one MDE and one hypomanic episode with no manic episodes

101
Q

which bipolar is more common in females?

A

bipolar 2

102
Q

which bipolar is equally common in males and females?

A

bipolar 1

103
Q

Schizoaffective disorder combines (blank) symptoms such as psychosis with prominent mood symptoms

A

schizophrenia

104
Q

T/F: in schizoaffective, psychotic symptoms are present even when the mood symptoms are absent

A

true

105
Q

Cyclothymic disorder has a mood disturbance for how long?>

A

2 years

106
Q

Cyclothymic disorder shows (manic/hypomanic) symptoms that don’t meet the criteria for an actual episode and depressive symptoms that don’t meet the criteria

A

hypomanic

107
Q

T/F: cyclothymic disorder presents with no functional impairment

A

false; sig. distress or functional impairment

108
Q

Cyclothymia can be described as mild (blank) followed by hypomania

A

depression

109
Q

what does “neurovegetative” mean?

A

sx leading to dissociation from society as a whole

110
Q

what is 5HIAA?

A

the main metabolite of serotonin

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