Mood Disorders - Jacobs Flashcards
1
Q
What is the most common psychiatric illness?
A
depression
2
Q
depression affects what percent of outpt and inpts?
A
outpatient: 10%
inpatient: 15%
3
Q
What are the comorbidities associated with unipolar depression?
A
Substance use disorders, pathological gambling, personality disorders, anxiety
4
Q
What is the lifetime prevalence of depression?
A
16.5%
5
Q
Women are (blank) percent more likely to experience depression
A
70%
6
Q
What is the annual prevalence of depression in adults in the US?
A
7%
7
Q
What age group has the highest rate of depression?
A
40-59
8
Q
What race has the highest rate of depression/
A
non-hispanic black
9
Q
T/F: med students are more prone to depression than their peers
A
true
10
Q
What percent of med students report moderate-severe depression?
A
14.3%
11
Q
What is the correlation between marriage and depression amongst medical residents?
A
married residents have a lower rate of depression
12
Q
When is depression most common in residency?
A
1st year
13
Q
What percent of physicians know another physician who’s work has been compromised by depression?
A
43%
14
Q
What are two unique issues that physicians face when dealing with depression?
A
avoiding treatment
and
self prescribing anti-depressants
15
Q
Where is the largest burden of depression economically?
A
lost productivity in the workplace
16
Q
By what fold has the cost of depression increased since 1990?
A
two fold
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
18
Q
What are the diagnostic criteria for a major depressive episode?
A
- two weeks or more of symtpoms
- 5/9 of SIGECAPS
- marked distress or functional impairment
- rule out medical and substance etiologies
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
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
21
Q
What are some somatic symptoms associated with depression?
A
nausea constipation headaches back pain shortness of breath* chest pain* *anxiety type symptoms
22
Q
50% of the cases of depressive disorder onset in what age group?
A
20-50
23
Q
when is the peak incidence of depression?
A
20s
24
Q
what is the median age of onset of depression?
A
32
25
T/F: depression can occur in children and elderly
true
26
A single episode of a major depressive disorder may last for how long?
6-13 months
27
how quickly do you hope to see response in a MDE?
1-3 months
28
MDE treatment will respond quicker with what?
ECT
29
What percent of people that have had an MDE relapse?
70%
30
What percent of people with a repeat episode of MDE commit suicide?
15%
31
How do you classify a depression that has symptoms present but doesn't meet full criteria?
Depression NOS
32
How long must you have symptoms to have persistent depressive disorder?
2 years
33
how long must a child have symptoms to have persistent depressive disorder?
1 year
34
What are the characteristics of persistent depressive disorder?
Milder, more fluctuating symptoms
Presence of at least 2 of the following:
CHAFSS: concentration, hopelessness, appetite, fatigue, sleep, self-esteem
Distress or impaired functioning
35
What is double depression?
dysthymic disorder and an MDE at the same time
36
What is the time course of premenstrual dysphoric disorder?
>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
37
What are neurologic etiologies for depression?
```
Parkinsons
Huntingtons
TBI
CVA
dementia
MS
```
38
What are metabolic etiologies for depression?
renal failure, Wilson's, acute intermittent porphyria
39
What are GI etiologies for depression?
IBS, chronic pancreatitis, Crohn's, cirrhosis, hepatic encephalopathy
40
What are some endocrine etiologies for depression?
```
hypothyroidism
hyperthyroidism
Cushing's
Addison's
DM
parathyroid disease
```
41
What are some cardio etiologies for depression?
cardiomyopathies,
| MI
42
What are some pulmonary etilogies for depression?
obstructive sleep apnea
43
what are the malignant etiologies that cause depression?
pancreatic carcinoma
brain tumors
paraneoplastic effects of lung cancer
44
What are the autoimmune etiologies of depression?
SLE
RA
fibromyalgia
45
What are the infectious causes of depression?
HIV
46
what are some drugs that can cause depression?
```
EtOH
benzos
opioids
hallucinogens including cannabis
withdrawal from stims
THE PILL
steroids
antihypertensives like reserpine and beta blockers
```
47
What is the disorder where you have severe temper tantrums? What is the mininum and maximum ages?
Disruptive mood dysregulation disorder; onset before 10, min. age 6, max age 18
48
what is the mood like between temper tantrums?
persistently negative
49
how long must a person have these crazy tantrums in order to have disruptive mood dysregulation?
12 months and cannot be symptom free for three months in that time
50
How long should symptoms of grief clear?
after two months
51
T/F: bereavement may induce an MDE
false!! AND THE DSMV DROPS THE 2 MONTH RULE
52
what two things go into forming the learned helplessness model in someone?
exposure to uncontrollable negative stimuli plus attributional style
53
What are the four theories on the etiologies of depression?
1. learned helplessness
2. cognitive theory
3. genetics
4. biology
54
T/F: there is a strong familial pattern in depression
true
55
First degree relatives have what greater risk of having depression?
2-5 times the risk
56
What are the six important biogenic amines in depressoin?
```
Dopamine
Epi
ACh
NorEpi
Histamine
Serotonin
```
57
Where is NorEpi made?
locus ceruleus
58
Where is serotonin made?
dorsal raphe nuclei in the pons
59
Decreased CSF levels of 5HIAA are found in those that die of (blank) suicide
violent
60
Where is dopamine made?
1. VTA of the midbrain
2. substantia nigra pars compacta
3. arcuate nucleus
61
The Indoleamine hypothesis thinks that there is a deficiency of (blank) that causes depressoin
5HT
62
The Catecholemine hypothesis states that there is a deficiency in (blank or blank)
NE or DA
63
The Cholinergic-adrenergic balance hypothesis states that depression occurs when what two molec's are low compared to ACh?
NE and DA are low compared to ACh and mania occurs when NE and DA are too high compared to ACh
64
The neuroendocrine model says that the hypothalamus hypersecretes (blank), resulting in elevated ACTH, which then triggers the adrenal cortex to release extra cortisol
CRF
65
T/F: cortisol levels in unipolar and bipolar depression cannot be lowered with dexamethasone
true
66
(blank) can lower cortisol levels in depressed patients and can be used in treatment-resistant depression
ketoconazole
67
The infectious model says that the (blank) virus can cause depression and can be treated with amantadine
Borna virus
68
What is the mood in a manic episode?
elevated, can be irritable, lasting at least one week
69
What is the activity like in a manic episode?
increase in goal directed activity or energy lasting at least 1 week
70
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
3, but 4 if you are just irritable
71
T/F: a manic episode results in psychosis and a need for hospitalization
true, or at least there is a major functional impairment
72
what must you rule out to Dx a manic episode?
medical or substance etiologies
73
what is the average age of onset of bipolar 1?
20s and 30s
74
T/F: the first episode of bipolar 1 can be manic or depressed
true
75
how long do manic episodes last?
weeks to months
76
T/F: rapid cycling of 4+ episodes in a year is common in bipolar 1
false
77
The family history of someone with bipolar will be positive for (blank) 60% of the time
major mood disorder
78
Which of the following disorders has the highest genetic component?
depression
bipolar 1
schizophrenia
bipolar 1
79
what are some of the things on your DDx when thinking about bipolar 1?
drugs or medical problem
bipolar 2
schizoaffective disorder
cyclothymia
80
What are the neoplastic causes of bipolar?
meningiomas, gliomas, and thalamic nets
81
A stroke to what part of the brain can lead to bipolar?
thalamus
82
T/F: head trauma and Wilson's disease and MS can all cause bipolar
true
83
Trauma to the right frontal lobe results in....
mania
84
Trauma to the left frontal lobe results in...
depressoin
85
Trauma to the medial frontal lobe results in..
apathy
86
Trauma to the orbitofrontal lobe results in...
profanity, irritability, irresponsibility
87
which drugs of abuse can induce bipolar?
LSD
METH
PCP
88
what Rx meds can induce bipolar?
```
steroids
L-dopa
thyroxine
captopril
Withdrawal from clonidine
```
89
a hypomanic episode has (blank) days of increased mood with increased goal directed activity
4 days
90
How many other symptoms must be present for a hypomanic episode?
3, but 4 if you're just an irritable little shit
91
T/F: hypomania comes with a change in functioning
true
92
T/F: hypomanic episodes results in psychosis that requires hospitalization
false; not that severe
93
What are the two characteristics of bipolar 2?
hypomanic episode and major depressive episode, no history of manic episodes
94
T/F: a manic episode results in impairment of functioning
true
95
T/F: a hypomanic episode results in an impairment of functioning
false; just a change
96
T/F: hypomanic episodes show signs of psychosis
false
97
T/F: bipolar 1 may present without MDE
true
98
T/F: bipolar 2 neeeds at least one MDE and no history of manic episodes
true
99
What are the criteria for mania/depression for bipolar 1?
manic episodes with or without MDE
100
what are the critera for mania/depression in bipolar 2?
at least one MDE and one hypomanic episode with no manic episodes
101
which bipolar is more common in females?
bipolar 2
102
which bipolar is equally common in males and females?
bipolar 1
103
Schizoaffective disorder combines (blank) symptoms such as psychosis with prominent mood symptoms
schizophrenia
104
T/F: in schizoaffective, psychotic symptoms are present even when the mood symptoms are absent
true
105
Cyclothymic disorder has a mood disturbance for how long?>
2 years
106
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
hypomanic
107
T/F: cyclothymic disorder presents with no functional impairment
false; sig. distress or functional impairment
108
Cyclothymia can be described as mild (blank) followed by hypomania
depression
109
what does "neurovegetative" mean?
sx leading to dissociation from society as a whole
110
what is 5HIAA?
the main metabolite of serotonin
