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

Mood Disorders-Jacobs Flashcards

1
Q

What are the depressive disorders?

A

Major Depressive Disorder
Dysthymic Disorder (DSM-IV) or Persistent Depressive Disorder (DSM-V)
Premenstrual Dysphoric Disorder
Disruptive Mood Dysregulation Disorder (DSM-V)
Depressive Disorder NOS, specified or unspecified

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2
Q

What are the different types of bipolar disorders?

A

Bipolar I Disorder
Bipolar II Disorder
Cyclothymic Disorder
Bipolar Disorder NOS

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3
Q

What does it mean to have a secondary mood disorder?

A

due to something else

Mood Disorder Due to a General Medical Condition
Medication/Substance-Induced Mood Disorder

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4
Q

What percentage of inpatient & outpatients will likely have major depressive disorder?

A

10% outpatient

15% inpatient

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5
Q

What are comorbidities of depression?

A

Substance use disorders, pathological gambling, personality disorders, anxiety

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6
Q

What is the lifetime prevalence of depression?

A

16.5% of Americans

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7
Q

Who is more likely to experience depression…men or women?

A

Women 70% more likely than men to experience depression during their lifetime.

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8
Q

What is the annual prevalence of depression in adults?

A

7% of Americans

14.8 million adults

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9
Q

Which ethnicity has the most depression? Age group?

A

40-59 old DSM
18-29 new DSM
Females more prevalent.
Non-Hispanic Black highest rate of depression

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10
Q

What % of medical students are depressed & which % seek treatment?

A

1/4 depressed

1/4 sought treatment

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11
Q

What did Schwenk’s depression study show?

A

14.3% moderate-severe depression
3rd/4th year students reported more suicidal ideation than 1st/2nd years
Stigma associated with depression and use of mental health care services

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12
Q

What is the relationship b/w marriage & year of postgrad training in depression prevalence in medical residents?

A

married-less likely to be depressed

1st year-worst

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13
Q

T/F Many physicians who are depressed avoid treatment or self prescribe anti-depressants.

A

True.

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14
Q

Which have a risk for abuse-anxiolytics or antidepressants?

A

anxiolytics

not antidepressants

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15
Q

How many physicians do we lose each year to suicide?

A

400

much higher rates of successful suicides, rather than attempted suicides

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16
Q

What is a major risk factor for a suicide?

A

mood disorder

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17
Q

What are some things to consider before making a depression diagnosis?

A

bereavement
normal rxn to stress or loss
adjustment disorder
cultural factors

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18
Q

What is the diagnostic criteria for major depression according to DSM V?

A

2 weeks or more of symptoms.
5/9 symptoms, must include depressed mood or loss of interest/pleasure.

mood, loss of interests, weight or appetite changes, sleep changes, agitation or retardation, fatigue, worthlessness or guilt, thinking problems, thoughts of death

marked distress or functional impairment
rule out medical or substance etiologies

**can specify with anxious distress

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19
Q

What is the screening for depression?

A

SIGECAPS
depressed mood & loss of interest most of the day nearly every day plus 4 more

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 neurovegetative symptoms?

A 
sleep disturbance: initial, middle, or terminal insomnia
decreased appetite
loss of energy
decreased libido
psychomotor retardation/agitation
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21
Q

What are possible somatic companions to depression?

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

What is the age group that major depressive disorder usu occurs?

A

50% onset b/w ages 20-50
peak incidence 20s; median age 32
can occur in children & in elderly
children: usu somatic symptoms

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23
Q

What is pseudo dementia?

A

what looks like dementia in the elderly but is actually depression

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24
Q

HOw long does a depression episode last?

A

6-13 mo
w/ treatment: 1-3 mo
faster with psychotherapy or electroconvulsive therapy

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25
Q

Can depression recur?

A

can be a chronic relapsing disorder
70% have recurring episodes
15% result in suicide

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26
Q

If someone has a ton of GI symptoms…what could they have?

A

depression

with only anhedonia perhaps

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27
Q

What do the SIGECAPS criteria test for?

A

major depressive disorder

can use to test for others

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28
Q

What is depression NOS?

A

meet some criteria for depression, but doesn’t fall into one of the major categories

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29
Q

What is dysthymic disorder or persistent depressive disorder?

A 
milder but longer lasting depression
at least 2 years of low mood
in children--only 1 year
\+ 2 additional symptoms: appetite, sleep, fatigue, self esteem, concentration, hopelessness
distress or impaired functioning
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30
Q

What is double depression?

A

when someone has low level depression + short severe depression episode

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31
Q

What is premenstrual dysphoric disorder?

A

in most menstrual cycles
at least 5 symptoms before menses that improve after onset of menses
at least 1: irritability, anger, conflict, depressed mood, anxiety, affective lability
at least 1: anhedonia, difficulty concentrating, lethargy, changes in appetite, hypersomnia/insomnia, overwhelmed, physical symptoms
interference with function

32
Q

What is the prevalence of premenstrual dysphoric disorder?

A

2-6%

33
Q

What is depressive disorder due to a general medical condition?

A

Neurologic: Parkinson’s, Huntington’s, TBI, CVA, dementia, MS

Metabolic: renal failure, Wilson’s, acute intermittent porphyria

GI: IBS, Chronic pancreatitis, Crohn’s, Cirrhosis, Hepatic Encephalopathy

Endocrine
hypothyroidism, hyperthyroidism, Cushing’s, Addison’s, DM, parathyroid disease

Cardiovascular
cardiomyopathies, MI

Pulmonary
OSA

Malignancy
Pancreatic carcinoma, brain tumors, paraneoplastic effects of lung cancer

Autoimmune
SLE, RA, fibromyalgia

Infectious
HIV

34
Q

What is substance induced depressive disorder?

A

A prominent and persistent disturbance in mood that is judged to be due to the physiological effect of a substance or medication

Drugs
alcohol, benzo’s, opioids
hallucinogens (including cannabis)
withdrawal from stimulants (methamphetamine, cocaine)

Oral Contraceptives-more with high dose

Steroids

Antihypertensives
reserpine, beta blockers + many others

35
Q

What is the disruptive mood dysregulation disorder?

A

The disorder is characterized by severe recurrent temper outbursts in response to common stressors.
KIDS with temper tantrums

A. The temper outbursts are manifest verbally and/or behaviorally, such as in the form of verbal rages, or physical aggression towards people or property.
 The reaction is grossly out of proportion in intensity or duration to the situation or provocation.

B. The responses are inconsistent with developmental level.
C. Frequency: The temper outbursts occur, on average, three or more times per week.
D. Mood between temper outbursts: 1. Nearly every day, the mood between temper outbursts is persistently negative (irritable, angry, and/or sad).
2. The negative mood is observable by others (e.g., parents, teachers, peers).
E. Duration: Criteria A-D have been present for at least 12 months. Throughout that time, the person has never been without the symptoms of Criteria A-D for more than 3 months at a time.
F. The temper outbursts and/or negative mood are present in at least two settings (at home, at school, or with peers) and must be severe in at least in one setting.
G. Chronological age is at least 6 years (or equivalent developmental level) and not more than 18 years.
H. The onset is before age 10 years.

36
Q

What does the DSM V say about bereavement v. depression?

A

no 2 mo exclusion

at any time if they are meeting criteria for Major Depressive Episode can prescribe medications

37
Q

Not included in DSM V, but what are 2 things to look out for to distinguish grief from MDE?

A

grief probably doesn’t include feelings of worthlessness & suicide

38
Q

What is the learned helplessness & its relationship with depression?

A

exposure to uncontrollable negative events plus attributional style towards themselves rather than externally
**possible reason for depression

39
Q

What is the cognitive theory of depression?

A

depression results from cognitive errors

looking at the negative.

40
Q

What is the genetics of depression?

A

strong familial pattern
children of depressed parents who are adopted out–still increased risk for depression
twin studies–monozygotic twins more likely to both be depressed if one is.
First degree relative: 2-5X risk

41
Q

What are 6 pertinent biogenic amines?

A 
dopamine
epinephrine
acetylcholine
norepinephrine
histamine
serotonin
42
Q

Where is NE made?

A

locus ceruleus

43
Q

Where is serotonin made?

A

made in dorsal raphe nuclei in the pons

44
Q

Where is dopamine made?

A

made in VTA of the midbrain, substantia nigra pars compacta, & arcuate nucleus

45
Q

What is the indoleamine hypothesis of biologic depression?

A

deficits of 5HT cause depression

46
Q

What is the catecholamine hypothesis of biologic depression?

A

deficits of NE or DA cause depression

47
Q

What is the cholinergic-adrenergic balance hypothesis?

A

depression occurs when NE and DA are low relative to Ach, and mania occurs when the reverse occurs

48
Q

What is the NE model of biologic depression?

A

the hypothalamus hypersecrets CRF in depression, resulting in elevated ACTH, which then triggers the adrenal cortex to release extra cortisol; unipolar and bipolar depressed patients oft have elevated cortisol that cannot be suppressed with dexamethasone; ketoconazole lowers cortisol levels and can be efficacious in treatment-resistant depression

49
Q

What is the infectious model of biologic depression?

A

the Borna virus and other infectious agents can cause depression; the antiviral amantadine can be helpful

50
Q

What are the mood requirements of a manic episode of bipolar I?

A

elevated or irritable mood, lasting at least 1 week

51
Q

What is the activity requirement for Bipolar I diagnosis?

A

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

52
Q

What are additional symptoms used in diagnosis of bipolar i? at least 3 of these or 4 if mood isn’t elevated, but is irritable.

A

grandiosity
decreased need for sleep & still feel rested.
pressure speech
flight of ideas/racing thoughts
distractibility
increased goal-directed activity or psychomotor agitation
risky behaviors
SO BAD that psychosis, need for hospitalization or functional impairment

53
Q

What is psychosis?

A

hearing or visual hallucinations

54
Q

What are Bipolar I Types?

A 
Single manic episode
Most recent episode hypomanic
Most recent episode manic
Most recent episode depressed
Most recent episode unspecified
55
Q

What % of pop. have Bipolar I? Age of onset? What is their first episode like?

A

0.4- 1.2% of population
Age of onset: 20’s or 30’s
Fist episode can be manic or depressed
Manic Episodes last weeks to months (NOT transient mood swings)

56
Q

What is the natural history of bipolar I?

A

Subsequent manic episodes
Subsequent depressive episodes; significant risk for suicide
Less common type: Rapid Cycling less common (4+ episodes in a year)

57
Q

T/F It is possible that a person with bipolar I’s first episode is depressive.

A

True.

58
Q

How would it affect your treatment plan if someone with bipolar I’s first episode is depressive?

A

antidepressants could prompt a manic episode

59
Q

Which mental health disorder has the strongest genetic component?

A

bipolar disorder

in 60%+ patients…have a family hx of a major mood disorder

60
Q

What are some things on your differential diagnosis for a patient with bipolar disorder I?

A

Drugs or Medical Illness
Bipolar II
Schizoaffective Disorder
Cyclothymia

61
Q

Right frontal head trauma can cause which mood?

A

mania

62
Q

Left frontal head trauma can cause which mood?

A

depression

63
Q

Medial frontal head trauma can cause which mood?

A

apathy (limited spontaneous movement, gesture, speech)

64
Q

Orbitofrontal lobe damage can cause what?

A

profanity
irritability
irresponsibility

65
Q

Which drugs when abused can cause mania?

A

LSD
stimulants (meth)
PCP

66
Q

What is medication-induced bipolar disorder?

A

The disturbance in mood is due to the effects of a medication
Steroids, L dopa, thyroxine, captopril
Drug withdrawal
clonidine

67
Q

What is a hypomanic episode?

A

At least 4 days of elevated mood + increase in goal-directed activity or mood
3 or more other symptoms (4 if mood is just irritable)
Change in functioning
Not severe enough to severely impair functioning or necessitate hospitalization
No psychosis

68
Q

What is bipolar type II?

A

Hypomanic episode + Major depressive episode
Never a history of manic episodes
Treatment same as BP I

69
Q

If a patient has EVER had a history of a full blown manic episode…which disorder do they automatically have?

A

Bipolar I

70
Q

What are the main differences b/w manic & hypomanic episodes?

A 
manic: lasting at least 1 week
impairment in functioning often hospitalization required
psychosis
hypomanic: lasting 4 days
change in functioning
NO psychosis
71
Q

Once again, what is the definition of bipolar I?

A

Involves the occurrence of one or more manic episodes with or without a history of one or more major depressive episodes
Lifetime prevalence = .4-1.6%
Equally common in males and females

72
Q

Once again, what is the definition of bipolar II?

A

Involves at least one major depressive episode and one hypomanic episode with no history of manic episodes
Lifetime prevalence = .5%
More common in females

73
Q

What is schizoaffective disorder?

A

SCHIZOPHRENIA + MOOD
Combining aspects of two different disorders
Schizophrenia symptoms (psychosis, negative symptoms)
Prominent affective (mood) symptoms
**Psychotic symptoms present even when mood symptoms absent for at least 2 weeks

74
Q

If a patient has psychosis only in the context of other mood symptoms…which disorder do you think?

A

Mood disorder with psychotic features.

75
Q

What is cyclothymic disorder?

A

Chronic mood disturbance (over 2 years)
Hypomanic symptoms that don’t meet criteria for a hypomanic episode
Depressive symptoms that don’t meet criteria for a major depressive episode
No history of depressive, manic or hypomanic episodes
Clinically significant distress or functional impairment

Block 8; Week 1 (13 decks)

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