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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
Can depression recur?
can be a chronic relapsing disorder 70% have recurring episodes 15% result in suicide
26
If someone has a ton of GI symptoms...what could they have?
depression | with only anhedonia perhaps
27
What do the SIGECAPS criteria test for?
major depressive disorder | can use to test for others
28
What is depression NOS?
meet some criteria for depression, but doesn't fall into one of the major categories
29
What is dysthymic disorder or persistent depressive disorder?
``` 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 ```
30
What is double depression?
when someone has low level depression + short severe depression episode
31
What is premenstrual dysphoric disorder?
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
What is the prevalence of premenstrual dysphoric disorder?
2-6%
33
What is depressive disorder due to a general medical condition?
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
What is substance induced depressive disorder?
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
What is the disruptive mood dysregulation disorder?
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
What does the DSM V say about bereavement v. depression?
no 2 mo exclusion | at any time if they are meeting criteria for Major Depressive Episode can prescribe medications
37
Not included in DSM V, but what are 2 things to look out for to distinguish grief from MDE?
grief probably doesn't include feelings of worthlessness & suicide
38
What is the learned helplessness & its relationship with depression?
exposure to uncontrollable negative events plus attributional style towards themselves rather than externally **possible reason for depression
39
What is the cognitive theory of depression?
depression results from cognitive errors | looking at the negative.
40
What is the genetics of depression?
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
What are 6 pertinent biogenic amines?
``` dopamine epinephrine acetylcholine norepinephrine histamine serotonin ```
42
Where is NE made?
locus ceruleus
43
Where is serotonin made?
made in dorsal raphe nuclei in the pons
44
Where is dopamine made?
made in VTA of the midbrain, substantia nigra pars compacta, & arcuate nucleus
45
What is the indoleamine hypothesis of biologic depression?
deficits of 5HT cause depression
46
What is the catecholamine hypothesis of biologic depression?
deficits of NE or DA cause depression
47
What is the cholinergic-adrenergic balance hypothesis?
depression occurs when NE and DA are low relative to Ach, and mania occurs when the reverse occurs
48
What is the NE model of biologic depression?
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
What is the infectious model of biologic depression?
the Borna virus and other infectious agents can cause depression; the antiviral amantadine can be helpful
50
What are the mood requirements of a manic episode of bipolar I?
elevated or irritable mood, lasting at least 1 week
51
What is the activity requirement for Bipolar I diagnosis?
increase in goal directed activity or energy lasting at least 1 week
52
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.
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
What is psychosis?
hearing or visual hallucinations
54
What are Bipolar I Types?
``` Single manic episode Most recent episode hypomanic Most recent episode manic Most recent episode depressed Most recent episode unspecified ```
55
What % of pop. have Bipolar I? Age of onset? What is their first episode like?
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
What is the natural history of bipolar I?
Subsequent manic episodes Subsequent depressive episodes; significant risk for suicide Less common type: Rapid Cycling less common (4+ episodes in a year)
57
T/F It is possible that a person with bipolar I's first episode is depressive.
True.
58
How would it affect your treatment plan if someone with bipolar I's first episode is depressive?
antidepressants could prompt a manic episode
59
Which mental health disorder has the strongest genetic component?
bipolar disorder | in 60%+ patients...have a family hx of a major mood disorder
60
What are some things on your differential diagnosis for a patient with bipolar disorder I?
Drugs or Medical Illness Bipolar II Schizoaffective Disorder Cyclothymia
61
Right frontal head trauma can cause which mood?
mania
62
Left frontal head trauma can cause which mood?
depression
63
Medial frontal head trauma can cause which mood?
apathy (limited spontaneous movement, gesture, speech)
64
Orbitofrontal lobe damage can cause what?
profanity irritability irresponsibility
65
Which drugs when abused can cause mania?
LSD stimulants (meth) PCP
66
What is medication-induced bipolar disorder?
The disturbance in mood is due to the effects of a medication Steroids, L dopa, thyroxine, captopril Drug withdrawal clonidine
67
What is a hypomanic episode?
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
What is bipolar type II?
Hypomanic episode + Major depressive episode Never a history of manic episodes Treatment same as BP I
69
If a patient has EVER had a history of a full blown manic episode...which disorder do they automatically have?
Bipolar I
70
What are the main differences b/w manic & hypomanic episodes?
``` manic: lasting at least 1 week impairment in functioning often hospitalization required psychosis hypomanic: lasting 4 days change in functioning NO psychosis ```
71
Once again, what is the definition of bipolar I?
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
Once again, what is the definition of bipolar II?
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
What is schizoaffective disorder?
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
If a patient has psychosis only in the context of other mood symptoms...which disorder do you think?
Mood disorder with psychotic features.
75
What is cyclothymic disorder?
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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