Mood Disorders- Jacobs Flashcards
1
Q
THere are 5 different depressive disorders, what are they?
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
2
Q
What are the four types of bipolar disorders?
A
- bipolar I disorder
- bipolar II disorder
- cyclothymic disorder
- bipolar disorder NOS
3
Q
What are secondary mood disorders?
A
- Mood Disorder Due to a General Medical Condition
- Medication/Substance-Induced Mood Disorder
4
Q
What is the most common psychiatric illness you are likely see as a physician?
A
depression (unipolar)
5
Q
What are co-morbidities of depression?
A
-substance use disorders, pathological gambling, personality disorders, anxiety
6
Q
Who are more likley to be depressed?
A
Women
7
Q
Medical students are more likley to be depressed than normal student. WHat years are the most depressive years?
A
3rd and 4th year
8
Q
Who were more depressed, married or single people?
A
single people
9
Q
How many physicians do you lose a year to suicide? Are the majority female or male?
A
400
it is equal
10
Q
What are things to consider before diagnosing someone with depression?
A
- bereavement
- normal reaction to stress or loss
- adjustment disorder
- cultural factors
11
Q
What is the criterion or a major depressive disorder?
A
- 2 weeks or more of symptoms
- 5 or more of possible 9 symtpoms (one of which must be depressed mood or loss of interest/pleasure)
- marked distress or functional impairment
- rule out medical and substance etiologies
12
Q
What are the 9 symptoms of major depressive disorder?
A
- mood
- loss of interest
- weight or app changes
- sleep changes
- agitation or retardation
- fatigue
- worthlessness or guilty
- thinking problems
- thoughts of death
13
Q
What is the mneumonic for Depression screening?
A
SIGECAPS S-sleep I-interest reduced G-guilt E-energy loss and fatigue C- concentrations problems A-appetite changes P- psychomotor changes S- Suicidal thoughts (ask about mood)
14
Q
What are the (neuro)vegetative symptoms?
A
- sleep disturbance
- appetite problems
- loss of energy
- decreased libido
- psychomotor retardation/agitation
15
Q
What are the three ways you can have sleep disturbances?
A
initial, middle,terminal insomnia
16
Q
When you have appeptite problems associated with major depressive disorder are you eating too much or not enough?
A
not enough
17
Q
WHat are possible “companions” to depression?
A
nausea constipation headaches back pain shortness of breath* chest pain* *anxiety type symptoms
18
Q
In major depressive disorder, 50% onset between ages (blanK) and (blank)
A
20 and 30
19
Q
What is the peak incidence of major depressive disorder?
What is the median age of onset?
A
20s
32
20
Q
How long can a single episode of major depressive disorder last?
A
6-13 months untreated
1-3 months treated (faster with ElectroConvulsiveTherapy)
21
Q
What is the percent of MDD patients that relapse? What percent commit suicide?
A
70%
15% commit suicide
22
Q
What is persistent depressive disorder?
A
2 years of low mood (1 year for children/adolescents)
- milder, more fluctuating symptoms
- presence 2 additional symptoms (appetite, sleep, fatigue, self esteem, concentration, hopelessness)
- distress or impaired functioning
23
Q
What gender is more likely to have persistent depressive disorder?
A
women
24
Q
What do you call this:
persistent depressive disoder with a shorter more severe episode
A
double depression
25
What is premenstrual dysphoric disorder?
greater than 5 symptoms present during the week before menses
26
What are the symptoms of dysophoric disorder?
B. > 1 symptoms: affective lability, irritability/anger/conflict, depressed mood, anxiety
C. > 1 symptoms: anhedonia, difficulty concentrating, lethargy, change in appetite, hypersomnia/insomnia, overwhelmed/out of control, physical symptoms (bloating, pain, weight gain, etc)
D. causing clinically significant distress or interference with functioning
27
A depressive disorder due to a general medical condition (A prominent and persistent disturbance in mood that is judged to be due to the direct pathophysiological consequence of another medical disease). . WHat are some examples of diseases that cause this?
```
Malignancy
autoimmune
infectious
GI
metabolic
endocrine
pulmonary
CV
neuro
```
28
What is a 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
29
What are some drugs that cause substance-induced depressive disorders?
Alcohol, benzos, opoids
- hallucinogens (including cannabis)
- withdrawal from stimulants (meth, cocaine)
30
What are some other substance induced depressive disorder caues?
oral contraceptives
steroids
anti-hypertensives (reserpine, beta blockers etc.)
31
What is disruptive mood dysregulation disorder?
characterized by severe recurrent temper outbursts in response to common stressors
- occuring for 12 months
- in at least 2 settings
- 3 X or more a week
- have to be at least 6 and onset has to be before 10 and cant be over 18
32
How are the temper outbursts of disruptive mood dysregulation disorder manifested?
verbally and/or behaviorally such as verbal rage or agression
33
What is this:
| Other Specified/ Unspecified Depressive Disorders
Clinically significant depressive syndromes not meeting criteria for established categories of depression.
Clinician specify or not specify reasons that full criteria are not met (i.e., short duration, insufficient symptoms)
34
What is this:
| exposure to uncontrollable negative events plus attributional style
Learned Helplessness Model
35
What are some theories behind the etiology of depression?
- learned helplessness
- cognitive theory
- genetics of depression
- biology of depression
36
Is depression genetic?
yes, has strong familial pattern, and children of depressed parents who are adopted out are at increased risk for depression
37
If you have a first degree relative who is depressed, you are (blank) times more likely than the generally pop to be depressed
2-5 times
38
What are the 6 pertinent biogenic amides?
- dopamine
- epinephrine
- acetylcholine
- norepinephrine
- histamine
- serotonin
39
What is this
| made in the locus ceruleus
norepinephrine
40
What is this:
made in the dorsal raphe nuclei in the pons
decreased CSF 5HIAA levels in those who die of violent suicide
serotonin
41
WHat is this:
| made in VTA of the midbrain, substantia nigra parts compacta, and arcuate nucleus
Dopamine
42
What is the indeoleamine hypothesis?
deficit of 5 HT causes depression
43
What is the catecholaine hypothesisi?
deficit of NE or DA cause depression
44
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
45
What is the neuroendocrine model?
hypothalamus hypersecretes CRF in depression, resulting in elevated ACTH, which triggers adrenal cortex to releaase cortisol that cannot be suppressed with dexamethasone.
46
How do you treat neuroendocrine depression?
with ketoconazole which lowers cortisol levels and can be efficacious in treatment-resistant depression
47
What is the infectious model behind depression?
the Borna virus and other infectious agents can cause depression; the antiviral amantadine can be helpful
48
In Bipolar I, what are signs of manic episodes?
Mood: elevated (or irritable, can be labile) lasting one week
activity: increase in goal directed activity or energy lasting at least one week
- 3 symptoms
49
What are the symptoms of manic episodes?
Grandiosity, decr need for sleep, pressured speech, flight of ideas/racing thoughts, distractibility, incr goal-directed activity or psychomotor agitation, risky behaviors
50
IF you are manic but irritiable not elevated, how many extra symptoms do you need?
4
51
Are transient mood swings indicative of bipolar disorders?
NO!
52
How can you identify the most recent bipolar episode?
- Single manic episode
- Most recent episode hypomanic
- Most recent episode manic
- Most recent episode depressed
- Most recent episode unspecified
53
What is the age of onset of bipolar I?
20-30
| manic episodes lasts weeks to months
54
If you give an antidepressent for someone on their first depressive episode of bipolar disorder, what can happen?
you can induce a manic episode
55
What disoder has the stronest genetic component?
Bipolar disorder
56
First degree relatives are (blank) times more likley to have bipolar disorder
20
57
IS bipolar II more intense or less intesnt than Bipolar I?
less
58
What is in your differential of bipolar I?
Drugs or Medical Illness
Bipolar II
Schizoaffective Disorder
Cyclothymia
59
If you have right frontal head trauma what can result?
mania
60
If you have left frontal head trauma what can result?
depression
61
If you have medial frontal head trauma what can result?
apathy
62
If you have orbitofrontal lobe trauma what can result?
profanity, irritability, irresponsibility
63
T or F
| bipolar disorder can be due to another medical condition
T
64
T or F
| manic moods can be induced by drugs?
T
65
What are drugs of abuse that can resemble a bipolar manic episode?
LSD, stimulants (meth) PCP
66
What medications can cause medication induced bipolar disorder?
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 defines a bipolar type II disorder?
hypomanic episode + major depressive episode
- never a history of manic episodes
- treatment same as BP I
69
What the difference between manic and hypomanic episodes?
manic-impairment of functiong, lasts a week
| hypomanic- no impairment of functioning, lasts 4 days
70
What is the difference between bipolar I and bipolar II?
bipolar I- involves a manic episode, involves depressive episode
bipolar II- at least one major depressive episode and one hypomanic episode with no history of manic episodes
71
If you ever had a manic episode what are you????
bipolar I
72
What is schizoaffective disorder?
combing aspects of 2 different disorders
- shizophrenia symptoms (psychosis, negative symptoms)
- Prominent affective (mood) symptoms
- psychotic symptoms present even when mood symptoms are absent
73
In schizoaffective disorder, psychotic symptoms must occur for at least (blank) weeks in the ABSENCE of prominent mood symptoms
2
74
If psychotic symptoms occur ony in the context of mood symptoms, then think (Blank)
mood disoder with psychotic features
75
What is cyclothymic disoder?
- 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 signif distress or functional impairment
