Mood Disorders (Palmeri) - 10/12/16 Flashcards
1
Q
Depressive Disorders (5)
A
Disruptive Mood Dysregulation Disorder
Major Depressive Disorder
Persistent Depressive Disorder
Premenstrual Dysphoric Disorder
Substance/Medication Induced Depressive Disorder
2
Q
Disruptive Mood Dysregulation Disorder
A
- Severe, recurrent temper outbursts
- Verbal
- Behavioral
- Occur on average 3 or more times/week
- Above criteria present for 12 or more months
- Above criteria present in at least 2 of 3 settings (home/school/w peers) and severe in at least 1 setting
- Age 7-18 for diagnosis / Age of onset before 10
3
Q
Major Depressive Disorder
How long do major depressive episodes usually last?
How are episodes characterized?
What is the treatment?
A
How long do major depressive episodes usually last?
- 6-12 months
How are episodes characterized?
- At least 5 of the 9 symptoms for 2 or more weeks
- Depressed mood
- SIG E CAPS
- Sleep disorder (increased or decreased)
- Interest (decreased - anhedonia)
- Guilt (worthlessness, hopelessness, regret)
- Energy (decreased)
- Concentration (decreased)
- Appetite/weight changes
- Psychomotor retardation or agitation
- Suicidal ideations
What is the treatment?
- First line: CBT and SSRIs
- Additional: SNRIs, mirtazapine, bupropion
- Electroconvulsive therapy (ECT) in select patients
4
Q
MDD
Epidemiology and Course
A
- Females >> Males
- Risk of recurrence increases with severity of episode, younger populations, previous multiple episodes
- Depressions may be present as first episode of eventual bipolar or schizophrenic disorders
- Heritability: 40%
5
Q
MDD
Sleep abnormalities
A
- Delayed sleep onset
- Shortened REM latency
- Increased REM early in sleep cycle
- Increased total REM sleep
- Repeated nighttime awakenings
- Early-morning wakening (terminal insomnia) → tired more easily
6
Q
Selected Specifiers for Major Depression
- w/ anxious distress (2-5 symptoms)
- w/ melancholic features
- w/ atypical features
- w/ psychotic features
- w/ peripartum onset
- w/ seasonal pattern
A
- Feeling tense
- Feeling restless
- Difficulty concentrating due to worry
- Fear that something awful will happen
- Feeling that patient might lose control of self
7
Q
Selected Specifiers for Major Depression
- w/ anxious distress (2-5 symptoms)
- w/ melancholic features
- w/ atypical features
- w/ psychotic features
- w/ peripartum onset
- w/ seasonal pattern
A
- Either loss of pleasure in all or almost all activities or lack of reactivity to pleasurable activities AND
- 3 or more of the following symptoms:
- Despondency
- Depression worse in the morning
- Anorexia/weight loss
- Excessive guilt
- Psychomotor agitation/retardation
8
Q
Selected Specifiers for Major Depression
- w/ anxious distress (2-5 symptoms)
- w/ melancholic features
- w/ atypical features
- w/ psychotic features
- w/ peripartum onset
- w/ seasonal pattern
A
- Differs from classical forms of depression
- Mood reactivity AND
- 2 or more of the following symptoms
- Significant weight gain or increase in appetite (hyperphagia)
- Hypersomnia
- Leaden paralysis (feeling heavy in arms and legs)
- Interpersonal rejection sensitivity (really tuned into what other people think of them)
- Most common subtype of depression
- Treatment: CBT and SSRIs (first line); MAO inhibitors (second line)
9
Q
Selected Specifiers for Major Depression
- w/ anxious distress (2-5 symptoms)
- w/ melancholic features
- w/ atypical features
- w/ psychotic features
- w/ peripartum onset
- w/ seasonal pattern
A
- Delusions/hallucinations present
- Mood congruent (punishment, guilt) - depressed patients feel guilty
- Mood incongruent (atypical)
10
Q
Selected Specifiers for Major Depression
- w/ anxious distress (2-5 symptoms)
- w/ melancholic features
- w/ atypical features
- w/ psychotic features
-
w/ peripartum onset
- ”Blues”
- Postpartum depression
- Postpartum psychosis
- w/ seasonal pattern
A
Onset: within 4 weeks of delivery
Postpartum “blues”
- 50-85% incidence rate
- Depressed affect, tearfulness, fatigue starting 2-3 days after delivery; usually resolves within 10 days
- Treatment: supportive (follow up to assess for possible postpartum depression)
Postpartum depression
- 10-15% incidence rate
- Depressed affect, anxiety, poor concentration
- Treatment: CBT and SSRIs (first line)
Postpartum psychosis
- 0.1-0.2% incidence rate
- Mood-congruent delusions, hallucinations, thoughts of infanticide → infanticide
- Risk factors: history of bipolar or psychotic disorder, first pregnancy, family hx
- Treatment: hospitalization and initiation of atypical antipsychotic; if insufficient, ECT may be used
11
Q
Selected Specifiers for Major Depression
- w/ anxious distress (2-5 symptoms)
- w/ melancholic features
- w/ atypical features
- w/ psychotic features
- w/ peripartum onset
- w/ seasonal pattern
A
- Regular duration - October to February
- Full remission or switch to hypomania/mania occurs at characteristic time of year
12
Q
Grief
A
- Characterized by shock, denial, guilt, sadness, anxiety, yearning, and somatic symptoms
- Hallucinations of deceased person - common
- Duration varies widely; usually < 6 mo.
- Self esteem preserved
13
Q
Persistent Depressive Disorder (dysthymia)
A
Depression, often milder, lasting at least 2 years
14
Q
Premenstrual Dysphoric Depressive Disorder
Symptoms
A
- 5 symptoms must be present in the final week before the onset of menses
- Marked affective liability
- Irritability or Interpersonal conflict
- Depressed mood
- Tension/Anxiety
- Decreased interest in usual activities
- Difficulty with concentration
- Lethargy
- Change in appetite
- Change in sleep
- Sense of being out of control/overwhelmed
- Physical symptoms
- Symptoms must improve within a few days after onset of menses and become minimal in the week post menses
15
Q
Premenstrual Dysphoric Depressive Disorder
Treatments
A
- Mood charts
- Monitor caffeine, sugar, and sodium
- Exercise
- Calcium, B6
- Light therapy
- Cognitive behavioral therapy
- SSRIs
