Mood Disorders (Palmeri) - 10/12/16 Flashcards
Depressive Disorders (5)
Disruptive Mood Dysregulation Disorder
Major Depressive Disorder
Persistent Depressive Disorder
Premenstrual Dysphoric Disorder
Substance/Medication Induced Depressive Disorder
Disruptive Mood Dysregulation Disorder
- 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
Major Depressive Disorder
How long do major depressive episodes usually last?
How are episodes characterized?
What is the treatment?
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
MDD
Epidemiology and Course
- 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%
MDD
Sleep abnormalities
- 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
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
- Feeling tense
- Feeling restless
- Difficulty concentrating due to worry
- Fear that something awful will happen
- Feeling that patient might lose control of self
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
- 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
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
- 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)
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
- Delusions/hallucinations present
- Mood congruent (punishment, guilt) - depressed patients feel guilty
- Mood incongruent (atypical)
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
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
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
- Regular duration - October to February
- Full remission or switch to hypomania/mania occurs at characteristic time of year
Grief
- 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
Persistent Depressive Disorder (dysthymia)
Depression, often milder, lasting at least 2 years
Premenstrual Dysphoric Depressive Disorder
Symptoms
- 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
Premenstrual Dysphoric Depressive Disorder
Treatments
- Mood charts
- Monitor caffeine, sugar, and sodium
- Exercise
- Calcium, B6
- Light therapy
- Cognitive behavioral therapy
- SSRIs
Substance/Medication Induced Depressive Disorder
- Prominent and persistent disturbance in mood which predominates AND symptoms occur soon after intoxicatin/withdrawal/exposure to a substance/medication AND substance/medication capable of producing mood changes
- Substances:
- Alcohol
- PCP
- Hallucinogens
- Inhalants
- Opioids
- Sedative/hypnotic/anxiolytics
- Amphetamines
- Cocaine
- Medications:
- Steroids
- OCPs
- Stimulants
- BP meds (clonidine, guanethidine, methyldopa, reserpine)
- L-dopa
- Antibiotics
- CNS drugs
- Derm agents
- Chemotherapeutic and antivirals
- Substances:
- Mood disturbance not related to depressive disorder or delirium
Electroconvulsive therapy
- Used mainly for treatment-refractory depression, depression with psychotic symptoms, and acutely suicidal patients
- Produces grand mal seizure in anesthetized patient (tonic-clonic)
- Adverse effects:
- Disorientation
- Temporary headache
- Partial anterograde/retrograde amnesia usually resolving in 6 months
- Safe in pregnancy
BAD 1 vs BAD 2
Both feature presence of at least one manic (I) or hypomanic episode (II)
BAD 1: manic episode which may be preceded by or followed by hypomanic or major depressive episodes
- DIG FAST symptoms (at least 3 symptoms lasting at least 1 week)
BAD 2: hypomania must last at least 4 days
- Difference between hypomania and mania is degree of intensity of symptoms
- Generally don’t result in any sort of hospitalization
- Can go undetected for years
Cyclothymic disorder
Milder form of bipolar disorder lasting at least 2 years, fluctuating between mild depressive and hypomanic symptoms
Treatment for Bipolar 1 and 2
- Mood stabilizers
- Litium
- Valproic acid
- Carbamazepine
- ECT
- Very very cautious use of antidepressants (if at all)
