Mood disorders - Psychiatry medicine

Question 1

Diagnosis of major depressive episode ?

Answer 1

A- Five or more of the following symptoms, at least one of the symptoms is either (1) depressed mood or (2) loss of interest:
1- Depressed mood.
2- Loss of interest and pleasure in previously interestable activities.
3- Insomnia or hypersomnia.
4- Psychomotor retardation or agitation.
5- Decreased or increased appetite and loss or increase in weight.
6- Easy fatigability.
7- Decreased concentration.
8- Feelings of worthlessness or guilt.
9- Recurrent thoughts of death or suicidal ideation, plan or attempts.

B- The symptoms lasts for at least two weeks.

C- Significant impairment in social or occupational functions.

D- Not substance-induced or not due to general medical condition.

Question 2

Manic episode diagnosis

Answer 2

A. Elated mood or irritable mood for one week or more.
B. If mood is elated (3) or more of the following must be present but if mood is irritable (4) or more of the following must be present:
1- Inflated self-esteem or grandiosity.
2- Decreased need for sleep.
3- More talkative than usual.
4- Flight of ideas.
5- Distractibility.
6- psychomotor agitation.
7- Loss of normal social and sexual inhibition.
8- Excessive involvement in pleasurable activities that have a high potential for painful consequences.
C. Significant impairment in social or occupational functioning.
D. Not substance-induced or not due to general medical condition.

Question 3

Diagnosis of major depressive disorder?

Answer 3

A- Presence of one or more major depressive episodes.
B- There has never been a manic or hypomanic episodes.
C- Significant impairment of occupational and social functioning.

Question 4

ttt of major depressive disorder

Answer 4

A. Pharmacotherapy:
1- Serotonin specific reuptake inhibitors (SSRIs):
● Mode of action: inhibit reuptake of serotonin so promote its action on postsynaptic receptors.
● Indications: major depressive disorder, anxiety disorder, bulimia nervosa.
● Adverse effects: nausea, decreased appetite, delayed ejaculation.
● Examples: fluoxetine, paroxetine.
2- Tricyclic and tetracyclic antidepressants:
● Mode of action: inhibit reuptake of serotonin and norepinephrine so promote their actions on postsynaptic receptors.
● Indications: major depressive disorder, panic disorder.
● Adverse effects: sedation, atropine-like action.
● Examples: imipramine, maprotiline.
3- Buprobion:
● Mode of action: inhibit reuptake of dopamine and norepinephrine so promote their actions on postsynaptic receptors.
● Indications: major depressive disorder, attention deficit/ hyperactivity disorder, smoking cessation.
● Adverse effects: mild symptoms of weight loss, dry mouth or constipation.
B. Electro-convulsive therapy:
is useful in refractory major depressive disorder, major depressive episode with suicidal attempts or with psychotic symptoms (like delusions
and hallucinations).
C. Psychotherapy:
● Cognitive therapy: aims to correct negative cognitions.
● Supportive psychotherapy: aims to provide emotional support.
● Family therapy: if patient’s depression is disrupting the family stability, or when depression is related to family dynamics.

Question 5

Diagnosis of Bipolar I disorder

Answer 5

A-Presence of one or more manic episodes.
B- With or without presence of major depressive episodes.
C- Significant impairment of occupational and social functioning

Question 6

ttt of bipolar disorder

Answer 6

A- Hospitalization: especially with severily psychomotor agitated patients.
B- Pharmaotherapy:
I- Mood stabilizers: are used in the treatment and prevention of manic and depressive episodes of bipolar disorders.
1- Lithium (Standard)
2- Valproate (First line bp with dysphoric mood)
3- Lamotrigine (Most effective in dd)
4- Carbamazepine (if others contraindicated)
II- During manic episode antipsychotic drugs are used to promote rapid amelioration of the symptoms.
III- While during depressive episode; combination of olanzapine & fluoxetine (Symbyax) or quetiapine (300 mg) have been shown to be effective in treating acute bipolar depression for an 8-week period without inducing a switch to mania or hypomania..
C- Electroconvulsive tharpy: is at least equal to lithium in the treatment of acute and severe manic episodes.
D- Psychotherapy:
1- Cognitive therapy; to increase compliance with pharmacotherapy.
2- Supportive therapy: with chronic patients who may have significant interepisodic residual symptoms and social dysfunction.
3- Family therapy: if patient’s disorder is disrupting the family stability, and because the disorder is strongly familial.