Mood Disorders_ Flashcards
Chapter 4
What are the key criteria for a Major Depressive Episode (MDE)?
Five or more symptoms (including depressed mood or anhedonia) present for at least 2 weeks, causing significant distress or impairment.
What differentiates mania from hypomania?
Mania lasts at least 7 days, may require hospitalisation, and can have psychotic features.
Hypomania lasts at least 4 days, does not require hospitalisation, and has no psychotic features.
What is the significance of ‘mixed features’ in mood episodes?
Presence of depressive and manic/hypomanic symptoms simultaneously, which may impact treatment response.
Name at least two medical conditions that can cause depressive episodes.
Cerebrovascular disease, hypothyroidism, Addison’s disease, or Cushing’s syndrome.
What are the common features of atypical depression?
Hypersomnia, hyperphagia, reactive mood, leaden paralysis, and interpersonal rejection sensitivity.
What mnemonic is used to recall symptoms of a manic episode?
‘DIG FAST’: Distractibility, Insomnia, Grandiosity, Flight of ideas, Activity increase, Speech (pressured), Thoughtlessness.
What are the key treatments for Bipolar I Disorder?
Mood stabilizers (e.g., lithium, valproate), antipsychotics, psychotherapy, and treatment of co-occurring conditions.
What does the SAD PERSONS scale assess?
It assesses suicide risk factors, including demographics, history, and clinical symptoms.
What is the first-line treatment for Premenstrual Dysphoric Disorder (PMDD)?
SSRIs, either as continuous or luteal phase therapy.
What defines Disruptive Mood Dysregulation Disorder (DMDD)?
Severe irritability and recurrent temper outbursts inconsistent with developmental level, present for at least 1 year.
What is the duration required for Persistent Depressive Disorder (PDD)?
At least 2 years of depressive symptoms (1 year in children/adolescents).
How does Seasonal Affective Disorder (SAD) present?
Depressive episodes during fall/winter with full remission in spring/summer.
What is the role of ketamine in depression treatment?
Rapid-acting antidepressant effects in treatment-resistant depression.
What defines postpartum depression?
Depression occurring within 4 weeks postpartum, including severe symptoms.
What is the main mechanism of action for SSRIs?
Inhibition of serotonin reuptake, increasing serotonin levels in the synapse.
What is the first-line treatment for Bipolar II Disorder?
Mood stabilizers and psychotherapy.
What is the hallmark symptom of Cyclothymic Disorder?
Chronic fluctuations between subthreshold hypomania and depressive symptoms.
What defines melancholic depression?
Anhedonia, psychomotor changes, early awakening, weight loss, guilt.
How is treatment-resistant depression managed?
Augmentation with atypical antipsychotics, ketamine, or ECT.
What is the significance of neurovegetative symptoms in depression?
Disturbances in sleep, appetite, energy, and psychomotor activity.
What are common side effects of tricyclic antidepressants (TCAs)?
Sedation, weight gain, dry mouth, blurred vision, cardiac arrhythmias.
What differentiates acute stress reaction from adjustment disorder?
Duration of symptoms: Acute stress (≤1 month), adjustment (>6 months).
What are the diagnostic criteria for rapid cycling in bipolar disorder?
≥4 mood episodes in a 12-month period.
Which neurotransmitter is implicated in mania?
Dopamine dysregulation.
What is the therapeutic range for lithium?
0.6–1.2 mEq/L.
What lab monitoring is essential for patients on valproate?
Liver function tests and complete blood counts.
What is the role of electroconvulsive therapy (ECT)?
Treatment of severe depression or acute mania unresponsive to medications.
How does premenstrual syndrome (PMS) differ from PMDD?
PMS has mild symptoms; PMDD includes marked mood disturbances.
What is the relevance of serotonin in mood regulation?
Critical for mood stabilization; deficiency linked to depression.
Which brain regions are associated with depression?
Prefrontal cortex and hippocampus show decreased activity.
How is suicidal ideation assessed in a clinical setting?
Through structured interviews and validated scales (e.g., PHQ-9).
What distinguishes dysthymia from major depressive disorder?
Dysthymia: Chronic, less severe; MDD: Episodic, severe symptoms.
What is the effect of childhood trauma on mood disorders?
Increases vulnerability to mood dysregulation later in life.
What is the first-line medication for acute mania?
Lithium, valproate, or atypical antipsychotics.
How does borderline personality disorder overlap with mood disorders?
Emotional dysregulation overlaps with mood instability.
What are common triggers for mood episodes in bipolar disorder?
Stress, sleep disruption, and substance use.
What is the role of cognitive-behavioral therapy (CBT) in depression?
Effective in addressing negative thought patterns.
What defines a major depressive episode with psychotic features?
Presence of hallucinations/delusions consistent with mood themes.
How does substance use impact mood disorders?
Exacerbates or mimics depressive or manic episodes.
What is the effect of omega-3 supplementation in mood disorders?
Shows modest improvement in depressive symptoms.
What is the mechanism of action of SNRIs?
Inhibit reuptake of serotonin and norepinephrine.
How does bipolar disorder differ in pediatric populations?
Symptoms more irritable and rapid cycling in children.
What are common misdiagnoses for bipolar disorder?
ADHD, personality disorders, substance use disorders.
What is the relationship between hypothyroidism and depression?
Thyroid hormone replacement resolves depressive symptoms.
What defines secondary depression?
Depression secondary to medical/psychological factors.
How does electroconvulsive therapy (ECT) work?
Induces seizure activity to reset brain circuits.
What are the criteria for a mixed mood episode?
Simultaneous presence of mania and depression symptoms.
How is atypical depression treated?
SSRIs, psychotherapy, or light therapy.
What distinguishes hypomania from euthymia?
Hypomania: Mildly elevated mood; euthymia: Normal mood state.
What is the significance of genetic factors in depression?
Heritable factors contribute up to 40–70% of risk.
What are signs of serotonin syndrome?
Autonomic instability, agitation, clonus, hyperreflexia, fever.
What is the prognosis for cyclothymic disorder?
Often chronic with moderate functional impairment.
What is cyclothymic disorder, and how is it characterized?
Answer: A chronic mood disorder with hypomanic and depressive symptoms that do not meet full criteria for hypomanic or major depressive episodes. Duration: At least 2 years in adults (1 year in children/adolescents).
What are the DSM-5 diagnostic criteria for cyclothymic disorder?
Answer: Symptoms present for at least 2 years (1 year in children), with numerous periods of hypomanic and depressive symptoms. Symptoms occur at least half the time, with no symptom-free periods lasting more than 2 months.
How common is cyclothymic disorder, and what is its prognosis?
Answer: Prevalence is 0.4–1%. Onset often in adolescence or early adulthood. Chronic course with a risk of progressing to bipolar I or II without treatment.
What are the treatment options for cyclothymic disorder?
Mood stabilizers: Lithium, valproate, carbamazepine.
Atypical antipsychotics: Quetiapine for mood stabilization.
Psychotherapy: CBT to manage mood swings and coping strategies.
How is cyclothymic disorder different from bipolar I and II?
Bipolar I: At least one manic episode.
Bipolar II: At least one hypomanic episode and one major depressive episode.
Cyclothymic disorder: Never meets full criteria for mania, hypomania, or major depressive episodes.
How do anticonvulsants help in bipolar disorder?
Stabilize mood by modulating neurotransmitter release.
What are first-line medications for treating PMDD?
SSRIs like fluoxetine or sertraline.
A 28-year-old presents with depressed mood, anhedonia, fatigue, and worthlessness lasting 3 weeks. What is the most likely diagnosis?
Major Depressive Disorder (MDD).
A patient presents with grandiosity, decreased need for sleep, and pressured speech for 8 days. What is the diagnosis?
Manic Episode.
A patient with hypothyroidism presents with depressive symptoms. What should be ruled out before diagnosing primary depression?
Secondary depression due to medical causes.
What feature distinguishes atypical depression from melancholic depression?
Atypical depression includes mood reactivity, whereas melancholic depression involves anhedonia and early morning awakenings.
What is the role of light therapy in mood disorders?
It is effective in seasonal affective disorder to regulate circadian rhythms.
Which mood disorder has the highest genetic link?
Bipolar I Disorder.
What defines a psychotic feature in mood disorders?
Delusions or hallucinations occurring with mood congruence.
What is the treatment approach for catatonia associated with mood disorders?
Benzodiazepines (e.g., lorazepam) and electroconvulsive therapy (ECT).
Name one medication class that can induce manic symptoms.
Antidepressants or corticosteroids.
How does the SAD PERSONS scale guide clinical decisions?
It assesses suicide risk severity to guide intervention urgency.
What are the DSM-5 criteria for Major Depressive Disorder (MDD)?
At least 5 symptoms (e.g., depressed mood, anhedonia) for 2 weeks, causing significant distress/impairment.
What are the DSM-5 criteria for Bipolar I Disorder?
At least one manic episode lasting 1 week or requiring hospitalization, with or without depressive episodes.
What are the DSM-5 criteria for Persistent Depressive Disorder (PDD)?
Chronic depressive symptoms for at least 2 years (1 year in children/adolescents).
What is the DSM-5 diagnostic feature of Cyclothymic Disorder?
Chronic mood fluctuations involving hypomania and depressive symptoms for at least 2 years.
What is the first-line pharmacological treatment for Major Depressive Disorder (MDD)?
Selective Serotonin Reuptake Inhibitors (SSRIs) like sertraline or fluoxetine.
What is the updated first-line dosage for SSRIs in treating depression?
Sertraline: Start 50 mg daily, max 200 mg/day; Fluoxetine: Start 20 mg daily, max 80 mg/day.
What is the recommended dosage range for lithium in Bipolar I Disorder?
Therapeutic level: 0.6–1.2 mEq/L, dosed 600–900 mg/day in divided doses.
What is the initial treatment for acute mania in Bipolar Disorder?
Combination of lithium or valproate and an antipsychotic (e.g., olanzapine or risperidone).
What is the role of second-generation antipsychotics in mood disorders?
Effective in treating acute mania and psychotic symptoms in mood disorders.
What is the first-line treatment for treatment-resistant depression?
Augmentation with atypical antipsychotics like aripiprazole or use of ketamine infusions.
Symptoms of mania
DIG FAS
DIFFERENCES BETWEEN MANIC AND HYPOMANIC EPISODES
Suicide Risk Factors:
SAD PERSONS
What are the typical psychotic themes seen in mood congruent psychosis for depression and mania?
Depression: Psychotic themes of paranoia and worthlessness.
Mania: Psychotic themes of grandiosity and invincibility.
General Rule: Psychotic features in mood disorders are usually mood congruent.
: What are the most common
psychiatric disorders among those
who commit suicide
MDD and bipolar I disorder
What is the most effective antidepressant medication and how
quickly does it work?
All antidepressant medications
are equally effective but differ in
side-effect profiles. Medications
take 4–6 weeks to reach peak
efficacy.
: What is the first-line treatment
for bipolar disorder?
Lithium, valproic acid, and
carbamazepine, or secondgeneration antipsychotics.
Side effects of lithium include
Bipolar vs Border line differnce
check list for petients on Lithium
What are the key characteristics and symptoms of melancholic depression?
Subtype: Melancholic depression.
Key Features:
Neurovegetative symptoms:
Early morning awakening.
Significant weight loss or lack of appetite.
Psychomotor retardation or agitation (symbolized by the turtle for slowness).
Profound sadness or despondency (persistent feeling of hopelessness).
Lack of reactivity to positive stimuli.
Symptoms more pronounced in the morning.
What are the key features of atypical depression, and how is it treated?
Key Features:
Mood reactivity: Can feel better with positive events.
Increased appetite: Tendency to overeat (comfort foods).
Hypersomnia: Excessive sleeping.
Leaden paralysis: Feeling heavy or weighed down.
Interpersonal rejection sensitivity: Overreacting to rejection (symbolized by a broken heart).
Treatment:
MAOIs (Monoamine Oxidase Inhibitors) are effective.
Mnemonic: “Ate”-typical depression (emphasizing increased appetite).
What are the key features of seasonal depression (SAD), and how is it treated?
Key Features:
Symptoms typically worsen in winter (less sunlight) and improve in summer (more sunlight).
Often includes:
Low energy.
Hypersomnia (excessive sleep).
Overeating and weight gain.
Depressed mood during specific seasons.
Treatment:
Bright light therapy (mimics sunlight exposure).
Can be combined with medications or psychotherapy if needed.
What is psychotic depression, and how common is it in older, hospitalized patients with major depressive disorder (MDD)?
Definition:
Psychotic depression is characterized by the presence of delusions and/or hallucinations occurring alongside major depressive disorder (MDD).
Prevalence:
It is present in 24–53% of older, hospitalized patients with MDD.
What is dysthymia, and how is it characterized?
Back (Answer):
- Definition:
Dysthymia, also known as Persistent Depressive Disorder (PDD), is a chronic form of depression lasting for at least 2 years in adults (or 1 year in children/adolescents).
-
Key Features:
- Symptoms are less severe than major depressive disorder but more chronic.
- Includes:
- Low energy or fatigue.
- Poor appetite or overeating.
- Low self-esteem.
- Difficulty concentrating or making decisions.
- Feelings of hopelessness.
-
Mnemonic:
Think of dysthymia as “low-grade depression” that persists over a long duration.
What is double depression, and how does it present clinically?
-
Definition:
Double depression refers to the occurrence of major depressive episodes (MDE) superimposed on dysthymia (persistent depressive disorder). -
Clinical Presentation:
- A baseline of chronic low mood (dysthymia).
- Periodic exacerbations with more severe depressive symptoms during major depressive episodes.
-
Key Features:
- Patients often feel worse during the major depressive episodes.
- Double depression is associated with a worse prognosis compared to either condition alone.
-
Mnemonic:
Think of “double” depression as two layers:- Chronic dysthymia (persistent low mood).
- Acute episodes of major depression on top.
What is the diagnostic criterion for a manic episode in Bipolar I Disorder?
A period of abnormally elevated, expansive, or irritable mood and increased activity/energy lasting at least 1 week, present most of the day, nearly every day, or requiring hospitalization.
What are the required symptoms for a manic episode (need 3 or more, or 4 if mood is irritable)?
DIGFAST mnemonic: Distractibility, Indiscretion (excessive involvement in risky activities), Grandiosity, Flight of ideas, Activity increase (goal-directed or psychomotor agitation), Sleep deficit (decreased need for sleep), Talkativeness (pressured speech).
Can Bipolar I Disorder be diagnosed if there is no history of a depressive episode?
Yes, a diagnosis of Bipolar I Disorder requires at least one manic episode, with or without a depressive episode.
What differentiates Bipolar I Disorder from Bipolar II Disorder?
Bipolar I involves at least one manic episode, while Bipolar II involves hypomania (less severe than mania) and major depressive episodes.
What are common comorbidities associated with Bipolar I Disorder?
Anxiety disorders, substance use disorders, and attention-deficit/hyperactivity disorder (ADHD).
What is the first-line treatment for acute mania in Bipolar I Disorder?
Mood stabilizers (lithium, valproate) or atypical antipsychotics (e.g., olanzapine, quetiapine). Combination therapy may be used in severe cases.
What laboratory test is essential before initiating lithium treatment?
Check renal function (creatinine), thyroid function (TSH), and electrolytes. A baseline ECG is also recommended for older patients.
What are early and late side effects of lithium?
Early: Nausea, diarrhea, tremor, polyuria. Late: Hypothyroidism, renal dysfunction, nephrogenic diabetes insipidus.
Which mood stabilizer is contraindicated in pregnancy due to teratogenic effects?
Valproate (associated with neural tube defects). Lithium is also associated with fetal cardiac defects (Ebstein anomaly).
What psychotherapy is most effective for managing Bipolar I Disorder?
Psychoeducation, cognitive-behavioral therapy (CBT), and family-focused therapy are effective adjuncts to pharmacotherapy.
What is the risk of suicide in patients with Bipolar I Disorder?
15%-20% of patients attempt suicide at least once; it is a leading cause of mortality in this population.
What are common triggers for manic episodes in Bipolar I Disorder?
Sleep deprivation, stress, substance use (e.g., stimulants, alcohol), and antidepressant monotherapy without a mood stabilizer.
How does mixed features presentation differ in Bipolar I Disorder?
Mixed features include symptoms of mania and depression occurring simultaneously or in rapid sequence, increasing risk of suicide.
What is the role of ECT in Bipolar I Disorder?
Electroconvulsive therapy (ECT) is indicated for severe mania, refractory depression, or when rapid symptom resolution is required (e.g., catatonia, suicidality).
How does rapid cycling affect the prognosis of Bipolar I Disorder?
Rapid cycling (≥4 mood episodes/year) is associated with a worse prognosis and increased resistance to treatment.
What is the hallmark feature of Bipolar II Disorder?
At least one hypomanic episode and one major depressive episode, with no history of manic episodes.
How is hypomania different from mania?
Hypomania lasts at least 4 consecutive days, does not cause significant functional impairment, and does not require hospitalization. There are no psychotic features.
What are the required symptoms for a hypomanic episode (need 3 or more, or 4 if mood is irritable)?
DIGFAST mnemonic: Distractibility, Indiscretion (excessive involvement in risky activities), Grandiosity, Flight of ideas, Activity increase, Sleep deficit (decreased need for sleep), Talkativeness (pressured speech).
What distinguishes Bipolar II Disorder from Cyclothymic Disorder?
Bipolar II involves clear hypomanic and major depressive episodes, while Cyclothymic Disorder involves subthreshold hypomanic and depressive symptoms for at least 2 years.
What are common comorbid conditions in Bipolar II Disorder?
Anxiety disorders, substance use disorders, and eating disorders.
What is the treatment of choice for acute depressive episodes in Bipolar II Disorder?
Quetiapine, lurasidone, or lamotrigine. Avoid antidepressant monotherapy due to the risk of inducing hypomania.
What is the role of psychotherapy in Bipolar II Disorder?
Cognitive-behavioral therapy (CBT) and interpersonal and social rhythm therapy (IPSRT) help improve mood stability and adherence to treatment.
What is the risk of suicide in Bipolar II Disorder compared to Bipolar I Disorder?
Bipolar II Disorder has a higher lifetime risk of suicide attempts than Bipolar I Disorder, despite less severe mood episodes.
What is the first-line treatment for hypomania in Bipolar II Disorder?
Mood stabilizers (e.g., lithium, valproate) or atypical antipsychotics (e.g., quetiapine, olanzapine).
What medication is effective for long-term maintenance in Bipolar II Disorder?
Lamotrigine is particularly effective for preventing depressive episodes.
How does the prevalence of Bipolar II Disorder compare to Bipolar I Disorder?
Bipolar II Disorder is more common than Bipolar I Disorder, with a prevalence of approximately 1%-2% in the general population.
What are common triggers for hypomanic episodes in Bipolar II Disorder?
Stress, sleep deprivation, substance use, and antidepressants.
Why is it important to screen for hypomanic symptoms in depressive patients?
Misdiagnosing Bipolar II Disorder as unipolar depression can lead to inappropriate treatment (e.g., antidepressant monotherapy) and worsen mood instability.
How does rapid cycling present in Bipolar II Disorder?
Rapid cycling is defined as 4 or more mood episodes per year (hypomanic or depressive) and is associated with poor prognosis.
What are the most common challenges in diagnosing Bipolar II Disorder?
Underreporting of hypomanic episodes and focus on depressive symptoms.
