Psych 2 Flashcards
DSM-IV criteria for Major Depressive Episode
Must have at least 5 of the following symptoms (must include at least one starred) for at least a 2-week period.
- Depressed mood
- sleep changes
- Interest (anhedonia)
- Guilt (excessive feeling of guilt or anhedonia)
- Engery (decreased energy, fatigue)
- Concentration (decreased)
- Appetite (changes in appetite or body weight)
- Psychomotor changes (restlessness, slowness)
- Suicidal ideation (hopelessness, helplessness, worthlessness; recurrent thoughts of suicide or death)
**Symptoms cannot be due to substance use or medical conditions
**Symptoms must cause social or occupational impairment
DSM-IV criteria for a Major Depressive Epsiode
- At least one major depressive episode
- No history or manic or hypomanic episode
DSM-IV criteria for a Manic Episode
A period of abnormally and persistently elevated, expansive, or irritable mood lasting at least 1 week (or any duration if hospitalization is necessary) and including at least three of the following:
- Distractability
- Insomnia/impulsive behavior (dec. need for sleep)
- Grandiosity or inflated self-esteem
- Flight of ideas/Racing thoughts
- Activity/agitation (inc. in goal-directed activity)
- Speech (pressured)
- Thoughtlessness (excessive involvement in pleasurable activity that have negative consequences, e.g., shopping sprees, sexual indiscretions)
**Cannot be due to substance use or medical conditions; must cause social or occupational impairment
What is a mixed episode (depression and mania)?
DSM criteria are met for both manic episode and major depressive episode.
These criteria must be present nearly every day for at least 1 week.
**As with a manic episode, this is a psychiatric emergency.
Which psyciatric disorder has the highest rate of suicide of any disorder?
Major Depressive Disorder
Stroke patients are at risk of developing depression
What is anhedonia?
Loss of interest in pleasurable acitivites.
The inability to experience pleasure.
What sleep changes/problems are associated with MDD (major depressive disorder?)
- multiple awakenings
- Initial and terminal insomnia (hard to fall asleep and early morning awakenings)
- Hypersomnia
- REM sleep shifted to earlier in the night and stages 3 and 4 are decreased.
What is the course and prognosis of MDD?
If left untreated, depressive episodes are self-limited, but usually last from 6-13 months.
Generally, episodes occur more frequently as the disorder progresses.
The risk of a subsequent major depressive episode is 50% within the first 2 years after the first episode
When is hospitalization indicated for a patient with MDD?
If the patient is at risk for suicide, homicide, or is unable to care for themself.
What is the best treatment for atypical depression?
MAOIs
Although SSRIs and TCA are acceptable courses of treatment, MAOIs have been provento be more effective in treating atypical depression.
What is the recommendation for treatment of depression?
The combination of pharmacotherapy and psychotherapy is more effective for treating depression than either treatment alone.
What are the classes of antidepressant drugs?
SSRIs - safer and better tolerated than other classes of antidepressants
TCAs - most lethal in overdose
MAOIs - useful for treatment of refractory depression and atypical depression
When is Electrocolvulsive Therapy (ECT) indicated for depression?
If the patient:
- is unresponsive to pharmacotherapy
- cannot tolerate pharmacotherapy (e.g., pregnancy)
- If rapid reduction of symptoms is required (e.g., suicide risk)
**ECT is safe and can be used alone or in combination with pharmacotherapy
What are the DSM criteria for a diagnosis of Bipolar I Disorder?
The only requirement for this diagnosis is the occurence of one manic or mixed episode.
Between manic episodes, there may be interspersed euthymia, major depressive episodes, dysthymia, or hypomanic episodes, but none of these are required for the diagnosis
List three common treatments for bipolar disorder.
Lithium (mood-stabilizer)
Carbamazepine (for rapid cyclers)
Valproic acid
(Carbamazepine and valproic acid are anticonvulsants that are also mood stabilizers. They are especially useful for rapid cycling bipolar disorder and mixed episodes, although they are associated with an increased risk of suicide)
Why are antidepressants discouraged as monotherapy in bipolar disorder?
Due to concerns of activating mania or hypomania
Can ECT (electroconvulsive therapy) be used in treating bipolar I disorder?
–Works well in treatment of manic episodes
–usually requires more treatments than for depression
–especially effective for refractory or life-threatening acute mania or depression
DSM criteria for Bipolar II Disorder
Hx of one or more major depressive episodes and at least one hypomanic episode.
**Remember, if there is a history of a full manic episode, even in the past, the diagnosis is bipolar I disorder, not bipolar II.
Delusion
Fixed false belief that cannot be altered by rational arguments and is not accounted for by the cultural background of the individual
Hallucination
Perception in the absence of an external stimulus
Illusion
Misinterpretation of an external stimulus
Positive symptoms (re: psychosis)
Hallucinations, delusions, bizarre behavior, disorganized speech.
These tend to respond more robustly to current antipsychotic medications.
Negative symptoms (re: psychosis)
Flat affect
Anhedonia
Apathy
Alogia (poverty of speech)
Lack of purposeful actions
Lack of interest in socialization
These symptoms are often treatment-resistant and contribute to the social isolation of schizophrenic patients.
Risk Factors for suicide
SAD PERSONS
Sex (male)
Age (older, >60)
Depression
Previous attempts
Ethanol/substance abuse
Rational thought loss
Sickness (chronic illness)
Organized plan/access to weapons
No spouse
Social support lacking
Schizoaffective disorder
Combines the symptoms of schizophrenia with a major affective disorder
