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psych mood disorders Flashcards

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1
Q

mood disorders vs mood episodes

A

episodes are distinct periods of time (depression, mania, mixed-state, and hypomania); disorders are defined by their patterns of mood disorders (MDD, bipolar, dysthymic, cyclothymic)

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2
Q

major depressive episode

A

must have at least 5 of the following symptoms, includng depressed mood or anhedonia, for at least a 2 week period. SIGECAPS; must cause social or occupational impairment

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3
Q

SIGECAPS

A

sleep disturbance, lack of interest, guilt, lack of energy, less concentration, less appetite, psychomotor retardation or agitation, thoughts of suicide

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4
Q

manic episode

A

period of abnormally and persistently elevated or irritable mood lasting at least 1 week (or any duration if hospitalization is necessary) and including at least three of the following

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5
Q

manic episode including at least three of the following

A

DIGFAST; distractibility, inflated self esteem, goal directed activity, flight of ideas or racing thoughts; increased activities like spending money; decreased sleep, talkativitiy or pressured speech

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6
Q

what percent of manic patients have psychotic symptoms

A

seventy five percent

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7
Q

mixed episode

A

criteria are met for both manic episode and major depressive episode; these criteria must be present nearly every day for at least 1 week

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8
Q

hypomanic episode

A

period of elevated, expansive, or irritable mood that includes at least three of the sx listed for the manic episode criteria (four if moor is irritable)

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9
Q

differences between mania and hypomania

A

mania lasts at least 7 days; hypo at least 4; hypomania does not cause impairment in social or occupational functioning; hypomania does not require hospitalization or have psychotic features

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10
Q

diagnosis of MDD

A

at least one major depressive episdoe, with no history of manic or hypomanic episode

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11
Q

prevalence of MDD among women and men

A

twice as prevalent in women than men during reproductive years, but equal after menopause and before menses

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12
Q

sleep problems assoc with MDD

A

multiple awakenings, initial and terminal insomnia; hypersomnia; REM sleep shifted to earlier in night and stages 3 and 4 decrease

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13
Q

theory of depression

A

decreased nts in the brain; abnormal reg of beta adrenegic receptors; high cortisol; abnormal thyroid axis

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14
Q

prognosis of untreated depressive episode

A

self limited, but ususually last from 6 to 13 months; generally, episodes occur more freq as the disorder progresses; about 15% of patients commit suicide

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15
Q

what percent of patients with MDD show a response to antidepressants

A

50-60%; antidepressant plus psychotherapy gives a better response

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16
Q

examples of SSRIs

A

venlafaxine (Effexor), duloxetine (Cymbalta), bupropion (Wellbutrin)

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17
Q

side effects of SSRIs

A

headache, GI disturbance, sex dysfunction, and rebound anxiety

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18
Q

why are TCAs scary?

A

most lethal in overdose

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19
Q

side effects of TCAs

A

sedation, weight gain, orthostatic hypotension, and anticholinergic effects; can aggravate prolonged QTC

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20
Q

what are MAOIs used for

A

refractory depression

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21
Q

risk of MAOIs

A

hypertensive crisis when used with sympathomimetics or ingestion of tyramine-rich foods; risk of serotonin syndrome when used with SSRIs

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22
Q

most common side effect of MAOIs

A

orthostatic hypotension

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23
Q

adjunct meds for depression

A

stimulants, antipsychotics, T3, T4, lithium, or L-tryptophan

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24
Q

stimulants used to augment MDD

A

methylphenidate

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25
Q

antipsychotics in patients with MDD?

A

useful in patients with pyshcotic features in combination with the antidepressant

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26
Q

how is ECT performed

A

premedication with atropine, followed by general anesthesia and administration of a muscle relaxant; generalized seizure in induced by passing electricity

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27
Q

how many treatments of ECT does a person get

A

approx 8 treatments are administered over a 2 to 3 week period; signif improvement after the first treatment

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28
Q

side effect of ECT

A

retrograde and anterograde amnesia; usually disappears within 6 months

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29
Q

most effective in treating atypical depression

A

MAOIs like phenelzine

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30
Q

examples of atypical depression symptoms

A

mood reactivity (mood brightens in response to pos events), heavy feelings in her legs (leaden paralysis), and hypersomnia

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31
Q

melancholy

A

forty to sixty percent of hospitalized patients with MD have this; characterized by anhedonia, early morning awakenings, psychomotor disturbance; guilt, anorexia

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32
Q

atypical features of depression

A

hypersomnia, hyperphagia, reactive mood, leaden paralysis and hypersens to personal rejection

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33
Q

catatonic features of MD

A

catalepsy (immobility), purposeless motor activity, extreme negativism or mutism, bizarre postures, and echolalia

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34
Q

psychotic features of MD

A

ten to twenty five percent of hospitalized depressions; presence of delusions or hallucinations

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35
Q

bereavment

A

aka simple loss; lasts for 2 months and includes crying, sleep problems, and difficulty concentrating; normal bereavement should not have disorganization or suicidalit

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36
Q

normal grief versus depression

A

normal grief does not have suicidal thoughts or last more than 2 mos; mild cog disorder lasts less than a year and patients can be treated w benzos for sleep

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37
Q

normal grief v depression

A

in depression, hallucinations and delusions are more common, SI may be present and sx last more than 2 mos; mild cog disorder lasts for over a year

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38
Q

bipolar I disorder

A

episodes of mania and major depression; however, episodes of major depression are not required for the dx; traditionally known as manic depression

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39
Q

diagnosis of bipolar I

A

occurrence of one manic or mixed episode

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40
Q

what happens between manic episodes for bipolar I patients?

A

interspersed euthymia, MD episodes, dysthymia, or hypomanic episodes, but none of these are required for the dx

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41
Q

onset of bipolar I

A

usually before age 30

42
Q

how long do untreated manic episodes last?

A

about 3 months

43
Q

what percent of people with one manic episode will have another in less than 5 years

A

ninety percent

44
Q

suicide in bipolar disorder

A

25 to 50% and 15% die, which is significantly higher rates than that of MDD

45
Q

treatment for bipolar I

A

lithium; 7% treated with lithium show some results

46
Q

scary thing about lithium

A

mortality rate is 25% from acute overdose due to low therapeutic index

47
Q

other mood stabilizers that can be used for bipolar disorder besides lithium

A

anticonvulsants (carbamazepine, valproic acid); assoc with increased risk of suicide; atypical antipsychotics are effective as mono and adjunct therapy for actute mania

48
Q

antidepressants in bipolar disorder?

A

discouraged as monotherapy due to concerns of activating mania or hypomania; not effective as adjunct therapy

49
Q

ECT for bipolar?

A

works well in treatment of manic episodes; usually requires more treatments than for depression;

50
Q

bipolar II disorder

A

alternately called recurrent MD episodes with hypomania

51
Q

diagnosis of bipolar II

A

history or one or more MD episodes and and at least one hypomanic episodes (if there has been a full manic episode at least once, it is bipolar I)

52
Q

onset for bipolar II

A

before age 30

53
Q

epidemiology differences between bipolar I and bipolar II

A

bipolar II is more common; bipolar II is more common in women, whereas equal in bipolar I;

54
Q

dysthymic disorder

A

chronic, mild depression most of the time with no discrete episodes; rarely need hospitalization

55
Q

diagnosis of dysthymic disorder

A

depressed mood for the majority of the time most days for at least 2 years (in kids for at least 1 year); at least two of the criteria

56
Q

criteria for dysthymic disorder

A

need at least 2; poor concentration, feelings of hopelessness, poor appetite or overeating; insomnia or hypersomnia; low energy, low self esteem

57
Q

during the two year period of dysthymic disorder

A

the person has not been without sx for more than 2 mos at a time; no MD episodes; no hx of manic or hypomanic episode

58
Q

dysthymic disorder more common in what gender?

A

women

59
Q

prognosis of dysthymic disorder

A

20% of patients will delvelop MD, 20% will develop bipolar disorder; and greater than 25% will have lifetime symptoms

60
Q

most effective tx for dysthymic disorder

A

cognitive therapy and insight-oriented psychotherapy; antidepressant meds are useful when used concurrently with psychotherapy

61
Q

cyclothymic disorder

A

alternating periods of hypomania and mild to moderate depressive sx

62
Q

diagnosis of cyclothymia

A

numerous periods w hypomanic sx and periods w depressive sx for at least 2 years; patient was never sx free for more than 2 mos during that time; no MD or manic episode

63
Q

cyclothymic disorder may coexist with what personality disorder?

A

borderline

64
Q

onset of cyclothymic disorder

A

age 15 to 25

65
Q

prognosis of cyclothymic disorder

A

one third are eventually dx with bipolar disorder

66
Q

treatment for cyclothymic disorder

A

antimanic agents used to treat bipolar disorder

67
Q

minor depressive disorder

A

episodes of two to four depressive sx that do not meet the full five or more criteria for MDD; euthymic periods are also seen, unlike in dysthymic disorder

68
Q

other disorder of mood in DSM IV

A

recurrent brief depressive disorder, premenstural dysphoric disorder, mood disorder due to a general med condition; substance induced mood disorder; mood disorder NOS

69
Q

specifiers of mood disorders

A

specifiers are not considered separate mood disorders but rather a subtype within any major mood disorder; seasonal affective disorder and postpartum major depression

70
Q

seasonal affective disorder

A

at least 2 consecyears of two major depressive episodes during the same season, most commonly the winter; patients may respons to light therapy

71
Q

postpartum major depression

A

onset with 4 weeks of delivery

72
Q

adjustment disorders

A

maladaptive behavioral or emotional sx develop after a stressful life event; sx begin within 3 mos of the event and end within 6 mos; cause impairment in functioning and relationships

73
Q

dsm IV criteria for adjustment disorder

A

development of emtional or behav sx within 3 mos fo stressful event. These sx produce either severe distress or signif impairment in functioning; sx are not those of bereavement; sx resolve within 6 mos

74
Q

subtypes of adjustment disorder

A

depressed mood, anxiety, distrubance of conduct (aggression), or combinations

75
Q

adjustment disorder gender

A

more common in females

76
Q

treatment of adjustment disorder

A

supportive psychotherapy is the most effective; group therapy; pharmacotherapy fo assoc sx (insonia, anxiety, or depression)

77
Q

major depressive episodes can be present in either MDD or bipolar I or II

A

right

78
Q

a manic episode is a psych emergency

A

impaired judgment makes patient a danger to self and others

79
Q

predominent mood state in mixed epidoes

A

irritability

80
Q

patients with mixed episodes (manic and MD episodes) have a poorer response to lithium

A

anticonvulsants may help

81
Q

stroke patients are at very high risk for depressio

A

right

82
Q

highest rate of suicide of any disorder

A

MDD

83
Q

Hamilton Rating scale

A

meaure of depression severity that is used in research to assess the effectiveness of therapies

84
Q

pancreatic cancer has a high assoc with depression

A

makes sense

85
Q

all antidepressant meds are equal in effectiveness

A

but differ in SE profiles

86
Q

how long do antidepressant meds take to work

A

4-8 weeks

87
Q

serotonin syndrome

A

autonomic instability, hyperthermia, and seizures; coma or death may result

88
Q

postpartum depression

A

usually resolves without medication

89
Q

how is the catatonic type of major depression usually treated

A

antidepressants and antipsychotics concurrently

90
Q

Kubler-Ross model fo grief stages

A

denial, anger, bargaining, depression, acceptance (DAB DA)

91
Q

rapid cycling

A

4 or more mood episodes in 1 year (major depressive, manic, mixed)

92
Q

side effects of lithium

A

weight gain, tremor, GI disturbances, fatigue, cardiac arrythmias, seizures, goiter/hypothyroidism, leukocytosis (benign), coma, polyuria, polydipsia, alopecia, metallic taste

93
Q

best treatment for a manic woman in pregnancy

A

ECT; good alternative to antipsychotics and can be used with relative safety in all trimesters

94
Q

a patient with a hx of postpartum mania should be treated how in subsequent pregnancies

A

for prophylaxis in subsequent pregnancies, treat with antidepressants and lithium; however, these are contraindic to breast feeding

95
Q

sx of dysthymic disorder

A

CHASES; poor concentration; hopelessness; poor appetite or overeating; Somnia (hyper or hypo); low energy; low self-esteem

96
Q

dysthymic disorder; the 2 D’s

A

2 years of depression, 2 listed criteria; never asymptomatic for more than 2 mos

97
Q

double depression

A

patients with MDD with dysthymic disorder during residual periods

98
Q

dysthymia and psychotic features

A

dysthymia can never have psychotic featres; if the patient has delusions or hallucin with depression, consider another dx like MD with psychotic features or schizoaffective

99
Q

triad for seasonal affective disorder

A

irritability, carb craving, hypersomnia

100
Q

in adjustment disorder, the stressful even is not life threatening

A

in PTSD, it is

Psych (23 decks)

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