Psych- Mood Disorders & suicide

Question 1

Persistent complex bereavement disorder (aka complicated grief)

Answer 1

Characterized by extreme, persistent yearning for the deceased and prolonged emotional pain causing functional impairment and inability to resume normal life.

Maladaptive ruminative thoughts
Dysfunctional behaviors

Question 2

What chemical imbalance is associated with suicidal behavior.

Answer 2

Low levels of 5-hydroxindeleacetic acid (5-HIAA) in CSF.

5-HIAA is a metabolite or serotonin and low levels represent dysfunction of the serotonin system.

Question 3

Differentiate between MDD and normal grief

Answer 3

Greif:

1. Sadness focused on deceased, decreasing in intensity
2. Waves of grief mixed with positive memories

MDD:

1. persistent sadness
2. pervasive anhedonia
3. XS guilt, worthlessness, suicidality

Question 4

Diagnosis: Death of brother 2mo ago, sadness, ↓interest, poor energy and concentration, weight loss, can’t sleep

Answer 4

MDD!!

Symptoms sufficient in number and duration. MDD triggered by bereavement lack of improvement.

Question 5

Signs and symptoms of manic episodes

Answer 5

≥1 wk elevated/ irritable mood & ↑energy/ activity and 3+ following (DIGFAST):

Distractability
Impulsivity
Grandiosity
Flight of thought
↑Activity
↓Sleep
Talkativeness (pressure sleep)

Question 6

Tx of depressive episode with bipolar 1

Answer 6

Avoid antidepressant mono therapy, ↑ risk including manic episode.

First Line: 2nd-gen antipsychotics (quetiapine, lurasideon) or lamotrigine

Lithium, valproate, or olanzapine & fluoxetine

Question 7

Timeline Mania vs hypomania

Answer 7

Hypomania 4days

Mania 7 days

Question 8

What polysonographic findings are seen in MDD?

Answer 8

Decreased REM latency (time from sleep onset to start of first REM)
Decreased slow-wave sleep
Increased REM sleep duration and density
Disruptions in sleep continuity