Psych - Pathology (Mood disorders) Flashcards
Pg. 506-508 in First Aid 2014 Sections include: -Mood disorder -Manic episode -Hypomanic episode -Bipolar episode -Major depressive disorder -Atypical depression -Postpartum mood disturbances -Pathologic grief -Electroconvulsive therapy -Risk factors for suicide completion
What characterizes mood disorder?
Characterized by an abnormal range of modes or internal emotional states and loss of control over them
What complications/consequences can occur due to severity of moods in mood disorder?
Severity of moods causes distress and impairment in social and occupational functioning
What are 4 types of mood disorder?
Includes major depressive disorder, bipolar disorder, dysthymic disorder, and cyclothymic disorder
Besides mood swings, what other clinically relevant features may be present in mood disorder?
Psychotic features (delusions or hallucinations) may be present
Define manic episode.
Distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased activity or energy lasting at least 1 week.
How do patients often respond to their own manic episode(s)?
Often disturbing to a patient
What is required for diagnosis of manic episode?
Diagnosis requires hospitalization or at least 3 of the following (Think: “manics DIG FAST”); Distractibility, Irresponsibility (seeks pleasure without regard to consequences - hedonistic), Grandiosity - inflated self-esteem, Flight of ideas - racing thoughts, increase in goal-directed Activity/psychomotor Agitation, decreased need for Sleep, Talkativeness or pressured speech
Define hypomanic episode by contrasting it with manic episode.
Like manic episode except mood disturbance is not severe enough to cause marked impairment in social and/or occupational functioning or to necessitate hospitalization.
Does hypomanic episode have psychotic features?
No, No psychotic features
How long does hypomanic episode last?
Lasts at least 4 consecutive days
What defines Bipolar I versus Bipolar II.
Bipolar I defined by the presence of at least 1 manic episode with or without hypomanic or depressive episode; Bipolar II defined by the presence of a hypomanic and a depressive episode
Describe the patient’s mood and functioning between episodes in bipolar disorder.
Patient’s mood and functioning usually return to normal between episodes.
What is 1 medication risk and 1 behavioral risk to be aware of with bipolar disorder patients?
Use of antidepressants can lead to increased mania; High suicide risk
What are 2 categories of treatment for Bipolar disorder?
Treatment: (1) Mood stabilizers (e.g., lithium, valproic acid, carbamazepine) (2) Atypical antipsychotics
Give 3 examples of Mood stabilizers that may be used to treat Bipolar disorder.
Mood stabilizers (e.g., lithium, valproic acid, carbamazepine)
What is Cyclothymic disorder? What is its time course?
Cyclothymic disorder - dysthymia and hypomania; milder form of bipolar disorder lasting at least 2 years.
What is major depressive disorder? What is its time course?
May be self-limited disorder, with major depressive episodes usually lasting 6-12 months.
Characterize the episodes of major depressive disorder.
Episodes characterized by at least 5 of the following 9 symptoms for 2 or more weeks (symptoms must include patient-reported depressed mood or anhedonia and occur more frequently as the disorder progresses.)
What is Persistent depressive disorder? What is another name for it?
Persistent depressive disorder (Dysthymia) - depression, often milder, lasting at least 2 years
What is Seasonal affective disorder?
Symptoms usually associated with winter season
What improves Seasonal affective disorder?
Improves in response to full-spectrum bright-light exposure
What are the symptoms of major depressive disorder?
SIG E CAPS: (1) Sleep disturbance (2) loss of Interest (anhedonia) (3) Guilt or feelings of worthlessness (4) Energy loss and fatigue (5) Concentration problems (6) Appetite/weight changes (7) Psychomotor retardation or agitation (8) Suicidal ideations (9) Depressed mood
What are 6 changes in sleep stages experienced by patients with depression? Which of these is an important screening question?
Patients with depression typically have the following changes in their sleep stages: (1) Decreased slow-wave sleep (2) Decreased REM latency (3) Increased REM early in sleep cycle (4) Increased total REM sleep (5) Repeated nighttime awakenings (6) Early-morning awakening (important screening question)
What characterizes Atypical depression?
Differs from classical forms of depression. Characterized by mood reactivity (being able to experience improved mood in response to positive events, albeit briefly), “reversed” vegetative symptoms (hypersomnia and weight gain), leaden paralysis (heavy feeling in arms and legs), and long-standing interpersonal rejection sensitivity.
What is the most common subtype of depression?
Atypical depression
What are 2 treatment options for Atypical depression?
Treatment: (1) MAO inhibitors (2) SSRIs
What is the time of onset of Postpartum mood disturbances?
Onset within 4 weeks of delivery
What are 3 types of Postpartum mood disturbances?
(1) Maternal (postpartum) “blues” (2) Postpartum depression (3) Postpartum psychosis
Again, what are the 3 types of Postpartum mood disturbances? What is the incidence rate for each of these?
(1) Maternal (postpartum) “blues” (50-85% incidence rate) (2) Postpartum depression (10-15% incidence rate) (3) Postpartum psychosis (0.1-0.2% incidence rate)
What characterizes Maternal (postpartum) “blues”? What is its time course?
Characterized by depressed affect, tearfulness, and fatigue starting 2-3 days after delivery. Usually resolves within 10 days.
What characterizes Postpartum depression? What is its time course?
Characterized by depressed affect, anxiety, and poor concentration starting within 4 weeks after delivery. Lasts 2 weeks to a year or more.
What characterizes Postpartum psychosis? What is its time course?
Characterized by delusions, hallucinations, confusion, unusual behavior, and possible homicidal/suicidal ideations or attempts. Usually lasts days to 4-6 weeks.
What is the treatment for Maternal (postpartum) “blues”? What is the necessary follow-up?
Treatment: supportive. Follow-up to assess for possible postpartum depression.
What are 2 treatments for Postpartum depression?
Treatment: (1) Antidepressants (2) Psychotherapy
What are 4 treatment/management considerations for Postpartum psychosis?
Treatment: (1) Antipsychotics (2) Antidepressants (3) Possible inpatient hospitalization (4) Assessment of child safety
What defines normal bereavement versus pathologic grief?
Normal bereavement characterized by shock, denial, guilt, and somatic symptoms; Pathologic grief includes excessively intense grief
What is the time course of normal bereavement versus pathologic grief?
Normal - Duration varies widely, up to 6-12 months; Pathologic - Prolonged grief lasting >6-12 months, or grief that is delayed, inhibited, or denied
What are the symptoms associated with normal bereavement versus pathologic grief?
Normal - May experience simple hallucinations (e.g., hearing name called); Pathologic - May experience depressive symptoms, delusions, and hallucinations.
What are 5 clinical contexts in which Electroconvulsive therapy is considered?
Treatment option for major depressive disorder refractory to other treatment and for pregnant women with major depressive disorder. Also considered when immediate response is necessary (acute suicidality), in depression with psychotic features, and for catatonia.
What effect does Electroconvulsive therapy have?
Produces a relatively painless seizure in an anesthetized patient.
What are 3 adverse effects associated with Electroconvulsive therapy? When do they usually resolve?
Adverse effects include disorientation, temporary headache, and partial anterograde/retrograde amnesia usually fully resolving in 6 months.
What are 10 risk factors for suicide completion?
(1) Sex (male) (2) Age (teenager or elderly) (3) Depression (4) Previous attempt (5) Ethanol or drug use (6) loss of Rational thinking (7) Sickness (medical illness, 3 or more prescription medications) (8) Organized plan (9) No spouse (divorced, widowed, or single, especially if childless) (10) Social support lacking; Think: “SAD PERSONS are more likely to complete suicide”
Which gender attempts suicide more often? Which gender successfully completes suicide more often?
Women try more often; Men succeed more often.
