Psych - Pathology (Mood disorders)

Question 1

What characterizes mood disorder?

Answer 1

Characterized by an abnormal range of modes or internal emotional states and loss of control over them

Question 2

What complications/consequences can occur due to severity of moods in mood disorder?

Answer 2

Severity of moods causes distress and impairment in social and occupational functioning

Question 3

What are 4 types of mood disorder?

Answer 3

Includes major depressive disorder, bipolar disorder, dysthymic disorder, and cyclothymic disorder

Question 4

Besides mood swings, what other clinically relevant features may be present in mood disorder?

Answer 4

Psychotic features (delusions or hallucinations) may be present

Question 5

Define manic episode.

Answer 5

Distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased activity or energy lasting at least 1 week.

Question 6

How do patients often respond to their own manic episode(s)?

Answer 6

Often disturbing to a patient

Question 7

What is required for diagnosis of manic episode?

Answer 7

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

Question 8

Define hypomanic episode by contrasting it with manic episode.

Answer 8

Like manic episode except mood disturbance is not severe enough to cause marked impairment in social and/or occupational functioning or to necessitate hospitalization.

Question 9

Does hypomanic episode have psychotic features?

Answer 9

No, No psychotic features

Question 10

How long does hypomanic episode last?

Answer 10

Lasts at least 4 consecutive days

Question 11

What defines Bipolar I versus Bipolar II.

Answer 11

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

Question 12

Describe the patient’s mood and functioning between episodes in bipolar disorder.

Answer 12

Patient’s mood and functioning usually return to normal between episodes.

Question 13

What is 1 medication risk and 1 behavioral risk to be aware of with bipolar disorder patients?

Answer 13

Use of antidepressants can lead to increased mania; High suicide risk

Question 14

What are 2 categories of treatment for Bipolar disorder?

Answer 14

Treatment: (1) Mood stabilizers (e.g., lithium, valproic acid, carbamazepine) (2) Atypical antipsychotics

Question 15

Give 3 examples of Mood stabilizers that may be used to treat Bipolar disorder.

Answer 15

Mood stabilizers (e.g., lithium, valproic acid, carbamazepine)

Question 16

What is Cyclothymic disorder? What is its time course?

Answer 16

Cyclothymic disorder - dysthymia and hypomania; milder form of bipolar disorder lasting at least 2 years.

Question 17

What is major depressive disorder? What is its time course?

Answer 17

May be self-limited disorder, with major depressive episodes usually lasting 6-12 months.

Question 18

Characterize the episodes of major depressive disorder.

Answer 18

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.)

Question 19

What is Persistent depressive disorder? What is another name for it?

Answer 19

Persistent depressive disorder (Dysthymia) - depression, often milder, lasting at least 2 years

Question 20

What is Seasonal affective disorder?

Answer 20

Symptoms usually associated with winter season

Question 21

What improves Seasonal affective disorder?

Answer 21

Improves in response to full-spectrum bright-light exposure

Question 22

What are the symptoms of major depressive disorder?

Answer 22

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

Question 23

What are 6 changes in sleep stages experienced by patients with depression? Which of these is an important screening question?

Answer 23

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)

Question 24

What characterizes Atypical depression?

Answer 24

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.

Question 25

What is the most common subtype of depression?

Answer 25

Atypical depression

Question 26

What are 2 treatment options for Atypical depression?

Answer 26

Treatment: (1) MAO inhibitors (2) SSRIs

Question 27

What is the time of onset of Postpartum mood disturbances?

Answer 27

Onset within 4 weeks of delivery

Question 28

What are 3 types of Postpartum mood disturbances?

Answer 28

(1) Maternal (postpartum) “blues” (2) Postpartum depression (3) Postpartum psychosis

Question 29

Again, what are the 3 types of Postpartum mood disturbances? What is the incidence rate for each of these?

Answer 29

(1) Maternal (postpartum) “blues” (50-85% incidence rate) (2) Postpartum depression (10-15% incidence rate) (3) Postpartum psychosis (0.1-0.2% incidence rate)

Question 30

What characterizes Maternal (postpartum) “blues”? What is its time course?

Answer 30

Characterized by depressed affect, tearfulness, and fatigue starting 2-3 days after delivery. Usually resolves within 10 days.

Question 31

What characterizes Postpartum depression? What is its time course?

Answer 31

Characterized by depressed affect, anxiety, and poor concentration starting within 4 weeks after delivery. Lasts 2 weeks to a year or more.

Question 32

What characterizes Postpartum psychosis? What is its time course?

Answer 32

Characterized by delusions, hallucinations, confusion, unusual behavior, and possible homicidal/suicidal ideations or attempts. Usually lasts days to 4-6 weeks.

Question 33

What is the treatment for Maternal (postpartum) “blues”? What is the necessary follow-up?

Answer 33

Treatment: supportive. Follow-up to assess for possible postpartum depression.

Question 34

What are 2 treatments for Postpartum depression?

Answer 34

Treatment: (1) Antidepressants (2) Psychotherapy

Question 35

What are 4 treatment/management considerations for Postpartum psychosis?

Answer 35

Treatment: (1) Antipsychotics (2) Antidepressants (3) Possible inpatient hospitalization (4) Assessment of child safety

Question 36

What defines normal bereavement versus pathologic grief?

Answer 36

Normal bereavement characterized by shock, denial, guilt, and somatic symptoms; Pathologic grief includes excessively intense grief

Question 37

What is the time course of normal bereavement versus pathologic grief?

Answer 37

Normal - Duration varies widely, up to 6-12 months; Pathologic - Prolonged grief lasting >6-12 months, or grief that is delayed, inhibited, or denied

Question 38

What are the symptoms associated with normal bereavement versus pathologic grief?

Answer 38

Normal - May experience simple hallucinations (e.g., hearing name called); Pathologic - May experience depressive symptoms, delusions, and hallucinations.

Question 39

What are 5 clinical contexts in which Electroconvulsive therapy is considered?

Answer 39

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.

Question 40

What effect does Electroconvulsive therapy have?

Answer 40

Produces a relatively painless seizure in an anesthetized patient.

Question 41

What are 3 adverse effects associated with Electroconvulsive therapy? When do they usually resolve?

Answer 41

Adverse effects include disorientation, temporary headache, and partial anterograde/retrograde amnesia usually fully resolving in 6 months.

Question 42

What are 10 risk factors for suicide completion?

Answer 42

(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”

Question 43

Which gender attempts suicide more often? Which gender successfully completes suicide more often?

Answer 43

Women try more often; Men succeed more often.