Psychopathology of Mood Disorders and Anxiety

Question 1

What are the criteria for Biopolar I?

Answer 1

one or more episodes of idiopathic mania; usually one or more episodes of idiopathic major depression. Mixed episodes of mania and depression at the same time are possible (dysphoric mania)

Question 2

What are clanging associations?

Answer 2

words strung together based on sound rather than on meaning.

Question 3

What is the prevalence of bipolar disorder? What is the typical onset?

Answer 3

Lifetime prevalence around 1%

typical onset: teens and 20s.

Question 4

What do we know about the neurobiology of bipolar disorder?

Answer 4

circadian rhythms play a role. phase advance of sleep deprivation contributes to mania in vulnerable ppl. may also involve a dysregulation of frontostriatal functioning.

Question 5

What should I know about the medications for mania?

Answer 5

in active mania use antipsychotics and mood stabilizers
in acute depression, you may use antidepressants, but do so with caution because antidepressants can cause a flip into mania.

Question 6

What does bipolar II refer to?

Answer 6

episodes of hypomania and major depression.

Question 7

What is cyclothymic disorder?

Answer 7

episodes of hypomania and low-level depression. may be hard to tell the difference between cyclothymic disorder and affective instability seen in personality disorders.

Question 8

What is premenstrual dysphoric disorder?

Answer 8

recurrent depressive symptoms only during the late luteal phase.

Question 9

What is adjustment disorder with depressed mood?

Answer 9

symptoms in response to astressor that don’t meet diagnostic criteria for a mood disorder.

Question 10

Besides anxiety disorders, what other psychiatric problems can cause anxiety and trump an anxiety diagnosis?

Answer 10

delirium/dementia
mood disorders
psychotic disorders
anxiety secondary to a general medical condition (ex. pheochromocytoma)

Question 11

What is a major source of disability in panic disorder?

Answer 11

anticipatory anxiety (worry about having another panic attack) and avoidance behaviors (altered behavior to minimize chances of having another attack or to reduce consequences of the attack) often occurs with agoraphobia.

Question 12

What should I know about panic attacks?

Answer 12

last minutes rather than seconds/days. have a crescendo onset.

Question 13

How prevalent is panic disorder?

Answer 13

1-2% point prevalence. usually onset is late adolesence to early 30s.

Question 14

What are the characteristics of obsession in OCD?

Answer 14

recurrent/persistent thoughts which are foreign and inappropriate.
they are anxiety producing.

Question 15

What is the prognosis/natural history for OCD?

Answer 15

usually waxing and waning, but 15% get progressive deterioation in function.

Question 16

What is the difference btw PTSD and acute stress disorder? Prognosis?

Answer 16

time. acute distress disorder is less than a month; PTSD is more than a month.
50% recover in 3 months.

Question 17

What are the symptoms of PTSD?

Answer 17

intesne fear, helplessness, horror, followed by re-experiencing the trauma (intrusive memories, nightmares, flashbackes, strong responses when exposed to reminders), avoidance of things that remind the person of the trauma or more general symptoms, hyperarousal ( insomnia, irritability, hypervigilanc,e exaggerated startle)

Question 18

How long does generalized anxiety disorder last?

Answer 18

more than 6 mo, though course tends to fluctuate over time.

Question 19

What structure do we think is involved in panic disorder and PTSD?

Answer 19

central nucleus of the amygdala. gets input from the cortical sensory areas and thalamus and gives outputs to NE, DA, and 5HT neurons. can orchestrate multiple aspects of anxiety reactions. part of the “salience network.”

Question 20

What are links between PTSD and emotional regulation?

Answer 20

overmodulation of corticolimbic areas may lead to dissociation and withdrawal symptoms, while undermodulation may be related to hyperarousal.

Question 21

What structures are involved in OCD?

Answer 21

frontal and striatal mechanisms; 5HT systems important. Basal ganglia most important structure; may be part of other movement disorders (tics, PANDAS)

Question 22

What si the cognitive behavioral psychology approach to OCD?

Answer 22

catastrophic misinterpretaion of normal bodily sensations, which initiate a downward cascade. CBT effective for treating OCD.

Question 23

What are some social factors that contribute to OCD?

Answer 23

enablers: family companions/ppl who alter life to allow OCD pt to perform compulsions.

Question 24

What meds work for anxiety (classes)?

Answer 24

most antidepressants except bupropion
for OCD, only SSRIs.
anxiolytics only used for acute/adjunctive roles
beta blockers for pefromance anxiety