SM_108b-108b: Depression and Bipolar Disorder I and II Flashcards
Describe phenomenology of depression episodies
Depression episodes
- Mood: depressed / sad / despondent / empty or blue, anxiety and irritability can be more prominent, lack of interest in pleasurable activities
- Behavior: agitated or retarded, appetite and sleep disturbances
- Thought: hopelessness / pessimisim / lack of self-esteem / guilt, somatic preoccupations, suicidality, and slowed mentation
Depressive symptoms include
- ____
- ____
- ____
- ____
- ____
- ____
- ____
- ____
Depressive symptoms include
- Sleep disturbance
- Interest reduced (anhedonia)
- Guilt and worthlessness
- Energy loss and fatigue
- Concentration problems
- Appetite problem
- Psychomotr agitation or retardation
- Suicidality
(SIGECAPS)
Describe DSM-5 criteria for major depressive episode
Major depressive episode DSM-5 criteria
- Five or more of the following during the same 2 week period: depressed mood most of day nearly every day, markedly diminished interest or pleasure in activities, significant weight loss / gain or change in appetite, insomnia / hypersomnia, psychomotor agitation / retardation, fatigue / loss of energy, worthlessness / inappropriate guilt, diminished ability to think / concentrate / indecisiveness, recurrent thoughts of death or suicidal ideation
- Symptoms cause significant distress or impairment in social, occupation, or other areas of functioning
- Not attribuate to physiological effects of a substance or other medical condition
Depression may have ____ or ____ features
Depression may have melancholic or atypical features
Describe the phenomenology of mania
Mania
- Mood: expansion / euphoric / grandiose / irritable / hospital, anxiety can be prominent
- Behavior: decreased need for sleep, extravagance, agitation, impulsivity, high pursuit of pleasurable activities, pressured speech, loud
- Cognition: racing thoughts, distractability, poor judgement, possible delusions, and hallucinations
Describe DSM-5 criteria for a manic episode
Manic episode DSM-5 criteria
- ≥ 1 week of abnormally and persistently elevated, expansive, or irritable mood and persistently elevated activity / energy
- During the period, 3 or more of: inflated self esteem / grandiosity, decreased need for sleep, more talkative, racing thoughts / flight of ideas, distractability, increase in goal-directed activity / psychomotor agitation, and excessive involvement in activities that have a high potential for painful consequences
- Causes marked impairment in functioning
- Not attributable to physiological effects of a substance or other medical condition
Describe DSM-5 criteria for a hypomanic episode
Hypomanic episode DSM-5 criteria
- ≥ 4 days of abnormally or persistently elevated, expansive, or irritable mood and persistently increased activity or energy
- During the period, 3 or more of: inflated self-esteem / grandiosity, decreased need for sleep, more talkative, flight of ideas / racing thoughts, distractability, increased goal directed activity / agitation, excessive involvement in activities that have a high potential for painful consequences
- Unequivocal changes in functioning uncharacteristic of individual when not symptomatic
- Change is observable by others
- Not severe enough to cause marked impairment in social / occupational functioning or require hospitalization
- Not attributable to physiological effects of a substance or other medical condition
Mixed features specifier applies when ____
Mixed features specifier applies when at least 3 subthreshold symptoms from the opposite pole are present during a mood episode
(can be used to describe depressive, manic, or hypomanic episodes)
Major depressive disorder with mixed features has ____ prognosis
Major depressive disorder with mixed features has poorer prognosis
(use mood stabilizers and some atypical antipsychotics)
Psychotic features specifier can be either ____ or ____
Psychotic features specifier can be either mood-congruent or mood-incongruent
(occur in major depressive, mania, or hypomania)
Depressive disorders include ____ and ____, while bipolar disorders include ____, ____, and ____
Depressive disorders include major depressive disorder and persistent depressive disorders, while bipolar disorders include bipolar I disorder, bipolar II disorder, and cyclothymic disorder
Describe DSM-5 criteria for major depressive disorder
Major depressive disorder DSM-5 criteria
- One major depressive episode
- Not better explained by other psychotic disorder
- Never experienced a manic or hypomanic episode
Persistent depressive disorder requires never having had a ____ or ____
Persistent depressive disorder requires never having had a manic / hypomanic episode or cyclothymia
Bipolar I disorder requires a history of ____
Bipolar I disorder requires a history of manic episodes
Bipolar II disorder requires a history of ____
Bipolar II disorder requires a history of hypomanic episodes
(no manic episodes)
Cyclothymic disorder requires recurrent ____ and ____ lasting ≥ 2 years
Cyclothymic disorder requires recurrent mild depressive symptoms and hypomanias lasting ≥ 2 years
Conditions commonly comorbid with major depressive disorder and bipolar disorder include ____, ____, and ____
Conditions commonly comorbid with major depressive disorder and bipolar disorder include alcohol / substance abuse, OCD / anxiety disorders, and other medical illnesses
_____, defined as _____, describes the trend of recurrence of depression or bipolar disorder
Kindling, defined as increased risk of recurrence with each episode, describes the trend of recurrence of depression or bipolar disorder
Depression with melancholic features involves ____ and ____
Depression with melancholic features involves loss of pleasure and lack of reactivity
Depression with atypical features involves ____, ____, ____, ____, and ____
Depression with atypical features involves mood reactivity, significant weight gain / appetite increase, hypersomnia, leaden paralysis, longstanding pattern of interpersonal rejectio
Neutrophic hypothesis of depression involves ____ and ____
Neutrophic hypothesis of depression involves
- Atrophy, cellular, or damage with subsequent stressors in vulnerable individuals
- Reduced neurogenesis (decreased BDNF)
____ has been implicated in depression
Serotonin has been implicated in depression
Biomarkers of recurrent major depressive disorder include ____, ____, ____, and ____
Biomarkers of recurrent major depressive disorder include
- Decreased immune functioning: elevated TNFa, IL-6, CRP and mitochondrial dysfunction
- Dysregulation of hypothalamic-pituity-thyroid axis: blunted TSH response to TRH
- Volume reduction in basal ganglia, hippocampus, and frontal cortex
- Decreased activity in left prefrontal cortex
Elevated serum cortisol and CSF CRH, especially at night, indicates ____
Elevated serum cortisol and CSF CRH, especially at night, indicates major depressive disorder
(atypical disorder is hypocortisolemic)
Describe bipolar pathogenesis
BIpolar pathogenesis
- Norepinephrine
- Altered glutamate transmission in hippocampus, thalamus, and other structures
- Circadian dysregulation
- Disruptions in cellular and membrane metabolism
- Immunologic / inflammatory factors
- Neuroanatomic reductions and neurocognitive impairment early in life
- Regional differences in neurocircuitry activity: hypoactive PFC and overactive anterior cingulate and subcortical structures
