Week 7 Mood Disorders

Question 1

Define Mood, Affect, and Mood Disorder.

Answer 1

1. Mood=sustained emotional tone perceived along a normal continuum from sad to happy, an internal state
2. Affect=external expression of present emotional content (facial expression, tone of voice, posture)
3. Mood disorder=prolonged and abnormal disturbance of mood, generally of a depressive, elated, or irritable nature, with syndromal features that result in significant subjective distress and objective disturbance in functioning

Question 2

What is the DSM criteria for a major depressive episode?

Answer 2

Changes in feelings, thinking, behavior, body
Must have one:
1. Depressive mood most of the day, nearly every day for 2 weeks OR
2. Markedly diminished interest or pleasure in all, almost all, activities most of the day, nearly every day (anhedonia)
Must have at least 4+ of:
1. weight loss or weight gain, or decreased or increase in appetite nearly every day
2. insomnia or hypersomnia nearly every day
3. psychomotor agitation or retardation every day
4. fatigue or loss of energy nearly every day
5. worthlessness or inappropriate guilt
6. diminished ability to think
7. recurrent thoughts of death, suicidal ideation
Duration: 2 weeks
Significant impairment of functioning

Question 3

What is the prevalence of major depressive episode? age of onset? prognosis? risk factors?

Answer 3

1. Prevalence
   - men: 10%
   - women: 20% lifetime
2. age of onset: any
3. prognosis: >50% have 2nd episode, 80% recover, 20% don’t
4. risk and prognosis factors
   - temperament
   - environmental
   - genetic and physiological
   - course modifiers: comorbidities- substance abuse, anxiety, borderline PD

Question 4

What is the treatment of major depressive disorder?

Answer 4

1. biological
   - R/o medical causes
   - antidepressants
   - exercise
   - light therapy
2. Psychological
   - psychotherapy
   - relaxation
3. social elements
   - address real stressors
   - involve family

Question 5

Describe bereavement

Answer 5

• feelings of emptiness and loss, dysphoria in grief occurring in waves
• physical symptoms: insomnia, decreased appetite/weight loss, psychomotor retardation, decreased libido
• may include thoughts of death and wanting to be with person who died, but not suicidal ideation
• may have guilt, worthlessness, around memories of deceased
• may have hallucinations of seeing/hearing/feeling the deceased

Question 6

Define adjustment disorder with depressed mood.

Answer 6

• depressed mood secondary to an identifiable stressor
• must cause distress and impairment
• symptoms must start within 3 months of acute stressor and resolve within 6 months
• If you meet criteria for a major depressive episode, you don’t have adjustment disorder

Question 7

Define bipolar disorder according to DSM criteria.

Answer 7

1. Bipolar I
   - manic episode with or without depression
   - usual age of onset: late adolescence
   - life time prevalence: 1-2%
2. Bipolar II
   - hypomanic episodes plus MDE
   - life long with # of episodes>MDD or BD1
   - duration of ax-4 days
   - intensity of manic episode symptoms is less severe than Bipolar I

Question 8

What are the risk and prognostic factors for bipolar disorder?

Answer 8

• genetic and physiological
• presence of psychotic features increases risk of recurrence
• lifetime risk of suicide 15x greater than general population
• 30% have severe impairment in work role fx

Question 9

How is bipolar disorder treated?

Answer 9

• requires meds
• mood stabilizers, e.g. lithium, anti-epileptics like valproic acid or carbamezepine
• unopposed antidepressants can provoke a flip into mania or hypomania
• family support, avoid street drugs, individual therapy

Question 10

Define a manic episode.

Answer 10

1. Must have at least 1 week of abnormally elevated, expansive or irritable mood
2. At least 3 of the following:
   - grandiosity
   - decreased need for sleep
   - more talkative
   - flight of ideas
   - distractibility
   - increased goal directed activity
   - excessive involvement in pleasurable activities: spending sprees, investments, sex
3. marked impairment
4. not secondary to general medical condn.

Question 11

What are causes of mood disorders secondary to medical condition?

Answer 11

1. Neuro: parkinsons, stroke, MS, dementia
2. Metabolic: electrolyte, toxins, metals
3. GI: cirrhosis, pancreatitis
4. Endocrine: hypo or hyperthryroidism
5. CV: MI, angina
6. pulmonary: COPD, sleep apnea
7. Heme: anemias, brain tumors,
8. autoimmune: lupus, RA