Week 8.3 Flashcards
How do we assess someone’s mood?
it must be self-reported
What is a euthymic mood?
a normal mood with appropriate valence and moderate variability
What are the clinical features of depression?
- persistent sad or irritable mood
- anhedonia
- significant weight or appetite change
- difficulty sleeping or oversleeping
- psychomotor retardation
- difficulty concentrating
- recurrent thoughts of death/suicide
What are the three depressive disorders?
- major
- persistent (dysthymic)
- NOS
What are the criteria for MDD?
- five or more symptoms
- duration of two weeks
Post-partum depression typically begins when?
within the first four weeks of delivery
How does PDD compare to MDD?
it is longer but less severe
What are the criteria for PDD?
- two or more symptoms
- last for two years or more
What are the criteria for DD NOS?
symptoms insufficient to meet criteria for MDD or PDD
Depression is linked to what cardiovascular issues?
- hypertension
- MI
How does the risk of suicide change with age?
- increases throughout life for caucasians
- peaks between 25-35 for AA and Native Americans
What are some risk factors for suicide in depressed patients?
- alcohol or other substance use
- chronic illness
- social isolation
- previous attempts
- family history
Which brain structure is key to the pathogenesis of depression?
the hypothalamus
How does the HPA play a role in depression?
hyper-secretion of cortisol is believed to contribute
Most of the physical symptoms of depression come from what mechanism?
excessive cortisol release
What is the dexamethasone suppression test?
- used to assess the HPA axis
- should see a decrease in ACTH and cortisol after
What anatomic change has been associated with depression?
hippocampal atrophy
What role do cytokines appear to play in depression?
- up regulate subcortical functioning, making us more sensitive to stress
- down regulate cortical functioning that would regulate and decrease this
What are the three major bipolar mood disorders?
- bipolar I
- bipolar II
- cyclothymic disorder
Criteria for Bipolar I
- manic episode lasting one week
- three or more characteristic symptoms
What are the characteristic symptoms of bipolar disorder?
- inflated self-esteem
- decreased need for sleep
- distractibility
- pressured speech
What is Bipolar II?
a milder, shorter form of bipolar mood disorder with three symptoms lasting 4 days
What are the criteria for cyclothymic disorder?
- two years (1 if adolescent) of numerous hypomanic episodes and depressive episodes not meeting criteria for MDD
- not without symptoms for more than two months
What is a mixed manic episode?
one with symptoms of depression and mania
What is the kindling effect?
as a person ages, episodes of mania become more frequent, shorter, and more severe
What are the major complications of bipolar mood disorder?
- suicide
- social or financial devastation
- catatonia
Describe the neuroanatomic changes associated with bipolar mood disorder.
- frontotemporal hyper-intensities
- alterations to the neuronal phospholipid membranes causing them to depolarize more
What NT changes are seen in those with bipolar mood disorder?
- elevated NE
- elevated glutamate
- chronic HPA activation
The kindling effect of bipolar disorder is often attributed to what mechanism?
chronic activation of the HPA axis and the effects of chronic steroids
How can bipolar disorder with psychosis be differentiated from schizophrenia?
- bipolar is more cyclic in course
- bipolar has fewer negative symptoms
The mental status exam for assessing mood includes what four basic features?
- presentation and behavior
- cognitive status
- emotional functioning
- thought processes and content
What two questions can be quickly used in the primary care setting to assess for depression?
- felt down, depressed, or hopeless
- felt little interest or pleasure in doing things
Antidepressants have a black box warning for what?
suicide
Depression is commonly comorbid with what other disorder?
anxiety
How do tricyclics work?
block reuptake of NE and serotonin
How do MAOIs work?
block metabolism of NE and DA
How do SSRIs work?
block reuptake of serotonin
How do SNRIs work?
block reuptake of NE
Electroconvulsive therapy is indicated for which patients?
those with depression and…
- psychosis
- high suicide risk
- comorbid medical risks
What is the primary treatment for bipolar disorder?
lithium
What are the major disadvantages of lithium?
- it takes a long time to build the necessary steady state levels in the blood
- therapeutic doses are near toxic
Name four drugs used in the treatment of bipolar mood disorders.
- lithlium
- valproic acid
- carbamazepine
- lamotrigine
Lithium has what advantages?
- shortens episodes
- prolongs remission (is prophylactic)
- lowers suicide potential
Advantages of valproic acid?
better tolerated by elderly, patients with CNS damage, rapidly cycling patients
Why is psychotherapy given before onset of an episode of bipolar disorder?
because the therapy focuses primarily on prevention (e.g. sleep hygiene)
