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Flashcards in 1: Mood Disorders Deck (41)
1

what are the four types of mood episodes?

-major depressive episode (MDE)
-manic episode
-mixed episode
-hypomanic episode

2

what is a mixed episode?

over a 1 week period, patient satisfies criteria for both manic and MDE

3

what is a hypomanic episode?

shorter, less severe than manic episode

4

what are mood disorders defined by?

a pattern of episodes over time, with each episode being defined by a pattern of symptoms and signs

5

MDE - symptomatic definition

at least 5 of the following nearly every day for 2 weeks, and the symptoms must be causing distress/impairment:
**depressed mood (irritability in adolescents)
** anhedonia (don't enjoy things as much as before)
-change in weight/appetite
-insomnia or hypersomnia
-psychomotor agitation (crying spells) or retardation
-fatigue or loss of energy/ lastitude
-feelings of worthlessness or guilt
-diminished ability to think or concentrate
-recurrent thoughts of death or suicide

-anxiety and mixed state are now specifiers; bereavement is no longer an exclusion

6

describe the pathophysiology of MDE

-3 nt's: serotonin, norepi, dopamine
-increased cortisol/ CRH secretion
-hypothesized adaptive changes in second messengers and transcription factors

7

epidemiology of MDE

15% of population will have MDD in lifetime
20% women and 10% of men affected

8

what are the 3 important parts of a history to address when a new patient comes into a psych clinic?

-sleep
-pain (chronic)
-meds with psychotropic effects

9

definition of lastitude

not able to initiate things, but fine doing them once initiated

10

what 3 things do MDE people have negative thoughts about? what is the significance of this?

-themselves
-the world
-the future

increased risk of suicide

11

what is a nihilistic delusion?

"don't think my heart is beating anymore"

12

what groups of people are at high risk of suicide?

SAD PERSONS
Sex (male)
Age (teenager or elderly)
Depression
Previous attempt
Ethanol or drug use
Rational thought loss
Sickness (medical illness or >3 prescription meds)
Organized plan
No spouse (divorced, widowed, or single, esp. w/o child)
Social support lacking

women try more often; men succeed more often.

13

manic episode - symptomatic definition

elevated or irritable mood characterized by the following:
(manics DIG FAST)
Distractibility/ Delusions and/or hallucinations
Irresponsibility/impulsivity
Grandiosity (can lead to delusions)
Flight of ideas (thoughts racing)
Activity/Agitation increase
Sleep need decrease*
Talkative/pressured speech

mixed state and anxiety are now specifiers

14

time and symptomatic differentiation of mania vs. hypomania

mania: one week, 3-4 sx

hypomania: 4 days, 3-4 sx

15

why is it hard for some people to accept that hypomania is a problem?

it may include mild or moderate impairment, but may also be associated with enhancement of function

16

what is a good symptomatic question to ask to distinguish hypomania?

do you have energy swings?

17

what is dysthymic disorder?

pattern of chronic ongoing mild depressive symptoms

18

treatment of MDD

-CBT -> rational defeat concept concerning automatic negative thoughts (mild/moderate depression)

-SSRI's
-SNRI's
-TCA (tricyclic antidepressants)
-MAOi

-ECT (electroconvulsive therapy)
-TMS (transcranial magnetic stimulation)

-adjunct tx: augment with atypical antipsychotics (Abilify/Flutiapine)

19

ECT vs. TMS

ECT more effective, but major issue = memory loss

TMS not as good, but much less harmful to patient

20

what are the 4 biggest adverse effects of SSRI's?

-anxiety
-insomnia
-GI effects
-decreased sexual function

21

what are two things you must ALWAYS ask about in a psych evaluation of depression? (or probably in general)

-suicide
-substance abuse

22

when do you follow up with a MDD patient?

re-evaluate at 2 weeks for compliance and side effects, then again at 2 months b/c takes that long for meds to work

23

3 major subtypes of bipolar disorders and how to distinguish them

Bipolar I - mania + mild depression

Bipolar II - hypomania + major depression

cyclothymia - cyclic hypomania + mild depression

24

what is the 'kindling effect' of bipolar disorder pathogenesis?

over time, episodes can be more easily stimulated/increased susceptibility to an event

25

do you ever question depressed patients about mania?

yes - most bipolar patients start by just showing depressed symptoms then progress

26

bipolar disorder treatment

for mania/hypomania: mood stabilizers
-lithium carbonate
-valproic acid

for depression: atypical antipsychotics
-Seroquel (quetiapine)
-Symbyax (fluoxetine/olanzapine)
-Latuda

27

psychiatric co-morbidities in bipolar patients

-substance abuse disorders (alcohol, marijuana)
-anxiety disorders (panic, social phobia, simple phobia)
-eating disorders (bulimia, anorexia)

28

describe health utilization among persons with affective disorders

if have a psych disorder, more likely to have more medical problems

if treat psych disorders, you decrease medical utilizations

29

specific organic causes of depression: drugs/meds

catecholamine depletion or blockade
-reserpine
-propranolol
-cocaine withdrawal

cholinergic agonists
-physostigmine
-insecticide poisoning

CNS depressants
-valium
-barbituates

steroids
H2 blockers
analgesics

30

specific organic causes of depression: endocrine disease

-hypothyroidism (rarely hyperthyroidism)
-Cushing's disease

31

specific organic causes of depression: neurologic disease

-CVA (cerebrovascular accidents), esp. frontal
-Parkinson's
-Huntingtons
-Alzheimers

32

specific organic causes of depression: infectious disease

-HIV
-hepatitis
-mono
-flu

33

specific organic causes of depression: neoplastic disease

-lung
-pancreas
-CNS

34

specific organic causes of depression: metabolic disease

-folate or B12 deficiency
-high calcium
-low magnesium

35

specific organic causes of depression: other disease

-alcoholism
-any condition causing CNS depression

36

specific organic causes of mania: drugs/meds

sympathomimetics -stimulants
-amphetamine
-cocaine
-decongestants
-weight loss preps

dopamine agonists
-L-DOPA
-bromocriptine

antidepressants
steroids

37

specific organic causes of mania: endocrine disease

-hyperthyroidism

38

specific organic causes of mania: neurologic disease

-temporal lobe seizures
-temporal lobe CVA
-MS
-Huntington's

39

specific organic causes of mania: infectious disease

-HIV
-encephalitis

40

specific organic causes of mania: neoplastic disease

CNS tumors

41

specific organic causes of mania: metabolic disease

-hypocalcemia
-dialysis encephalopathy