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Block 8 Week 1 > Jacobs: Mood Disorders > Flashcards

Jacobs: Mood Disorders Flashcards

1
Q

Most common psychiatric illness you are likely to see as a physician

A

depression

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2
Q

Co-morbidities of depression?

A

substance abuse disorders
pathological gambling
personality disorders
anxiety

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3
Q

Women are (blank) more likely than men to experience depression during their lifetime.

A

70%

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4
Q

Lifetime prevalence of depression?

A

16.5%

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5
Q

What age group has the highest rate of depression? What nationality?

A

40-59;

non-hispanic black

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6
Q

T/F: Medical students are more prone to depression than nonmedical peers

A

True

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7
Q

(blank) is a disproportionally high cause of death among physicians

A

suicide

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8
Q

Total annual cost of depression?

A

$83 billion

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9
Q

When diagnosing depression, what are some things to consider?

A

bereavement
normal reaction to stress or loss
adjustment disorder
cultural factors

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10
Q

Things included in major depressive episode diagnostic criteria?

A
  • 2+ weeks of symptoms
  • 5+ of 9 possible symptoms (depressed mood or loss of interests must be one symptom, weight/appetite changes, sleep changes, fatigue, etc)
  • marked distress of functional impairment
  • rule out medical and substance etiologies
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11
Q

Use SIGECAPS to screen for depression. What does it stand for?

A 
Sleep disturbance
Interest reduced
Guilt and self-blame
Energy loss and fatigue
Concentration probs
Appetite changes
Psychomotor changes
Suicidal thoughts

**need depressed mood or loss of interest

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12
Q

Depression = depressed mood or loss of interest most of the day nearly every day plus at least (blank) of the symptoms for at least 2 weeks.

A

4

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13
Q

What are these?

sleep disturbance
appetite problems
loss of energy
decreased libido
psychomotor retardation
A

neuro vegetative symptoms

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14
Q

What are some “somatic symptoms” that might accompany depression?

A 
nausea
constipation
headaches
back pain
SOB
chest pain
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15
Q

When do 50% of major depressive orders begin? When is the peak incidence? What is the median age of onset? Can it occur in children/elderly?

A

ages 20-50;
peak incidence in 20’s;
onset age 32;
yes!

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16
Q

How long does a single episode of major depressive disorder last?

A

6-13 months untreated

1-3 months treated

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17
Q

Are relapsing depressive episodes common?

A

yes; 70% can have a recurrence

**15% suicide

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18
Q

2 years of low mood (1 year for children/adolescents)
Milder, more fluctuating symptoms
Presence 2 additional symptoms
appetite, sleep, fatigue, self esteem, concentration, hopelessness
Distress or impaired functioning

A

Persistent depressive disorder

**milder, longer lasting form of depression - low mood for two years

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19
Q

What is double depression?

A

low level of chronic persistent depressive disorder complexed with a shorter more severe spout of depression

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20
Q

Used to be “Depression NOS” in DSM-IV
A. In the majority of menstrual cycles, > 5 symptoms present during the week before menses, improving within a few days of onset of menses, and becoming minimal/absent in the week after menses
B. > 1 symptoms: affective lability, irritability/anger/conflict, depressed mood, anxiety
C. > 1 symptoms: anhedonia, difficulty concentrating, lethargy, change in appetite, hypersomnia/insomnia, overwhelmed/out of control, physical symptoms (bloating, pain, weight gain, etc)
***D. CSD or interference with functioning

A

premenstrual dysphoric disorder

**focus on D, because lots of women have bad menses, but women who meet criteria have it so bad that it causes clinically significant distress or interferes w functioning

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21
Q

A patient can have a prominent and persistent disturbance in mood that is judged to be the direct pathophysiological consequence of another medical disease. Give an example.

A

neurologic: parkinson’s, huntington’s
metabolic: renal failure

GI: IBS, chronic pancreatitis

endocrine: hypothyroidism
cardiovascular: cardiomyopathy, MI
pulmonary: OSA

etc etc..

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22
Q

A prominent and persistent disturbance in mood that is judged to be due to the physiological effect of a substance or medication

A

substance-induced depressive disorder

23
Q

Some drugs known to cause substance-induced depressive disorder

A 
alcohol, benzos, opioids
hallucinogens
withdrawal from stimulants
oral contraceptives
steroids
antihypertensives (reserpine, beta blockers)
24
Q

T/F: There are clinically significant depressive syndromes that do not meet criteria for established categories of depression

A

True

25
Q

How is bereavement different from depression?

A

bereavement should not induce a major depressive episode

**it used to be that grief should clear in 2 months… not an exclusion in DSM V

26
Q

T/F: Children of depressed parents who are adopted out are at increased risk for depression

A

True

27
Q

T/F: There is a strong familial pattern with depression

A

True

  • *first degree relatives are 2-5x more likely to depressed
  • *monozygotic twins at greater risk
28
Q

6 pertinent biogenic amines

A 
dopamine
epinephrine
ACh
norepi
histamine
serotonin
29
Q

4 theories on etiology of depression

A 
learned helplessness model (exposure to uncontrollable negative events)
cognitive theory (depression is a result of cognitive errors)
genetics
biology (dopamine, epi, etc)
30
Q

What is this?

the hypothalamus hypersecrets CRF in depression, resulting in elevated ACTH, which then triggers the adrenal cortex to release extra cortisol; unipolar and bipolar depressed patients oft have elevated cortisol that cannot be suppressed with dexamethasone; ketoconazole lowers cortisol levels and can be efficacious in treatment-resistant depression

A

neuroendocrine model of depression

31
Q

What is this?

the Borna virus and other infectious agents can cause depression; the antiviral amantadine can be helpful

A

infectious model

32
Q

elevated mood + increase in goal-directed activity or energy for a week or more
3 or more additional symptoms
inc self-esteem/ grandiosity
decr need for sleep
more talkative
racing thoughts/ FOI
distractible
incr activity (school, work, sex, social)
activities with neg. consequences (shopping sprees, business investments, gambling)

A

manic episode

33
Q

The disorder is characterized by severe recurrent TEMPER outbursts in response to common stressors.
A. The temper outbursts are manifest verbally and/or behaviorally, such as in the form of verbal rages, or physical aggression towards people or property.
 The reaction is grossly out of proportion in intensity or duration to the situation or provocation.

B. The responses are inconsistent with developmental level.
C. Frequency: The temper outbursts occur, on average, three or more times per week.
D. Mood between temper outbursts: 1. Nearly every day, the mood between temper outbursts is persistently negative (irritable, angry, and/or sad).
2. The negative mood is observable by others (e.g., parents, teachers, peers).

A

Disruptive mood dysregulation disorder

34
Q

What are these?

Single manic episode
Most recent episode hypomanic
Most recent episode manic
Most recent episode depressed
Most recent episode unspecified
A

bipolar types

35
Q

What is the avg age of onset of bipolar disorder?

A

20’s-30’s

36
Q

How long do manic episodes last?

A

weeks to months

**not transient mood swings

37
Q

Is rapid cycling common in bipolar disease? Ex: 4+ episodes in a year

A

no, less common

38
Q

T/F: 60% of people with bipolar disease have a family history of mood disorder

A

True

39
Q

T/F: Bipolar disorder is likely a mixture of genetic and environmental factors

A

True

40
Q

T/F: Bipolar disorder can be secondary to another medical condition

A

True

41
Q

If there is head trauma to the right frontal lobe, what is the result?

A

mania

42
Q

If there is head trauma to the left frontal lobe, what is the result?

A

depression

43
Q

If there is head trauma to the medial frontal lobe, what is the result?

A

apathy

44
Q

If there is head trauma to the orbitofrontal lobe, what is the result?

A

profanity
irritability
irresponsibility

45
Q

Which drugs can cause substance-induced bipolar disorder?

A 
LSD
stimulants (meth)
PCP
steroids
L dopa
thyroxine
captopril
**drug withdrawal of clonidine
46
Q

At least 4 days of elevated mood + increase in goal-directed activity or mood
3 or more other symptoms (4 if mood is just irritable)
Change in functioning
Not severe enough to severely impair functioning or necessitate hospitalization
No psychosis

A

hypomanic episode

47
Q

Hypomanic episode + Major depressive episode

Never a history of manic episodes

A

Bipolar type II

48
Q

So how is a hypomanic episode different from a manic episode?

A
  1. hypomanic episodes are usually not severe enough to impair functioning, but cause a change in functioning
  2. hypomanic episodes have no psychotic symptoms
  3. manic episode lasts at least 1 week; hypomanic episode lasts at least 4 days
49
Q

Involves the occurrence of one or more manic episodes with or without a history of one or more major depressive episodes
Lifetime prevalence = .4-1.6%
Equally common in males and females

A

Bipolar I

50
Q

Involves at least one major depressive episode and one hypomanic episode with no history of manic episodes
Lifetime prevalence = .5%
More common in females

A

Bipolar II

51
Q

Combining aspects of two different disorders
Schizophrenia symptoms (psychosis, negative symptoms)
Prominent affective (mood) symptoms
Psychotic symptoms present even when mood symptoms absent

A

Schizoaffective

52
Q

What two types of symptoms are present in schizoaffective disorders. Which symptoms are always present?

A

schizophrenia symptoms (psychosis, negative symptoms)
prominent mood symptoms;
Psychotic symptoms present even when mood symptoms absent

53
Q

Chronic mood disturbance (over 2 years)
Hypomanic symptoms that don’t meet criteria for a hypomanic episode (hypomania)
Depressive symptoms that don’t meet criteria for a major depressive episode (mild depression)
No history of depressive, manic or hypomanic episodes
Clinically significant distress or functional impairment

A

Cyclothymic disorder

Block 8 Week 1 (12 decks)

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