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Clin Med- P > Mood Disorders > Flashcards

Mood Disorders Flashcards

1
Q

Mood disorders encompass what two main types of disorders?

A

depressive and bipolar

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2
Q

what are the five main mood disorders?

A

1) . major depressive disorder
2) . persistent depressive disorder
3) . premenstrual dysphoric disorder
4) . bipolar disorder (I, II, cyclothymic disorder)
5) . adjustment disorder

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3
Q

Likelihood of recurrence of depression after one episode is ___%. How about after two? three?

A

50%, 70%, 90%

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4
Q

what is the cause of depression?

A

Complex psychobiological syndrome, with neurochemical (serotonin, norepineprine, dopamine), genetic, psychosocial factors playing parts

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5
Q

what are the four types of symptoms in depression?

A

cognitive, affective, behavioral, physiological

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6
Q

what are some affective symptoms of depression? (4)

A

angry, irritable, down, flat

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7
Q

what are some cognitive symptoms of depression? (5)

A 
cognitive triad: self, outside world, future
self criticism
loss of self worth
ruminating thoughts
hard to focus
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8
Q

what are some behavioral symptoms of depression? (4)

A

isolation, poor hygiene, libido decreases, develop bad habits

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9
Q

what are some physiological symptoms of depression?

A

change in weight/appetite (inc or dec), muscle aches, chronic pain, digestion slows, headaches

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10
Q

what is anhedonia?

A

you don’t enjoy the things you normally would

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11
Q

difference between MDD, single episode and MDD, recurrent?

A

presence of a single MD episode VS 2 or more MDEs AT LEAST 2 months apart

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12
Q

what are six specifiers for MDD?

A

with peripartum onset, with seasonal pattern, with psychotic features, atypical depression, catatonic depression, melancholia

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13
Q

MDD criteria (5)

A

1) . 5 or more present during 2 week period (must have 1 or 2)- SIGECAPS
- depressed mood most of the day, nearly every day
- diminished interest
- significant weight loss or gain
- insomnia or hypersomnia
- agitation or retardation
- fatigue
- feelings of worthlessness
- diminished ability to concentrate
- recurrent thoughts of death
2) . impairment in functioning
3) . not due to a substance or medical condition
4) . not better accounted for by schizoaffective DO
5) . never had a manic episode, mixed episode or hypomanic episode

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14
Q

Persistent Depressive Disorder (compared to MDD)

A

PDD = depressed mood for most of the day, more days than not for AT LEAST 2 YEARS (1 yr for children/adolescents)
***presence of 2 or more: poor appetite/overeating, low energy, insomnia/hypersomnia, low self esteem, poor concentration, feelings of hopelessness
AND never without symptoms for more than 2 months

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15
Q

what did PDD used to be called?

A

dysthymia

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16
Q

criteria for premenstrual dysphoric disorder (6)

A

1). at least 5 symptoms present in the final week before menses onset (start to improve with menses onset), minimal or absent in week postmenses
*Physical, emotional, behav
2). one or more: lability (rapidly changing emotions), irritability/anger, depressed mood, anxiety, tension
3). one or more: decreased interest, difficulty in concentration, lethargy, change in appetite, hypersomnia/insomnia, overwhelmed, physical symptoms
1-3# MUST BEEN MET FOR MOST CYCLE IN PRECEDING YR
4). impairment in functioning
5). not exacerbation of another disorder
6). not caused by substance or other medical condition

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17
Q

what are two screenings for depression?

A

Beck depression inventory and PHQ-9

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18
Q

what two aspects of depression should you focus on when asking a patient if they’re depressed?

A

sleep and anhedonia

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19
Q

treatment for depression is __-__% effective

A

70-90%

20
Q

Med treatment for MDD and Persistent depressive Disorder

A

SSRI 1st line- also help with anxiety
Maybe SNRIs, Wellbutrin, Remeron, serzone, Effexor
Maybe TCAs

21
Q

what therapy is most effective for treating depression?

A

CBT- addresses irrational thoughts, increases enjoyable activities, works on problem solving skills, need to be combined with antidepressants

22
Q

when is ECT used to treat depression?

A

if medication or other therapy hasn’t worked (TC RESISTANT DEPRESSION), may have short term memory loss tho

23
Q

what is vagus nerve stimulation? when is it used?

A

used for treatment resistant depression; surgical implantation of a nerve stimulator wrapped around the left vagus nerve

24
Q

what is the most over diagnosed psych disorder?

A

bipolar

25
Q

bipolar disorder: onset, prognosis, genetics

A

20-30 years (early onset coincides with more psychotic features), poor prognosis with psychotic symptoms; first degree relatives have increased incidence of inheriting (monozygotic twin rate is 75%)

26
Q

Manic episode criteria (4)

A

1) . period of abnormality and persistently elevated or irritable mood, goal directed activity (LASTING AT LEAST ONE WEEK)
2) . 3 or more, notable change from previous behavior: inflated self esteem, decreased need for sleep, more talkative, flight of ideas, distractibility, inc in goal directed activity, involvement in activities that have high potential for painful consequences
3) . marked impairment in functioning or relationships, need hospitalization, or psychotic features are present
4) . not due to substance or medical condition

27
Q

criteria for hypomanic episode (3)

A

same as manic episode EXCEPT:

  • present for at least 4 DAYS
  • must be a change from usual behavior
  • NOT severe enough to cause marked impairment in functioning
28
Q

3 criteria for bipolar I

A
  • must have at least one manic episode
  • MAY have MD episode
  • may have hypomanic episodes
29
Q

one criterion for bipolar II

A

recurrent major depressive episodes with hypomanic episodes (HAS NEVER HAD a manic episode)

30
Q

what is cyclothymic disorder?

A

chronic, fluctuating mood disturbance with numerous periods of hypomanic symptoms and periods of depressive symptoms that are distinct from each other.

31
Q

criteria for cyclothymic disorder (3)

A

hypomanic symptoms (don’t meet criteria for hypomanic episode) AND depressive symptoms (but don’t meet criteria for MDE) for AT LEAST 2 YEARS

  • never met manic criteria either
  • not symptom free for greater than 2 months
32
Q

4 common specifiers for cyclothymic disorder

A

1) . rapid cycling- at least 4 mood episodes in previous 12 months meet criteria for MD, manic or hypomanic episode
2) . with psychotic features: delusions/hallucinations
3) . with anxious distress
4) . with seasonal pattern

33
Q

treatment for bipolar: meds and therapy

A

1) . meds: mood stabilizers (lithium FIRST LINE)
2) . anticonvulsants- Depakote or carbamazepine (if pt doesn’t respond to stabilizers)
3) . 2nd gen antipsychotics if psychotic symptoms present
4) . therapy- CBT, family

34
Q

what are the three characteristics of atypical depression? how do you tx this?

A

mood reactivity
appetite increase/weight gain
hypersomnia
tx: MAOIs

35
Q

what is seasonal depression?

A

depression symptoms at the same time each year

36
Q

what is catatonic depression?

A

motor immobility, stupor and extreme withdrawal

37
Q

what is melancholia?

A

anhedonia, lack of mood reactivity, severe weight loss/loss of appetite, excessive guilt, sleep disturbance

38
Q

what does DIGFAST mean?

A 
acronym for bipolar sxs
D- distractibility
I - Irresponsibility
G- Grandiosity
F- Flight of Ideas
A- Activity increase
S- Sleep Deficit
T- Talkative
39
Q

how to treat acute mania?

A

antipsychotics: Risperidone > Olanzapine > Haldol

OR mood stabilizers (lithium or Depakote)

40
Q

what happens if you use antidepressant monotherapy in a patient with bipolar disorder?

A

it could precipitate a manic episode

41
Q

how to treat premenstrual dysphoric disorder?

A

SSRIs for emotional symptoms with dysfunction

***oral contraceptives for pts who do not want to take SSRIs

42
Q

what is adjustment disorder?

A

maladaptive emotional or behavioral reaction to an identifiable stressor (I.e. job loss, physical illness, divorce) that causes a disproportionate response THAN would normally be expected WITHIN THREE MONTHS of the stressor
- usually RESOLVES WITHIN 6 MONTHS

43
Q

criteria for adjustment disorder

A

1) . one or both:
- marked distress out of proportion to the severity of the stressor
- impairment in functioning
2) . may manifest as depressed mood, anxiety, or conduct disturbance

44
Q

tx for adjustment disorder

A

PSYCHOTHERAPY 1st

- meds in select cases

45
Q

adjustment DO specifiers (6)

A

1) . with depressed mood
2) . with anxiety
3) . with mixed anxiety and depressed mood
4) . with disturbance of conduct
5) . with mixed disturbance of emotions and conduct
6) . unspecified

46
Q

what is a mixed episode?

A

meeting criteria for both major depressive and manic episodes nearly every day for at least a week

Clin Med- P (124 decks)

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