Clinical Approach to Mood Disorders Flashcards
(37 cards)
What is the NE activity in a patient with depression?
Down-regulate beta-receptors; noradrenergic function abnormal in depression.
What is the DA activity in a patient with depression vs. mania?
Decreased in depression; increased in mania.
What is the 5-HT activity in a patient with depression?
Decreased in depression
What disease process does glutamate play in integral role?
Dementia
What is the requirement to diagnose a major depressive episode?
In addition, it requires…
At least 5 symptoms for a 2-week period, with at least one either (1) depressed mood or (2) loss of interest or pleasure.
One or more major depressive episodes and the absence of any manic, hypomanic or mixed episodes.
What might be on the DDx for major depressive disorder?
Substance-induced d/o
Mood disorders from a general medical condition
Normal grief (bereavement): may last beyond 2 mo. and up to 1-2 yrs.
What might be used as treatment for major depressive disorder?
Hospitalization
Somatic therapies
- TCAs
- MAOIs
- SSRIs
- Trazodone
- Bupropion
- SNRIs
- all are pretty effective.
ECT/TMS
What is electroconvulsive therapy (ECT) used for?
What mild side-effect can occur as a result of the treatment?
What ALWAYS happens during administration?
It is considered to be…
Treatment resistant depression.
May cause a short-term memory loss (long-term less common).
Induction of a seizure.
Safe and effective - no absolute contraindications and has a 75-80% response to treatment.
What is transcranial magnetic stimulation (TMS)?
A newer treatment that was thought at first to be almost as effective as ECT, but is more likely closer to 50% as effective.
What is Ketamine’s MOA?
What does it produce in a patient?
Overdose may lead to…
It is very similar chemically to which other drug?
What does it help with?
NMDA antagonist
Produces dissociative anesthesia
Overdose may lead to panic attacks and aggressive behavior; rarely seizures, increased ICP and cardiac arrest
Similar to PCP, but shorter acting and less toxic
Leads to a 50% reduction in suicidal thoughts in 24 hrs
How is Ketamine given?
How frequently?
By a psychiatrist for 45-60 min. at a time. There are 4-6 infusions over a 2-3 period of time.
The problem with the drug is that it is highly costly ($400-1000 per infusion).
How must Esketamine (Spravato) be given?
How quickly does it work?
Must be given at an approved health center and is given via a nasal spray formulation.
It is rapid acting, but also highly pricey.
What is the criteria for diagnosing Persistent Depressive Disorder (Dysthymia)?
Depressed mood for most of the day (for at least 2 years in duration for adults and 1 year for kids) that has not been severe enough to meet criteria for major depressive episode.
During the 2 years, there cannot be a >2 mo. period the patient is symptom-free.
What is “double depression”?
Dysthymic disorder and major depression that occur simultaneously.
What is the treatment for Persistent Depressive Disorder (Dysthymia)?
The same as other forms of depression, but tends to be more difficult to treat.
Meds: SSRIs, SNRIs, MAOIs
CBT
What is the “essential feature” of Depression with Seasonal Pattern (SAD)?
What are symptoms of the disorder?
What level of treatment is indicated?
The onset and remission of major depressive episodes at characteristic times of the year.
Patients tend to sleep and eat more; increased fatigue.
Only light therapy is indicated.
What is Premenstrual Dysphoric Disorder (PMDD)?
What is the treatment?
How should pharmalogical be done (timing, etc.)?
Mood instability with anxiety, depression and irritability that occurs the week prior to menses. It has a consistent pattern over the year.
Treatment
- exercise, diet and relaxation therapy
- SSRIs: Sertraline, Fluoxetine, Paroxetine
- treat during cycle or 2 wks. prior to menses
What is the diagnosis of a Manic Episode require?
Overall, it is a…
Abnormally and persistently elevated, expansive or irritable mood lasting at least 1 week, with at least 3 other features (inflated self-esteem, decreased need for sleep, more talkative, racing thoughts, distractibility, more goal-oriented, excessive involvement in pleasurable activities) - “DIGFAST”.
It is a mood disturbance severe enough to cause marked impairment in occupational functioning or in usual social activities/relationships.
-the symptoms are not caused by the direct effects of a substance or a general medical condition.
What is a Hypomanic Episode?
It is similar to a manic episode, but is less severe. Episodes only need to last 4 days and must not include psychotic features.
There is no social/occupational impairment.
What is required for a diagnosis of Bipolar I Disorder?
What is NOT required for a diagnosis, but might be the first symptom?
What is the prognosis?
A single manic episode is necessary (only one “pole” needed) AND at least 1 manic or mixed episode.
A major depressive episode is not required for diagnosis, but typically presents first.
Can be a psychotic episode - delusions and/or hallucinations.
Prognosis is worse than major depressive disorder.
What is required for diagnosis of Bipolar II Disorder?
Patients have had at least one major depressive episode and one hypomanic episode in the absence of any manic or mixed episodes.
Which is more prevalent: BID or BIID?
BIID
What is the first-line treatment for Bipolar Disorders?
Mood stabilizers: Li+ or Valproic acid
What is Cyclothymic disorder?
What is the requirement for diagnosis?
It is characterized by Dysthymic Disorder with intermittent hypomanic periods.
Patients who, over past 2 years (1 year for kids), experience repeated episodes of hypomania and depression (not severe enough to be major depressive disorder).
