[CLMD] Mood Disorders [Hill]

Question 1

What are the (5) major neurotransmitters involved in mood disorders?

Answer 1

Norepinephrine

Dopamine

5-HT

GABA

Glutamate

Question 2

What are the relative levels of dopamine during

(Depression)

and

(Mania)

Answer 2

Depression = Dopamine is LOW

Mania = Dopamine is HIGH

Question 3

What are the levels of 5-HT during depression?

Answer 3

5-HT is LOW in depression

Question 4

What is the major excitatory neurotransmitter of the CNS?

What is the major inhibitory neurotransmitter of the CNS?

Answer 4

Excitatory = Glutamate

Inhibitory = GABA

Question 5

What is the definition of a major depressive episode?

Answer 5

At least (5) of the following for a 2-week period with at least one either (1) depressed mood or (2) loss of interest or pleasure

Question 6

What is the gold standard questionaaire that is used in nearly every primary care office to assess for depression?

Answer 6

Patient Health Questionnaire (PHQ-9)

Question 7

What is required for the diagnosis of major depressive disorder?

Answer 7

Diagnosis requires the presence of one or more major depressive episodes and the ABSENCE of any manic,hypomanic or mixed episodes

Question 8

What are associated features with major depressive disorder (6)?

Answer 8

Psychotic

Anxious distress

Melancholic

Catatonic

Peripartum onset

Mixed features

Question 9

What are the (5) stages of grieving?

Answer 9

Denial –> Anger –> Bargaining –> Depression –> Acceptance

Question 10

What are some major categories of treatments for major depressive disorder??

Answer 10

Pharmacologic

Electroconvulsive therapy (ECT)

Transcranial magnetic stimulation

Question 11

What is electroconvulsive therapy used for?

What is it?

Answer 11

Treatment resistant depression

Induces a seizure

Question 12

Efficacy of electroconvulsive therapy (ECT)?

Answer 12

75-80% treatment response

Question 13

What drug therapy has shown a 50% reduction in suicidal thoughts within 24 hours of major depressive disorder patients?

Answer 13

Ketamine

Question 14

What is spravato?

Answer 14

Spravato aka esketamine

Nasal spray formulation of ketamine

Rapid acting and expensive

Question 15

What is the name of the disorder related to this description:

Depressed mood for most of the day for at least 2 years in duration for adults and 1 year for children that has not been severe enough to meet criteria for a major depressive episode

Answer 15

Persistent depressive disorder (Dysthymia)

Question 16

What is double depression?

Answer 16

Double depression = Dysthymic disorder + Major depression can occur simultaneously

Question 17

What is depression w/ seasonal pattern?

Answer 17

Onset and remission of major depressive episodes at characteristic times of the year

Sleep more and eat more; fatigued

Light therapy is effective

Question 18

What is premenstrual dysphoric disorder (PMDD)?

Answer 18

Mood instability w/ anxiety, depression, irritability

Occur the week before menses

Treatment includes : (Exercise, diet, relaxation thearpy, SSRIs)

Question 19

Define a manic episode

Answer 19

Abnormally and persistently elevated, expansive or irritable mood lasting at least 1 week with at least three of the following:

• Inflated self-esteem or grandiosity
• Decreased need for sleep
• More talkative
• Flight of ideas/racing thoughts
• Distractibility
• Increased goal-oriented behavior
• Excessive involvement iin pleasureable activities

Question 20

What is a hypomanic episode?

Answer 20

Similar to manic episode but it is less severe

Episodes only need to last 4 days and must not include psychotic features

No social/occupational impairment

Question 21

What is bipolar I disorder?

Answer 21

Single manic episode is necessary to diagnose

At least one manic or mixed episode

Can be psychotic episode, delusions and/or hallucinations

Question 22

Define bipolar II disorder?

Prevalence?

Answer 22

Patients have had at least one major depressive episode and one hypomanic episode in the absence of any manic or mixed episodes

More prevalent than Bipolar I

Question 23

What are the 1st line agents to treat bipolar disorders?

Answer 23

Mood stabilizers:

Lithium

Valproic Acid

Question 24

What is cyclothymic disorder?

Answer 24

Characterized as dysthymic disorder w/ intermittent hypomanic periods

Patient who over the last 2 years experiences repeated episodes of hypomania and depression (not severe enough to meet criteria for major depressive disorder)

Question 25

What is **separation anxiety disorder?**

Answer 25

Recurrent excessive stress when **anticipating** or **experiencing separation from major attachment figures or home**

Question 26

Describe a **panic attack**

Answer 26

A discrete period of intense fear or discomfort, in which **four** or more of the following developed abruptly and reached **peak within 10 min** and usually last \<25 min - Palpitations - Sweating - Trembling/Shaking - Sensations of SOB - Chest pain/discomfort - Feeling dizzy - Fear of losing control - Paresthesia - Chills or hot flashes

Question 27

What is **agoraphobia?**

Answer 27

Anxiety about being in situations from which **escape may be difficult** or embarrassing or for which help may not be available in the event of panic

Question 28

Define **social phobia (social anxiety disorder)**

Answer 28

The fear, anxiety or avoidance is persistent Typically lasting 6 or more months

Question 29

Define **generalized anxiety disorder**

Answer 29

Excessive anxiety and worry **occuring more days than not** for at least **6 months** for MOST OF THE DAY about a number of events or activities

Question 30

Define **obsessions**

Answer 30

Recurrent and persistent **THOUGHTS**, impulses or images experienced as intrusive and inappropriate and causing **marked anxiety or distress**

Question 31

Define **compulsions**

Answer 31

Repetitive behaviors or mental acts that the person feels drive to perform

Question 32

What are a few **obsessive compulsive** **RELATED disorders?**

Answer 32

Hoarding Trichotillomania (hair pulling) Excoriation disorder (skin picking) Substance-medication induced OCD

Question 33

What is the difference b/w **OCD** and **Obsessive compulsive personality disorder (OCPD)?**

Answer 33

OCPD = they don't perceive they have a problem OCD = they know their compulsions and obsessions are not reasonable (most of the time)

Question 34

What are examples of **obsessions?**

Answer 34

Contamination Safety/harm Unwanted acts of aggression Unacceptable sexual or religious thoughts Need for symmetry or exactness

Question 35

What are examples of **compulsions?**

Answer 35

Excessive cleaning Checking, ordering and arranging rituals Counting

Question 36

Define **phobia**

Answer 36

Marked and persistent fear that is excessive or unreasonable, cued by the presence or anticipation of a specific object or situation

Question 37

What are examples of **anxiety treatments?**

Answer 37

**Psychotherapy** (supportive therapy, psychodynamic, cognitive behavioral therapy) **Psychopharmacology** (SSRIs, SNRIs, TCAs, MAOIs, Buspirone, Benzos, Antipsychotics)

Question 38

What is the pneumonic for **depression?**

Answer 38

**_SIG E CAPS_** Sleep-lack of Interest-anhedonia Guilt Energy -lack of Concentration - difficulty Appetite - decreased or increased Psychomotor- decreased Suicidal ideation

Question 39

What is the pneumonic for **manic?**

Answer 39

**_DIG FAST_** Distractability Inflated self esteem/impulsive Grandiosity Flight of ideas Activity Speech pressured Thoughtlessness

Question 40

What is the pneumonic for **dysthymic?**

Answer 40

**_CHASES_** Concentration-poor Hopelessness Appetite-poor Sleep- Insomnia Energy-low Self-esteem low