2. Atypical --> mood reactivity, weight and sleep increase, leaden paralysis

Psychotic --> Hallucinations and/or delusions are evident with mood congruent psychotic features: content of all delusions/hallucinations is consistent with typical depression with mood incongruent psychotic features: content of delusions/hallucinations does not involve typical depression

4. Catatonia --> mutism, immobility, waxy flexibility, stereotypes, other odd posturing

5. Anxious Distress --> MDE associated with feeling tense, restless and fearful

6. Peripartum Onset ->MDE onset is during pregnancy or within 4 weeks post delivery

7. Seasonal Pattern --> consistent temporal relationship between time of year and MDEs.

Depressive Disorders and Bipolar Related Disorders Flashcards by Nicole Pritchard

What do all depressive disorders have in common?

low mood WITHOUT abnormally high mood periods

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What is the diagnostic criteria for Major Depressive Disorder (MDD)?

Must experience >1 major depressive episode (MDE)
No history of mania or hypomania
> /= 5 of SIG-ECAPS that last > 2 weeks

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What is MDD also known as?

Unipolar Depression

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What are the 9 major depressive episode (MDE) symptoms?

Depressed Mood
Anhedonia (inability to feel pleasure)
Significant Weight change
Insomnia/hypersomnia
loss of energy
Psychomotor changes
Feeling guilty/worthless
Decreased concentration
Thoughts of death/suicidal ideation
(1-2= affective; 3-5=neuro-vegetative; 6-9 cognitive)

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What is the criteria for MDE?

At least 2 weeks of >5 of the symptoms and one symptom must be one of the first two symptoms (affective)

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What is the mnemonic for MDE symptoms?

SIG-ECAPS 
Sleep change
Interest loss
Guilt 
Energy problem
Concentration poor
Appetite change 
Psychomotor change 
Suicidal Ideation

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What is the assessment tool used by physicians for depression?

Physician’s Health Questionnaire (PHQ-9)

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There are seven MDD specifiers each card will go through one. 1–>

Melancholic –> severe anhedonia, lack of mood reactivity, profound despondency and guilt, depression worse in the AM, early morning awakenings, and decreased appetite
(one or more symptom)

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MDD specifier, 2–>

Atypical –> mood reactivity, weight and sleep increase, leaden paralysis

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MDD specifier, 3–>

Psychotic –> Hallucinations and/or delusions are evident

with mood congruent psychotic features: content of all delusions/hallucinations is consistent with typical depression
with mood incongruent psychotic features: content of delusions/hallucinations does not involve typical depression

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MDD specifier, 4–>

Catatonia –> mutism, immobility, waxy flexibility, stereotypes, other odd posturing

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MDD specifier, 5–>

Anxious Distress –> MDE associated with feeling tense, restless and fearful

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MDD specifier, 6 –>

Peripartum Onset ->MDE onset is during pregnancy or within 4 weeks post delivery

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MDD specifier, 7 –>

Seasonal Pattern –> consistent temporal relationship between time of year and MDEs.

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What is the course of MDD?

MDEs persist 6-12 months
Recurrent
Eventually develop mania and therefore dx changes

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What are the four etiology factors of MDD?

Genetic Vulnerability
Environmental Stressors
Neuroendocrine Dysfunction (HPA axis overactivity)
Decreased Monoamines

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What is the risk of developing MDD?

General Population –> 10%
1st relative –> 20%
MZ co twin with MDD –> 30%

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How does the HPA axis work in non depressed individuals?

When rising cortisol levels are detected by GR (glucocorticoid receptor) in the hippocampus, the hippocampus stops production of CRH.
(the negative feedback loops suppresses the HPA axis)

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How does the HPA axis work in a depressed individual?

Continued production of CRH due to failure of the negative feedback loop to suppress the HPA axis

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Describe the Dexamethasone Suppression Test (DST) in patients with MDD

patients show non suppression of cortisol on the DST.

aka HPA axis malfunction

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What are the three effects of chronic HPA axis activation?

1) Anxiety (cortisol and catecholamines)
2) Depressive symptoms (decreased monoamines)
3) Immune system dysregulation

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Antidepressant Drugs (ADs) are common drugs to treat MDD with, what is their mechanism of action?

Increase the monoamines (Serotonin) to varying extents

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What are the different classes of ADs?

1) SSRIs ( selective serotonin-reuptake inhibitors) -> most common class; ex: Fluoxetine (prozac)
2) SNRIs (Serotonin-norepinephrine reuptake inhibitors) –> newest class
3) TCAs (tricyclic antidepressants) –> monoamine reuptake inhibitors
4) MAOIs (monoamine oxidase inhibitors) –> diet restrictions

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What are the major side effects of ADs?

1) Increased risk of suicide

2) Serotonin Syndrome –> hyperthermia, tachycardia, HTN and delirium (resulting when inadequate washout period occurs)

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The third treatment option for MDD is ECT (electroconvulsive therapy), describe what this procedure involves

electrical induction of a generalized seizure | patient does receive a muscle relaxant to avoid injury!

What are the main indications for ECT treatment?

Treatment Resistant Depression/Mania Severe Depression Pregnant depressed patients ERIC in the video --> the musician

In regards to electrode placement in ECT which is more effective? Unilateral or Bilateral?

Bilateral ( frontotemporal )

What are some initial side effects of ECT?

1) cardiac arrhythmias 2) Headache and confusion 3) memory loss for recent long term memory

What are the final two treatments for MDD?

1) Transcranial Magnetic Stimulation (TMS) --> magnetic pulses stimulate patients prefrontal cortex 2) Vagus Nerve Stimulation (VNS) --> electrical stimulation of the vagus nerve

What is the diagnostic criteria for persistent depressive disorder (PDD)?

1) Chronic depressed mood for >2 years characterized by at least 2 of the following symptoms: * poor appetite or overeating * insomnia/hypersomnia * low energy * low self esteem * trouble concentrating or making decisions * feelings of hopelessness

For PDD if symptoms are subthreshold aka a MDE does not occur during PDD then what do you diagnose the patient with?

with pure dysthymic syndrome (aka dysthymic disorder)

Describe an individual with pure dysthymic syndrome (dysthymic disorder)

low self image, brooding, sullen, pessimistic appetite, sleep and energy have always been low no treatment sought usually

For PDD, if symptoms of an MDE does occur then what do you diagnose the patient with?

with persistent MDE ( > 2 years) | intermittent MDEs

Can you diagnose a patient with both MDD and PDD?

How do you treat someone with PDD?

Same psychotherapeutic and drugs used from MDD treat dysthymic PDD

What is the diagnostic criteria for Premenstrual Dysphoric Disorder (PMDD)?

1) Must present in the week before menses 2) Improve after Menses Onset 3) Minimize in the week post menses

What are the symptoms in PMDD?

1) Mood lability, irritability, dysphoria and anxiety | 2) anhedonia, problems concentrating, lethargy, appetite and sleep change, physical symptoms

What are treatment options for PMDD?

1) SSRIs (taken either intermittently or continuously) 2) Birth Control 3) Nutritional Supplements 4) Diet and Lifestyle changes

What is the diagnostic criteria for Disruptive Mood Dysregulation Disorder (DMDD)?

1) Severe temper outbursts at least 3 times/ week 2) Sad, irritable or angry mood daily 3) Reaction does not equal situation 4) Present in multiple settings

What is the timeline for DMDD?

1) Symptoms must begin before age 10 | 2) Diagnosis Cant be made before age 6 or after age 18

What is the diagnostic criteria for Bipolar I disorder (BPI) aka manic-depression?

1) Must experience at least 1 manic episode 2) Symptoms last at least 1 weeks 3) Marked impairment in functioning

Are MDEs necessary for a BPI diagnosis?

NO (despite the term bipolar)

In general terms what is a manic episode?

Abnormally elevated mood or irritability PLUS increased energy

What additional symptoms are required for a manic episode?

``` Person must have 3: 1) Inflated self-esteem/grandiosity (G) 2) Decreased need for sleep (S) 3) Pressured speech or Talkativeness (T) 4) Flight of ideas (F) 5) Distractibility (D) 6) Increased goal directed activity (I) 7) Excessive involvement in risky activities (A) DIG FAST ```

What are the three specifiers for BPI?

1) With Mixed Features: MDE symptoms occur during the same time period as mania 2) With Rapid Cycling: patient experiences > 4 mood episodes/yr 3) With Psychotic Features: delusions or hallucinations

Can BPI begin with MDEs before the patient experiences the first manic episode?

YES

How long does mania usually last?

about 3 months | and occurs directly before/after an MDE

Is there a high genetic vulnerability in BPI? Explain why

YES | Based on studies showing MZ co-twin with BPI about 80%

Is BPI more genetically controlled than MDD?

YES

Manic episodes involve increased activity of what?

Monoaminergic activity

What are the three main drugs used to treat manic episodes in individuals with BPI?

1) Lithium 2) Anticonvulsants 3) Antipsychotics

What are the two main drugs used to treat MDEs in individuals with BPI?

1) Antidepressants (ADs)--> need mood stabilizer if used | 2) Antipsychotics ---> different then the mania antipsychotics used

What are the use of Antidepressants (ADs) contraindicated in treatment of MDEs in BPI patients?

risk of inducing mania

What is the only FDA approved drug for BP depression?

Antipsychotics

ECT treatment is also used in BPI patients, does this treatment treat the manic or depressed states?

BOTH

Is psychotherapy used for BPI patients?

Yes but not to treat primary symptoms

What is the diagnostic criteria for BPII patients?

Person experiences at least 1 MDE and at least 1 hypomanic episode

Hypomania includes the same symptoms of mania, so how are they different?

Severity Mania= marked impairment in functioning Hypomania= does not (therefore does not significantly affect patients life)

How long does a hypomania episode need to last for BPII?

At least 4 days

In BPI the disruptive problem is the manic episodes however in BPII the patient only experiences hypomanic episodes so therefore what is the main disruptive problem in BPII?

Depressed phase

How do you treat BPII?

Same as BPI with a focus on bipolar depressed drugs

What is the diagnostic criteria for cyclothymic disorder?

1) >2 years a person experiences periods of hypomanic symptoms that fluctuate with periods of depressive symptoms 2) Criteria for MDE has not been met

How is cyclothymic disorder and BPI different?

Mood shifts are not as extreme

What is the treatment for cyclothymic disorder?

Mood Stabilizers

In BP disorders is an MDE or manic/hypomanic episode the first mood episode?

could be either

What are some factors suggesting a bipolar depression?

1) Family History 2) Onset in adolescence 3) Short MDEs 4) Psychotic features

Depressive Disorders and Bipolar Related Disorders Flashcards

(66 cards)