Major Mood Disorders Flashcards
(38 cards)
What are the major mood disorders?
Major Depressive Disorders
–Co-morbid conditions:
- Anxiety disorders
- Personality disorders
- Substance abuse
Bipolar Disorder
Persistent Depressive Disorder
What is the criteria for a manic episode?
MUST have elevated, expansive, or irritable mood + 3 or > of the following:
- Grandiosity
- Excessive involvement in pleasurable activities with high risk
- Pressured speech
- Flight of ideas, racing thoughts
- Distractibility
- Increased goal-directed activity
- Decreased need for sleep
Mania= symptoms > 1 week; significant dysfunction
What is the criteria for a hypomanic episode
MUST have elevated, expansive, or irritable mood + 3 or > of the following
- Grandiosity
- Excessive involvement in pleasurable activities with high risk
- Pressured speech
- Flight of ideas, racing thoughts
- Distractibility
- Increased goal-directed activity
- Decreased need for sleep
Hypomania= sx > 4 days; limited dysfunction
Mixed= combination of depressive and manic symptoms
What is the diagnostic criteria for Bipolar I Disorder?
- At least one manic episode
- No need for a prior depressive episode
- More severe illness than Bipolar II and easier to diagnose
What is the diagnostic criteria for Bipolar II Disorder?
- At least one previous major depressive episode
- At least one hypomanic episode
- Less severe than BP I; difficult to diagnose
What is cyclothymia/ the diagnostic criteria for cyclothymic disorder?
- Fluctuating minor depressive, hypomanic episodes
- No prior major depressive, manic or mixed episodes
- Over 2 year period, no symptom free period >2 months
- After 2 years, Bipolar I or II may develop
What are the criteria for a Major Depressive Episode?
A. Five (or more) of the following symptoms have been present DURING THE SAME 2-WEEK PERIOD and represent a change from previous functioning; a. at least one of the symptoms is either:
Note: Do not include symptoms that are clearly attributable to another medical condition.
- Depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g., feels sad, empty, hopeless) or observation made by others (e.g., appears tearful). (Note: In children and adolescents, can be irritable mood.)
- Anhedonia: markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (as indicated by either subjective account or observation).
- Sleep: insomnia or hypersomnia nearly every day.
- Interest/ Anhedonia
- Guilt: feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about being sick).
- Energy: fatigue or loss of energy nearly every day.
- Cognition: siminished ability to think or concentrate, or indecisiveness, nearly every day (either by subjective account or as observed by others).
- Appetite: significant weight loss when not dieting or weight gain (e.g., a change of more than 5% of body weight in a month), or decrease or increase in appetite nearly every day.
- Note: In children, consider failure to make expected weight gain.
- Psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings of restlessness or being slowed down).
- Suicidal Ideation: recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide
B. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
C. The episode is not attributable to the physiological effects of a substance or to another medical condition.
What are the criteria for a major depressive disorder?
A. Five (or more) of the following symptoms have been present during the same 2-week period and represent a change from previous functioning; at least one of the symptoms is either:
- Depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g., feels sad, empty, hopeless) or observation made by others (e.g., appears tearful). (Note: In children and adolescents, can be irritable mood.)
- Anhedonia: markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (as indicated by either subjective account or observation).
- Sleep: insomnia or hypersomnia nearly every day.
- Interest/ Anhedonia
- Guilt: feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about being sick).
- Energy: fatigue or loss of energy nearly every day.
- Cognition: siminished ability to think or concentrate, or indecisiveness, nearly every day (either by subjective account or as observed by others).
- Appetite: significant weight loss when not dieting or weight gain (e.g., a change of more than 5% of body weight in a month), or decrease or increase in appetite nearly every day.
- Note: In children, consider failure to make expected weight gain.
- Psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings of restlessness or being slowed down).
- Suicidal Ideation: recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide.
Note: Do not include symptoms that are clearly attributable to another medical condition.
B. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
C. The episode is not attributable to the physiological effects of a substance or to another medical condition.
Note: Criteria A–C represent a major depressive episode.
D. The occurrence of the major depressive episode is not better explained by schizoaffective disorder, schizophrenia, schizophreniform disorder, delusional disorder, or other specified and unspecified schizophrenia spectrum and other psychotic disorders.
E. There has never been a manic episode or a hypomanic episode. a. —-Note: This exclusion does not apply if all of the manic-like or hypomanic-like episodes are substance-induced or are attributable to the physiological effects of another medical condition.
What is the difference between a major depressive episode and grief?
Note: Responses to a significant loss (e.g., bereavement, financial ruin, losses from a natural disaster, a serious medical illness or disability) may include the feelings of intense sadness, rumination about the loss, insomnia, poor appetite, and weight loss noted in Criterion A, which may resemble a depressive episode. b. Although such symptoms may be understandable or considered appropriate to the loss, the presence of a major depressive episode in addition to the normal response to a significant loss should also be carefully considered. i. If longer than 2 months→ treatment: CBT c. This decision inevitably requires the exercise of clinical judgment based on the individual’s history and the cultural norms for the expression of distress in the context of loss.
What are the symptoms associated with MDE?
Anxiety–very common
–> Obsessive rumination
–> Panic attacks
Somatization– fairly common
–> Body aches, pains
–> Headaches
–> GI distress
Psychosis- uncommon
–> hallucinations, delusions
–> Often requires specific treatment
Catania- uncommon
–> often requires specific treatment
In what population of patients are depressive disorders more common?
–> HOSPITALIZED PATIENTS. depressive disorders occur in up to 33% of hospitalized patients
–> MI PTS: myocardial infarction (MI) days immediately following the event and 3 to 4 months later
–> GERIATRIC PTS
–> CANCER PATIENTS
–> STROKE PATIENTS
–> PARKINSON’S DISEASE
List conditions associated with depression.
Thyroid abnormalities
Cortisol abnormalities
Parkinson’s disease
Multiple sclerosis
Epilepsy
Brain tumor
Cancer (i.e. pancreatic)
Dementia
Traumatic brain injury
Autoimmune disorders
Stroke
Huntington’s disease
Chronic infections
Certain medications:
- steroids
- interferon (esp. alpha-interferon treatment for Hep C)
- beta-blockers
- isotretinoin (Accutane)
- Oral contraceptives
What are the MDD/ MDE qualifiers?
Features of current episodes
- Atypical
- Melancholic
- Psychotic
- Catatonic
- Post-partum onset
- Chronic
- Mixed features (new with DSM-V)
Course specifiers
Clinical status
What is the prognosis for chronic/ recurrent depression?
- Untreated episodes generally last 4-6 months
- Risk of recurrent episode
- >/= 60% if 1 previous episodes
- >/= 70% if 2 previous episodes
- >/= 90% if 3 previous episodes
-Up to 46.7% of clinical cases may be chronic (> 2 years duration)
What is the diagnostic criteria for persistent depressive disorder?
Persistent Depressive Disorder = Chronic MDD + dysthymia
-Dysthymia
–> Depressed mood nearly every day for > 2 years
–> Associated with ≥ 2 of the following:
- (S) decreased or increased sleep
- (H) hopelessness
- (G) low self-esteem
- (E) low energy or fatigue
- (C) poor concentration or indecisiveness
- (A) decreased or increased appetite
–> No more than 2 months symptom free
List other depressive disorders beyond MDD and Persistent Depressive Disorder.
· Depression secondary to a general medical condition
· Substance-induced mood disorder
· Adjustment disorder with depressed mood
· Premenstrual dysphoric disorder
· Disruptive mood dysregulation disorder (<18 y/o)
· (Bereavement)
What is the prevalence of Major Depressive Disorder?
Lifetime (U.S.)= 17%
One year (U.S.)= 7%
One year (worldwide)= 3.2%
Women> Men (2:1)
Family history: increases risk 1.5 -3x –first-degree relative
Age of onset
- Can occur at nearly any time of life
- Median age of symptom onset= 30 years
- 6-8 year delay between symptom onset and treatment contact
What is the social impact of major depression?
What is the social impact of major depression?
Major depression is a leading cause of disability/burden of disease worldwide:
- # 1 cause of years lost due to disability
- # 3 contributor to overall burden of disease
- 2rd among 15-24 year olds, 4th among 18-65 year olds
63% of depressed patients have severely impaired quality of life2
- Depression worsens overall health care outcomes1,2
- Greater impact than angina, arthritis, asthma, or diabetes1
- Patients with depression are 2-4 times more likely to have an adverse health care outcome2
- Worsens health in patients with co-morbid medical conditions
Depression is associated with a doubling of overall health care costs
More than 60% of suicides occur in patients with depression
- 10th leading cause of death (all ages, genders)
- Only top 10 cause of death that continues to increase year to year
- Depression increases all-cause mortality: esp. cardiovascular disease, cancer, and diabetes
- Even when controlling for health habits and other clinical factors
What is the prevalence of dysthymia?
- Lifetime risk = 6%; point prevalence = 3%
- Equal male/female prevalence
- Age on onset similar to MDD
- Family history of MDD or dysthymia increases risk
- Often comorbid with personality disorders (mainly Clusters B and C)
- Chronic course; <10% remission per year
- Can respond to treatment – may need higher doses, longer duration of treatment
- Risk of suicide and disability is ≥ MDD
What is the prevalence of bipolar disorders?
Lifetime risk:
- Bipolar I Disorder: 1% (men = women)
- Bipolar II Disorder: 0.5% (women > men)
- Cyclothymia: 0.4%-1%
Age of onset late teens to early 20’s
Family history (1° relative with bipolar I):
- 10%-20% risk of bipolar I
- 1%-5% risk of bipolar II
- 10%-20% risk of MDD
What is the prevalence of treatment-resistant depression?
Treatment-resistant depression (TRD): 1%-3% prevalence
At least 20% of patients are significantly treatment resistant
What is the first line treatment for depression?
- Medications and/or psychotherapy are appropriate first-line tx for depression
- Medication + psychotherapy better than either alone
How long does it take get a response to depression treatments?
- Response can often take several weeks
- Initial treatment for depression often differs for unipolar (MDD) and bipolar depression
- 67% of patients do not remit with a single antidepressant medication
- 33% of patients do not remit with multiple treatments
- At least 20% of patients are significantly treatment resistant
- Successful treatment does not necessarily prevent recurrence
