Flashcards in Module 2 Mood Disorders Deck (46):
Common features of mood disorder
presence of sad, empty, or irritable mood accompanied by somatic and cognitive changes that significantly affect the person's ability to function
What symptoms may indicate hospitalization?
assess for suicide or homicide, not eating, no shelter, basic needs not being met, history of rapidly progressing symptoms in past, significant rupture of usual support system; unable to make decision to go to hospital voluntarily
What is the core feature of disruptive mood dysregulation disorder?
chronic, severe persistent irritability
What are the age criteria for diagnosis of disruptive mood dysregulation disorder?
Do not diagnose before the age of 6 or after the age of 18 and the onset must occur before age 10
What are the frequency criteria for diagnosing mood dysregulation disorder?
occur frequently (3x/week) over the past year in at least 2 settings and be devleopmentally inappropriate
What is significant about the type of irritability that occurs with mood dysregulation disorder?
irritable mood is present between severe temper outbursts
What is significant about the treatment of disruptive mood dysregulation disorder?
individualized to the needs of the child and his or her family
What are the 2 criteria that must be present to diagnose Major Depressive Disorder?
Must have either depressed mood or loss of interest or pleasure and must be a change from previous functioning
What is the prevalence of major depressive disorder in the US among adults?
18-29 year olds have a 3x higher prevalence than 60 year olds
What is the pneumonic SIGECAPS used for?
What does the pneumonic SIGECAPS stand for?
S-leep changes; I-Interest (loss); G-uilt (worthless); E-nergy (lack of); C-ognition/ oncentration (reduced); A-ppetite (weight loss or change); P-sychomotor (agitation with anxiety or retardation with lethargy); S-uicide/death preoccupation
What are some key things to remember when diagnosing major depressive disorder?
consider laboratory testing and assess for suicide
What things are used for treatment of major depression?
psychotherapy, vagal nerve stimulation, transcranial magnetic stimulation, phototherapy, and sleep deprivation; Meds- SSRI's; SNRI's; MAOI's; TCA's; Atypical antidepressants; hybrids
What is the other term for persistent depressive disorder?
What is the key piece of criteria for dysthymia?
Individuals whose symptoms meet MDD criteria for 2 years should be given a diagnosis of persistent depressive disorder as well as major depressive disorder
What questions should be asked before treating dysthymia?
Is this treatment resistant depression or personality disorder or truly dysthymia?
What is a key treatment consideration for patients with dysthymia?
ask the patient how they feel about where they are at. Be aware of your own hidden agenda and make sure you are meeting the patient's goals and not your own
What are the 3 main criteria for premenstrual dysphoric disorder?
1. Occurs in the majority of menstrual cycles 2. 5 symptoms are present in the final week of menses 3. symptoms improve within a few days after the onset of menses and becomes minimal or absent in the week after menses
What are the key points to consider when diagnosing Premenstrual Dysphoric Disorder?
Consider having a patient keep a journal and consider lab testing especially CBC, TSH and FSH.
What is the treatment for premenstrual dysphoric disorder?
Exercise, relaxation, CBT; may consider vitamins but no solid evidence this helps; SSRIs, benzoiazepines, combined oral contraceptives (may refer to PCP or OBGYN for this; referral for medical or surgical oophorectomy to OBGYN if all else fails
What are common medications involved with Substance/Medication-Induced Depressive Disorder?
stimulants, steroids, L-dopa, antibiotics, CNS drugs, dermatological agents, chemotherapeutic drugs, immunologic agents, antivirals, etc......
What are common causes of depressive disorder due to another medical condition?
often are diseases of the brain: stroke, Huntingtons disease, Parkinson's disease, TBI, Cushing's disease, hypothyroidism, possibly MS
What is the treatment for depressie disorder due to another medical condition?
make appropriate referrals, treat depression as normal but make sure to consider the medical factors that could be impacting the treatment
What qualifies as an "other specified depressive disorder?
recurrent brief depression, insufficient symptoms, or short duration episode
What are the key criteria for Bipolar I disorder?
must meet the criteria for a manic episode, manic episode may have been preceded by and may be folowed by a hypomanic or major depressive episode
What does the pneumonic DIGFAST measure?
What does the pneumonic DIGFAST stand for?
D-istractability; I-ndiscretion; G-randiosity; F-light of Ideas; A-ctivity increase; S-leep deficit; T-alkativeness
Suicide rate for Bipolar I
15 times higher than general population
What meds are most commonly used for Bipolar I disorder?
Lithium carbonate, valproate, carbamazepine
What is the normal serum lithium range?
What is the normal serum valproic acid range?
What is the normal serum carbamazepine level?
What is the dosage range for valproate?
What is the normal dosage range for carbamazepine?
What is the typical treatment for acute bipolar depression?
Antidepressant and mood stabilizer or atypical antipsychotics
What medication is helpful with depression in bipolar I disorder but not help with acute manic episode and can also be used as maintenance?
What are the key criteria for Bipolar II disorder?
must have hypomanic episode and major depressive episode: there has NEVER been a manic episode
What percentage of those with Bipolar II have substance use disorder?
What fraction of those with bipolar have attempted suicide?
What is the treatment for Bipolar II disorder?
Same as bipolar I
How long should symptoms be present in adults with cyclothymic disorder?
How long should symptoms be present in children under 18 with cyclothymic disorder
WHat are the criteria for cyclothymic disorder?
numerous periods with hypomanic symptoms that do not meet criteria for hypomanic episode and numerous periods with depressive symptoms that do not meet criteria for a major depressive episode; there are symptoms at least half of the time but not without symptoms for more than 2 months
What is done with cyclothymic disorder diagnosis if another disorder develops?
Cyclothymic disorder diagnosis is dropped even if new diagnosis is MDD
What is first line drug treatment for cyclothymic disorder?
carbamazepine and valproic acid