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Flashcards in Mood Disorders Deck (63):
1

What is the essential feature of major depressive disorder?

a clinical course that is characterized by one or more major depressive episodes without a history of manic, mixed, or hypomanic episodes

2

What is criterion B for major depressive disorder?

not better accounted for by schizoaffective disorder, are not superimposed on schizophrenia, schizophreniform disorder, delusional disorder, or psychotic disorder NOS

3

If the full criteria are met for a major depressive episode, which specifiers may be used to describe the clinical status of the episode?

  • mild, moderate, severe without psychotic features
  • severe with psychotic features
  • chronic
  • with catatonic features
  • with melancholic features
  • with atypical features
  • with postpartum onset

4

If the full criteria for major mood episode are NOT currently met, which specifiers may be used to describe the current clinical status of the major depressive disorder?

  • in partial remission/in full remission
  • chronic
  • with catatonic features
  • with melancholic features
  • with atypical features
  • with postpartum onset

5

Which specifiers may be used to indicate the pattern of episodes and the presence of interepisode symptoms?

  • longitudinal course specifiers (with and without full interepisode recovery)
  • with seasonal pattern

6

What are associated descriptive features of major depressive disorder?

  • high mortality (15% w/severe commit suicide)
  • increase in death rates over 55
  • more pain and physical illness in medical settings
  • may be preceded by dysthymic disorder (10-25%)
  • co-occurs with substance disorders, panic disorder, OCD, anorexia, bulimia, borderline PD

7

Who are the people getting major depressive disorder?

  • twice as common in adolescent/adult females as males
  • atypical features more common in young patients
  • melancholic features more common in older patients

8

Does major depressive disorder generally get better or worse with age?

worse

  • episodes of remission last longer early in course of MDD
  • 60% with one episode will have another
  • 70% with two will have another
  • 90% with three will have another

9

What portion of people with MDD will experience remission of major depressive episodes?

about 2/3

The other third will experience partial remission or no remission at all.

10

A year after the diagnosis of major depressive disorder, what does the patient population look like with regard to symptoms?

  • 40% of individuals still have symptoms sufficiently severe to meet criteria for full major depressive episode
  • 20% continue to have some symptoms, but don't meet full criteria
  • 40% have no mood disorder

The severity of the first major depressive episode appears to predict persistence.

11

What other disorders might be confused with major depressive disorder?

  • mood disorder due to a general medical condition
  • substance-induced mood disorder
  • dysthymic disorder
  • schizoaffective disorder
  • schizophrenia/delusional disorder/psychotic NOS
  • dementia

12

What are the differences between major depressive disorder and dysthymic disorder?

differentiated by severity, chronicity, and persistence

MDD: Depressed mood must be present most of the day, nearly every day, for at least two weeks. 1+ discrete major depressive episodes, distinguished from person's major functioning.

Dysthymic: depressed mood must be present more days than not over period of two years. Chronic, less severe symptoms present for many years. Must have been present first for dual diagnosis.

13

What is the essential feature of dysthymic disorder?

a chronically depressed mood that occurs for most of the day more days than not for at least two years

14

What is the difference in dysthymic disorder diagnosis in children vs. adults?

Children only need to have depressed mood for one year, not two.

15

What is criterion B of dysthymic disorder?

presence, while depressed, of two or more of the following:

  1. poor appetite or overeating
  2. insomnia or hypersomnia
  3. low energy or fatigue
  4. low self-esteem
  5. poor concentration or difficulty making decisions
  6. feelings of hopelessness

16

What is criterion C for dysthymic disorder?

During the two-year period (1 for children/adolescents) of the disturbance, the person has never been without the symptoms in criterion A and B for more than two months at a time.

17

What is criterion D of dysthymic disorder?

No major depressive episode has been present during the first two years od the disturbance (1 for kids/ados); i.e., the distrubance isn;t better accounted for by chronic major depressive disorder or major depressive disorder in partial remission.

18

What is criterion E of dysthymic disorder?

There has never been a manic episode, a mixed episode, or a hypomanic episode, and the criteria have never been met for cyclothymic disorder.

19

What are criteria F and G of dysthymic disorder?

F. The disturbance does not occur exclusively during the course of a chronic psychotic disorder, such as schizophrenia or delusional disorder

G. The symptoms are not due to the direct physiological effects of a substance or general medical condition.

20

What is criterion H of dysthymic disorder?

The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

21

What are the specifiers for dysthymic disorder?

  • early onset (if before 21)
  • late onset (if 21 or older)
  • For most recent two years of dysthymic disorder, specify if "with atypical features"

22

What other disorder is frequently superimposed on dysthymic disorder?

major depressive disorder

  • this is often the reason patients with dysthymic disorder seek treatment
  • up to 75% of clinical patients with dysthymic disorder will develop MDD within five years

23

In children, do boys or girls get dysthimic disorder more?

They're both affected equally, and often result in impaired school performance and social interaction. Children and adolescents with dysthymic disorder are often cranky and irritable, as well as depressed.

24

In adulthood, do men or women develop dysthymic disorder more commonly?

women

Women are two to three times more likely to develop dysthymic disorder than men.

25

How can dysthymic disorder be differentiated from major depressive disorder?

  • onset: which one came first
  • duration: DD must last at least two years
  • severity: DD is generally less severe
  • persistence: DD is fairly chronic, not discrete mood episodes like in MDD

26

How can dysthymic disorder be distinguished from the mood symptoms that accompany psychotic disorders?

A separate diagnosis of dysthymic disorder is not made if the mood symptoms only occur during the course of the psychotic disorder (including residual phases).

27

How can dysthymic disorder be differentiated from the personality disorders?

it doesn't have to be

Dysthymic disorder is commonly associated with borderline, histrionic, narcissistic, avoidant, and dependent personality disorders, but they can coexist and both diagnoses can be made.

28

What is the essential feature of bipolar I disorder?

A clinical course that is characterized by the occurrence of one or more manic episodes or mixed episodes. Often individuals have also had one or more major depressive episodes.

29

In addition to the essential feature of bipolar I disorder, what are other requirements for diagnosis?

  • not substance-induced or due to a general medical condition
  • not better accounted for by schizoaffective disorder and are not superimposed on schizophrenia, schizophreniform, delusional disorder, or psychotic disorder NOS.

30

Bipolar I disorder is subclassified in the fourth digit of the code according to whether the individual is experiencing a _______ or whether the disorder is _______.

first episode; recurrent

31

How is recurrence indicated in bipolar I disorder?

either:

  • a shift in the polarity of the episode OR
  • an interval between episodes of at least two months without manic symptoms

32

With regard to bipolar I disorder, how is polarity shift defined?

a clinical course in which a major depressive episode evolves into a manic episode or a mixed episode, or in which a manic episode or mixed episode evolves into a major depressive episode

A manic that turns into mixed (or vice-versa) is still considered only one episode.

33

If the full criteria for manic/mixed/major depressive episode are currently met within bipolar I disorder, what three specifiers may be used?

  1. mild, moderate, severe without psychotic features/severe with psychotic features
  2. with catatonic features
  3. with postpartum onset

34

If the full criteria for manic, mixed, or major depressive disorder are NOT currently met within bipolar I disorder, what three specifiers may be used?

  1. in partial remission/in full remission
  2. with catatonic features
  3. with postpartum onset

These specifiers describe the current clinical state and the features of the most recent episode.

35

If the criteria for major depressive episode is currently met (or if they're not currently met but the last episode was major depressive) within bipolar I disorder, what three specifiers may be used?

  1. chronic
  2. with melancholic features
  3. with atypical features

36

What bipolar I specifiers can be used to indicate the pattern of episodes?

  1. longitudinal course specifiers (with and without full interepisode recovery)
  2. with seasonal pattern (note: applies only to the pattern of major depressive episodes)
  3. with rapid cycling

37

What are some associated features of bipolar I disorder?

In depressive or mixed state:

  • suicidal ideation and attempts

In manic state (or with psychotic features):

  • child abuse, spouse abuse, other violent behavior

In general:

  • alcohol/substance abuse
  • associated w/anorexia, bulimia, AD/HD, panic disorder, social phobia

38

What are the gender differences in bipolar I disorder?

While both males and females get bipolar I equally, the difference lies in the number and type of manic and major depressive episodes.
  • in males, first episode more likely to be manic
  • in females, first episode likely to be major depressive
  • in men, number of manic episodes equals or exceeds major depressive episodes
  • in women, major depressive episodes predominate
  • rapid cycling more common in women

39

What are some characteristics of the course of bipolar I disorder?

  • 60-70% of manic episodes immediately precede or follow major depressive episodes
  • number of lifetime episodes is greater than recurrent major depressive disorder
  • average of four episodes occurring in 10 year span
  • interval between episodes decreases with age
  • rapid cycling pattern is associated with poor prognosis

40

How can bipolar I disorder be differentiated from major depressive disorder or dysthymic disorder?

Bipolar I disorder includes at least one manic or mixed episode.

41

How can bipolar I disorder be differentiated from bipolar II disorder?

Bipolar I disorder must include one or more manic or mixed episodes. If someone with bipolar II disorder has a manic or mixed episode, the diagnosis is changed to bipolar I disorder.

42

How can bipolar I disorder be differentiated from cyclothymic disorder?

Cyclothymic disorder has numerous periods of hypomanic symptoms that do not meet criteria for manic episodes and depressive symptoms that do not meet criteria for major depressive episodes. Bipolar I must have at least one manic or mixed episode.

43

How can bipolar I disorder be differentiated from psychotic disorders?

psychotic disorders are characterized by periods of psychotic symptoms that occur in the absence of prominent mood symptoms.

44

When would one use the diagnosis Bipolar Disorder Not Otherwise Specified?

if there is a very rapid alternation (over days) between manic symptoms and depressive symptoms that do not meet minimal duration criteria for a manic or major depressive episode

45

What is the essential feature of bipolar II disorder?

a clinical course that is characterized by the occurrence of one or more depressive episodes accompanied by at least one hypomanic episode

46

If a patient has major depressive episodes and hypomanic episodes, then has a manic or mixed episode, can it be diagnosed as bipolar II disorder?

no

A manic or mixed episode automatically precludes the diagnosis of bipolar II disorder (criterion C).

47

What are criteria D and E of bipolar II disorder?

D. Not better accounted for by schizoaffective disorder and are not superimposed on schizophrenia, schizophreniform, delusional disorder, or psychotic disorder NOS.

E. Symptoms must cause clinically significant distress or impairment in social, occupational, or other functioning.

48

What specifiers are used in bipolar II disorder to indicate the nature of the current or most recent episide?

  1. hypomanic
  2. depressed

49

What specifiers may be used in bipolar II disorder if the full criteria are currently met  for major depressive episode?

  1. mild, moderate, severe without psychotic features/severe with psychotic features
  2. chronic
  3. with catatonic features
  4. with melancholic features
  5. with atypical features
  6. with postpartum onset

50

If the full criteria for hypomanic or major depressive episode are not currently met, what bipolar II disorder specifiers can be used to describe the current clinical status?

  1. in partial remission/in full remission
  2. chronic
  3. with catatonic features
  4. with melancholic features
  5. with atypical features
  6. with postpartum onset

51

What specifiers are used in bipolar II disorder to indicate the pattern or frequency of episodes?

  1. longitudinal course specifiers (with and without interepisode recovery)
  2. with seasonal pattern
  3. with rapid cycling

52

What other mental disorders are associated with bipolar II disorder?

  • substance abuse/dependence
  • anorexia/bulimia
  • AD/HD
  • panic disorder
  • social phobia
  • borderline personality disorder

53

Does the course of bipolar II disorder differ markedly from the course of bipolar I disorder?

no

The exception is the symptoms, as bipolar II is depressive/hypomanic and bipolart I is manic or mixed and possible major depressive episodes.

54

How can bipolar II disorder be differentiated from major depressive disorder?

If there is at least one hypomanic episode during the individual's lifetime, it can't be major depressive disorder.

55

How can bipolar II disorder be differentiated from bipolar I disorder?

If there is the presence of a manic or mixed episode, the diagnosis of bipolar II disorder must be changed to bipolar I disorder.

56

How can bipolar II disorder be differentiated from cyclothymic disorder?

Bipolar II disorder must have at least one major depressive episode, and cyclothymic disorder has symptoms that do not meet criteria for major depressive episodes.

57

What is the essential feature of cyclothymic disorder?

a chronic, fluctuating mood disturbance involving numerous periods of hypomanic symptoms and numerous periods of depressive symptoms lasting at least two years.

58

What is criterion B for cyclothymic disorder?

B. during the initial two-year period, the person has not been without the symptoms in criterion A for more than two months at a time.

59

What is criterion C for cyclothymic disorder?

C. No major depressive, manic, or mixed episode has been present in first two years of the disturbance

After initial two years (one year in children/adolescents), there may be superimposed manic/mixed episodes (bipolar I) or major depressive episodes (bipolar II), resulting in both diagnoses.

60

What are criteria D, E, and F for cyclothymic disorder?

D. not schizoaffective disorder, not superimposed on schizophrenia, schizophreniform, delusional disorder, or psych NOS

E. Not substance/general medical condition

F. cause clinically significant distress or impairment in social, occupational, or other areas of functioning

61

What is the likelihood that cyclothymic disorder will subsequently result in bipolar I or II disorder?

15-50%

62

How can cyclothymic disorder be differentiated from bipolar I or II disorder?

The mood symptoms in cyclothymic disorder are subthreshold for major depressive, manic, or mixed episodes.

63

How can cyclothymic disorder be differentiated from borderline personality disorder?

it doesn't need to be

Both cyclothymic disorder and borderline personality disorder can be diagnosed in the same individual.