Mood Disorders Flashcards by Tim Horrocks

What disorders is a major depressive episode involved with? With which is it a necessary part of diagnosis?


Isabuildingblock:

Necessaryfordiagnosisof:

MajorDepressiveDisorder(MDD)

BipolarIIdisorder

AlwayspartofBipolarIDisorder

Butnotnecessaryforthediagnosis

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What are the qualifications for a diagnosis of a major depressive episode ?


Fiveormoreofthefollowingsymptomshavebeenpresent,moredaysthat not,forATLEASTa2‐weeks: One of the first two must be present. 

Depressedmood

Diminishedinterestorpleasure

Weightlossorgain

Insomniaorhypersomnia

Psychomotoragitationorretardation(observablebyothers)

Lowenergyorfatigue

Feelingsofworthlessnessorguilt(excessiveorinappropriate/delusional)

Poorconcentrationorindecisiveness

Recurrentthoughtsofdeathorsuicidality


NotaMixedepisode(i.e.nocoexistingmanicsymptoms)

Theepisodemustcausedistressorsocial/occupationalimpairment

Notduetosubstanceuse,medicalcondition,orbereavement

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What are some examples of emotional/cognitive symptoms of MDE? Neurovegetative ones?


MDEcanbecharacterizedbyacombinationof:

Emotonal /cognitivesymptoms,example:

Depressedmood

Anhedonia

Hoplessness

SlowedThinking/PoorAttention(Memory)

Suicidality


Neurovegitative symptoms,example:

Sleep(mostlypoor,butcouldbebidirectional)

Appetite(mostlypoor,butcouldbebidirectional)

Energy(lossof,unidirectional)

Slowedmovements,stoopedpostures,lossofgesturing

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How is a major depressive disorder diagnosed? What are two types? What is the difference?


AtleastoneMDE

NohistoryofMixedorManicorHypomanic episode

MDD,singleepisode vs recurrenttype

InordertohaverecurrentMDD,theindividualmusthave
twoMDEseparatedbyatleast2months
offullrecovery.

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What are the qualifications for a diagnosis of dythymic disorder? What is double depression?


Depressedmood,moredaysthannot,foratleast2year

Children/Adolesents:depressed
OR
irritable moodforatleast1year.

Neversymptom‐freeformorethan2months

Atleast2ormoreassociatedsymptomswhiledepressed:
 Poorappetiteorovereating
 Insomniaorhypersomnia
 Lowenergyorfatigue
 Lowself‐esteem
 Poorconcentrationordifficultymakingdecisions
 Feelingsofhopelessness

NoMDEsduringtheinitial2yearperiod(otherwise–>MDD)

“doubledepression”
ifDysthymic disorderisfollowedbyMDE

NoHistoryofMania,Hypomania,Mixed episodeorCyclothymia

NointhecourseofChronicPsychoticDisorder(Schizophrenia)

Theepisodemustcausedistressorsocial/occupationalimpairment

Notduetoasubstanceuseormedicalcondition

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What is Depressive Disorder NOS? What are some examples?


PremenstrualDysphoric Disorder
 Markeddepression/anxiety,Affectivelability,Decreaseinterest
 Mostmenstrualcyclesforthepast12months
 Sx startduringthelastweekoftheluteal phase
 Absentforatleast1weekpostmenses

MinorDepressiveDisorder
 Depressionforatleast2weeks
 Fewerthan5symptomsofMDE

Recurrentbriefdepressivedisorder
 AllsymptomsofMDE
 >2days,but<2weeks
 Atleastoncepermonthoverthelastyear

PostpsychoticdepressivedisorderofSchizophrenia(residual)

MDEsuperimposedonDelusionalDisorder,activephaseofSchizophreniaorPsychosisNOS

Ifcliniciancannotdeterminetheifthedepressionisprimary,duetoGMCorSubstance Induced.

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What are the qualifications for a manic episode?

Adistinctperiodofabnormallyorpersistentlyelevated,expansive,orirritable mood,lastingatleast1weekwith>3(4ifmoodisirritable)ofthefollowing

Inflatedself‐esteemorgrandiosity

Decreasedneedforsleep

Moretalkativeorpressuredtokeeptalking

Flightofideasorracingthoughts(subjective)

Distractibility

Increasedgoal‐directedactivityorpsychomotoragitation

Excessiveinvolvementinpleasurableactivitiesthathavehighpotentialforpainful consequences(buyingsprees,sexualindiscretion,foolishinvestments)

Ifhospitalizationisnecessary, Anydurationissufficient

Theepisodemustcausedistressorsocial/occupationalimpairment

Notduetoasubstanceuse(includingsomatictx fordepression)ormedical condition

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What are the criteria for a mixed episode?


Criteriaaremetconcomitantly for:

ManicEpisode

MajorDepressiveEpisode(excepttheduration)

Theepisodemustcausedistressorsocial/occupational
impairment

Notduetoasubstanceuse(includingsomatictx for
depression)ormedicalcondition

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What are the criteria for a hypomanic episode?


Distinctperiodofelevated,expansive,orirritablemood
thatincludesatleast3(4ifmoodisirritable)symptoms
of
includedinthemanicepisode


Atleastfor4days

Unequivocalchangeinfunctioning

Nomarkedimpairmentinsocial/occupationalfunctioning

Nopsychoticfeatures

Doesnotrequirehospitalization

Notduetoasubstanceuse(includingsomatictx for
depression)ormedicalcondition

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What is the criteria for a diagnosis of Bipolar type I


ClassicManic
‐
DepressiveDisorder

Bydefinition,inordertoreceivediagnosisofbipolarIyou
MUSThaveexperiencedatleast
oneManic
or
Mixed
episode

MostindividualswithbipolardisorderhaveseveralMajor
DepressiveEpisodesprecedingtheirfirstManicorMixed
episode

MDEisnotneededforthediagnosis

NotaccountedforbySchizoaffectived/oandnot
superimposedonotherprimarypsychoticdisorders.

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What is the avg. age of onset for bipolar illness? What is they’re over 45? What is the course of illness like compared to MDD? How so? What is the initial episode normally like? What is the gender prevalence like?


Lifetimeprevalence~1
‐
2%

Averageageofonsetforbipolarillness=30y.o.


FirstonsetManicsympomts >age45
1rstthinkorganic etiology

lifecourseofillnessinbipolarIisgenerallyworsethan unipolar depression

Moredysfunctionandlifedisruption

Moreassociationwithsubstanceuse

MoreAttemptedandCompletedsuicides

Initialepisodemostcommonlyadepressiveone

NOsexdifferenceinprevalence(exceptforrapidcycling subtype)

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What are the criteria for Bipolar type II?


HistoryofoneormoreMajorDepressiveEpisodesAND at
leastoneHypomanic Episode

NohistoryofpriorManicorMixedMoodepisode

NotaccountedforbySchizoaffectived/oandnot
superimposedotherprimarypsychoticdisorders

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What are the criteria for cyclothymia?


Foratleasttwoyears(1yearfor<18y.o.)

IffollowedbyManicepisdoe

Cyclothymia
and
BPDI

IffollowedbyMDE

Cyclothymia
and
?

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What are 9 types of mood specifiers?


Severity:Mild,ModerateandSevere(MDE,Manicor
Mixedepisodes)

Chronic(MDE>2years)

MelancholicFeatures(MDE)

AtypicalFeatures(MDE&Dysthymia)

CatatonicFeatures(MDE,ManicorMixedepisodes)

PsychoticFeatures(MDE,ManicorMixedepisodes)

Post
‐
partumonset(MDE,ManicorMixedepisode)

Rapidcycling(BipolarIorII)

Seasonalpattern(MDEinMDDinBPI&II)

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What are melancholic features a specifier for? What are the criteria that need to be met for it? What is an implication for treatment?


OnlyforMDE(MDD,BipolarIorII)

Oneofthefollowing:

Completelossofpleasure

Lackofreactivitytousuallypleasurableactivities

Threeormoreofthefollowing:

Depressionisworseinthemorning

Distinctqualityofdepressedmood

Earlymorningawakening(atleast2hr)

Markedpsychomotorretardationoragitation

Significantanorexiaorweightloss

Excessiveinappropriateguilt

Responds better to ECT.

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What are atypical features a specifier for? What are the criteria that need to be met for it? What is the preferential treatment?

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
CanbeusetodescribeMDEofMDD,BipolarIorII.Italso
canbeusedasaspecifier forDysthymic d/o

Preservedmoodreactivityandtwoormoreof:

Hypersomnia

Hyperphagia

Leadenparalysis

Long‐standingpatternofinterpersonalrejectionsensitivity

MaypreferentiallyrespondtotreatmentwithMAOI’s

What are catatonic features a specifier for? When is it most commonly seen? What are the criteria that need to be met for it? What is the preferential treatment?

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
Canbeuseasaspecifier todescribeMDE(inMDDorBP),
ManicorMixedepisode

Twoofthefollowing:

Catalepsy(immobility/waxyflexibility)orStupor

Excessiveandpurposelessactivity

Extremenegativismormutisim

Peculiarityofmovements:posturing,stereotyped
movements,prominentmannerismorgrimacing

MostcommonlyseenwithBipolarDepression

ECT

What are psychotic features a specifier for? What are the criteria that need to be met for it? What is the preferential treatment?

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
Canbeuseasaspecifier todescribeMDE,ManicorMixed episode

Psychotic vs.nonpsychoticdepression
mayrepresentdistinctlydifferentdisordersintheir
pathogenesis

Shouldbedescribedas:

moodcongruent

voicestellingthepersontheyareworthless

moodincongruent

afixedbelievethataliensfromMars….

Moodincongruentpsychoticsymptomscouldsuggestthe possibilityofaprimarypsychoticillness

Areassociatedwithpoorerprognosis

Psychoticsymptomindepressionwarranttreatmentwith BOTHanantidepressantANDanantipsychoticand/orECT

What is rapid cycling a specifier for? What are the criteria? What is the preferenctial treatment? Who is it more common in?

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
MusthaveBipolarIorII

Musthaveatleast4separatemoodepisodeswithinthe
previous12months(MDE,Manic,MixedorHypomanic)

DOESNOTappeartoruninfamilies

Valproic AcidandCarbamezapine maybesuperiorin
treatingrapidcycling(lithiumisineffective)

Morecommoninyoungfemales

What is seasonal pattern a specifier for? What is it like? What are the criteria? What is a possible treatment? When can it be risky?

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AppliestotheMDEofRecurrentMDD,bipolarI&II

MDEsatadistincttimeoftheyear(fallandwinter)

Fullremission(ormanic/mixed/hypomanic episodes)
occuratadistincttimeoftheyear(spring)

Patternshouldoccurforatleast2years

CommonlyreferredtoasSAD=SeasonalAffective
Disorder

TheMDEarelikelytorespondtolighttherapy(Riskfor
“Switching”ifBipolard/o)

Waht is mood disorder due to a general condition? How should it be treated?

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
Moodsymptomsarebelievedtobethedirect
physiologicalconsequence ofageneralmedicalcondition

History,PhysicalExamand/orLaboratoryfindings

Notanadjustmentd/o(stressofmedicalillness)

NotDelirium

Ingeneralshouldtreatmoodwithpsychotropicand/or
psychotherapyinadditiontotreatingtheprimarymedical
problems(ex,hypothyroidism

What is a substance induced mood disorder?

Study These Flashcards


Substanceuse(orwithdrawalfrom)musthaveoccurred
withinONEMONTHofthemoodsymptoms

Mooddisorderbelievedtobeetiologicallylinkedtothe
substanceuse

examplesinclude:

Mania:corticosteroids,cocaine,amphetamines

Depression:Beta‐blockers,Reserpine,cocaine[withdrawal]
alcohol)

Thedisturbanceisnotaccountedforbyanongoing
primarymood

Nodelirium

What is serotonin made from? What does it dwell in the brain? How is its action terminated? How do suicidal patients differ in respect to 5HT? What effect do SSRIs have? Ecstasy?

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
Essentialaa Tryptophan

CellbodiesinMedianandDorsalRaphe nuclei(Pons)

ActionterminationbyreuptakeorMAO‐A


Suicidalpatientsdemonstrate:

lowCSFmetabolitesofserotonin

lowconcentrationofserotoninuptakesitesonplatelets.

SSRIs(ex:fluoxitine)blocksreuptake and ↑5HTinsynaptic cleft

Ecstacy (MDMA):Blocksreuptake&↑ thereleaseof5HT

Where does dopamine originate in the brain? What do misostriatal areas control? Misolimbic? Mesocortical? Tuberoinfundibular? How is the action of DA terminated? What effect does amphetamine have? Cocaine? reserpine? Parkinsons?

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
OriginateformtheVentralTegmental area(MidBrain)

Misostriatal (movements)

Misolimbic(reward,hallucination)

Mesocortical (neurocognitive)

Tuberoinfundular

ActionterminationMAO‐BandCOMT

Amphtamine

increaserelease(improvemood,mania)

Cocaine

stimulaterelease/blocksreuptake(mania)

Reserpine

depletesDA(depression&amp;movementd/o)

Parkinson'sdiseases

(depressionandmovementd/o)

Where are the cell bodies associated with NE located? How is its action terminated? What happens in depressed subjects? What supports its role in depression?

```  Cell bodies in Locus Ceruleus (upper Pons)  Action termination by reuptake MAO ‐ A and COMT  Upregulation of post ‐ synaptic adrenergic receptors occur in depressed subjects  NE modulating antidepressant drugs(desipramine) strongly support the important role of NE in depression  The antidepressent Mirtazapine Blocks α2 presynaptic receptor↑ release NE&5HT ```

What plays a central role in regulation of neuroendocrine functioning? What are 3 major neuroendocrine dysfunctional axes that are affected by mood disorders?

 The hypothalamus plays a central role in regulation of neuroendocrine functioning and receives neuronal (5HT,Dopamine,NE, Acetylcholine, Histamines)  The neuroendocrine abnormalities seen in mood disorders likely represent an underlying larger brain dysregulation.  The major neuroendocrine dysfunctional axes affected by mood disorders:  Adrenal axis  Thyroid axis  Growth hormone axis.

How is the adrenal system associated with depression? What is a test for this? In what ways is it useful/not? What effect can prednisone have?

 Hypersecretion of cortisol and depression(long known association)  Dexamethasone suppression test  NOT useful as a diagnostic tool(highly specific, but not sensitive)  May be predictive of likelihood of relapse  On the other hand prednisone (synthetic corticosteroid) can induce mania/hypomnia is susceptible individuals

What is the association between the thyroid axis and depression? How does it work? How can this be used for treatment? How does this relate to mania?

 All new cases of depression should screened for thyroid problems  1/3 depressed individuals with normal thyroid function have a blunted release of TSH (thyrotropin) by the pituitary to the administration of TRH.  Similar abnormalities of TSH blunting have been noted in other psychiatric disorders  Liothyronine(T3) used to augment antidepressent tx  thyrotoxicosis can mimic a Manic presentation

Describe the cognitive theory?

```  Originally proposed by Aaron Beck.  Automatic Thoughts  causes sadness/anxiety/irritibility  Cognitive Distortions:  All‐or‐Nothing Thinking  Fortune Telling(catastrophizing)  Emotional Reasoning  Mind Reading, etc.  Negative Core beliefs:  trust others (the world is a hostel to me)  control myself or environment (things will never change)  Self esteem (I am an ineffective person)  The therapist will try to help the patient be aware of cognitive distortion and challenge Automatic Thoughts (early on) resulting in reduce symptoms. ```

Describe the behavioral model.

 Learned Helplessness  Animal model: rats given sequential electric shocks eventually make no attempt to escape and stop eating  Adaptive and Maladaptive Behaviors  Is anything reinforcing a maladaptive behavior?(Operant Conditioning)  Is there anything that extinguishes a desired behavior?(Classical)  Is there an association between a behavior and environmental cue that initiate the behavior?(Classical Conditioning)  Ex: Therapist attempting to treat depression by teaching the patient to perceive some control over her/his environment

What is the stress diathesis model? What are some events that predict depression later in like? What events are most likely followed by depression? What is kindling?

 Stress‐Diathesis model = Vulnerbility (Genetics and/or psychological)  Event that predicts development of depression later in life:  loss of a parent before the age of 11  Neglect in infancy  Sexual abuse  Event most likely to be followed by depression:  Loss of a Significant Other  Death of close relative  Victim of assault  Marital problems(serious)  Dealing with separation or divorce  Loss of job / financial stressors/ Loss of housing/legal problems/ poor support system  Kindling (easier to relapse with less or no stress)  May represent changes in the function of neurotransmitter Circuits or intraneuronal signaling mechanisms

Mood Disorders Flashcards

(31 cards)