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Flashcards in mood disorders Deck (36):
1

mood disorder overview

Major Depressive Disorder
Persistent Depressive Disorder
Premenstrual Dysphoric Disorder
Bipolar I Disorder
Bipolar II Disorder
Cyclothymic Disorder

2

MDD prevalence

approximately 7%
-18- to 29-year-old individuals >>> age 60 years or older
-Females experience 1.5- to 3-fold higher rates than males

3

Causes of Depression

-The biopsychosocial model
-Monoamine Hypothesis: due to deficiency of monoamines: serotonin, dopamine, NE
-Diathesis-Stress/Dual-Risk Model

4

MDD dx criteria:
*5 (or more) 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 (1) depressed mood or (2) loss of interest or pleasure

*Depressed mood
*Anhedonia – loss of interest or pleasure in all, or almost all, activities
-Significant weight change (loss when not dieting or weight gain)
-Insomnia or hypersomnia
-Psychomotor agitation or retardation
-Fatigue or loss of energy nearly every day.
-Feelings of worthlessness or excessive or inappropriate guilt
-Diminished ability to think or concentrate, or indecisiveness
-Recurrent suicidal thoughts


5

MDD criteria acronym

SIG E CAPS
Suicidal thoughts
Interests decreased
Guilt
Energy decreased
Concentration decreased
Appetite disturbance (increased or decreased)
Psychomotor changes (agitation or retardation)
Sleep disturbance (increased or decreased)

6

MDD subtypes

-With mood-congruent psychotic features
-With mood-incongruent psychotic features
-With catatonia
-With peripartum onset
-With seasonal pattern

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MDD With peripartum onset

if full criteria are not currently met for a major depressive episode, most recent episode of major depression if onset of mood symptoms *occurs during pregnancy or in the 4 weeks following delivery*

8

MDD With seasonal pattern
(DSM – IV Seasonal Affective Disorder)

onset and remission of major depressive episodes certain time of year
Most episodes begin in fall or water and remit in spring

9

MDD dx

-Hamilton Rating Scale for Depression
-Beck Depression Inventory

10

Persistent Depressive Disorder Prevalence

2%

11

Persistent Depressive Disorder Criteria timeline
(DSM-IV dysthymic disorder)

Depressed mood for most of the day, for more days than not, as indicated by either subjective account or observation by others, for *at least 2 years*
Note: In children and adolescents >1 year.


12

Persistent Depressive Disorder Criteria
(DSM-IV dysthymic disorder)
2 (or more) of the following:

-Poor appetite or overeating.
-Insomnia or hypersomnia.
-Low energy or fatigue
-Low self-esteem
-Poor concentration
-Feelings of hopelessness.

13

more Persistent Depressive Disorder Diagnostic Criteria

During the 2-year period (1 year for children or adolescents) of the disturbance, the individual has never been without the symptoms in Criteria A and B for more than *2 months at a time*.
-Criteria for MDD may be continuously present for 2 years.
-There has never been a manic episode or a hypomanic episode, and criteria have never been met for cyclothymic disorder

14

MDD/PDD tx: meds

Psychotropic medications:
SSRI – selective serotonin reuptake inhibitor – fluoxetine, sertraline
SNRI – serotonin norepinephrine reuptake inhibitor – venlafaxine, duloxetine
NDRI – norepinephrine and dopamine reuptake inhibitor – bupropion

15

MDD/PDD tx: therapy

CBT – Cognitive Behavioral Therapy
Psychodynamic Therapy
Interpersonal Therapy

16

Premenstrual Dysphoric Disorder Prevalence
most common symptom??

Twelve-month prevalence of premenstrual dysphoric disorder is between 1.8% and 5.8% of menstruating women
-irritability.

17

PMDD dx criteria:
For most menstrual cycles during the past year, at least *5 of the following 11 symptoms* (including at least 1 of the first 4 listed) were present:

-Markedly depressed mood, feelings of hopelessness, or self-deprecating thoughts
-Marked anxiety, tension, feelings of being “keyed up” or “on edge”
-Marked affective lability (eg, feeling suddenly sad or tearful or experiencing increased sensitivity to rejection)
-Persistent and marked anger or irritability or increased interpersonal conflicts
-Decreased interest in usual activities
-Subjective sense of difficulty in concentrating



18

PMDD dx criteria symptoms part 2

-Lethargy, easy fatigability, or marked lack of energy
-Marked change in appetite, overeating, or specific food cravings
-Hypersomnia or insomnia
-A subjective sense of being overwhelmed or out of control
-Other physical symptoms, such as breast tenderness or swelling, headaches, joint or muscle pain, a sensation of bloating, or weight gain

19

PMDD symptoms must have been present ??

present for most of the time during the last week of the luteal phase, must have begun to remit within a few days of the onset of menstrual flow, and must be absent in the week after menses.

20

PMDD tx

Hormone therapy: OCTs, Estrogen, GnRH agonists

-Anti-depressant – can be just for the course of the symptoms

21

Bipolar disorder causes

Genetics
-Structural MRI: Increase in *volume of the lateral ventricles, globus pallidus*
-Functional MRI: abnormal modulation between *ventral prefrontal and limbic regions – amygdala*
-Kindling Hypothesis
-Early life stress and dysfunction of *HPA axis*, leads to overactivation

22

Bipolar I disorder dx criteria

-it is necessary to meet the following criteria for a manic episode.
-The manic episode may have been preceded by and may be followed by hypomanic or major depressive episodes.

23

Manic Episode

persistently elevated, expansive, or irritable mood and abnormally and persistently increased goal-directed activity or energy, lasting *at least 1 week*

24

Manic episode criteria
3 (or more) of the following symptoms (four if the mood is only irritable) are present:
(drawn out DIGFAST)

-Inflated self-esteem/ grandiosity.
-Decreased need for sleep
-More talkative than usual
-Flight of ideas
-Distractibility
-Increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation (i.e., purposeless non-goal-directed activity).
-Excessive involvement in activities that have a high potential for painful consequences

25

Bipolar I prevalence

The 12-month prevalence estimate in the continental United States was 0.6% for bipolar I disorder
-The lifetime male-to-female prevalence ratio is approximately 1.1 : 1

26

Bipolar II Disorder

Necessary to meet the following criteria for a current or past hypomanic episode and the following criteria for a current or past major depressive episode

27

Hypomanic Episode

A distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased activity or energy, lasting *at least 4 consecutive days* and present most of the day, nearly every day

28

Hypomanic episode:
3 (or more) of the following symptoms have persisted (four if the mood is only irritable): (same as manic episode criteria, except only have for 4 days instead of 1 week)

-grandiosity
-insomnia
-more talkative than usual
-Flight of ideas
-Distractibility
-Increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation
-Excessive involvement in activities that have a high potential for painful consequences

29

Bipolar II prevalence

In the United States, 12-month prevalence is 0.8%
Bipolar I, bipolar II, and bipolar disorder not otherwise specified yield a combined prevalence rate of 1.8% in U.S.

30

Mania mnemonic

DIG FAST
Distractibility
Indiscretion
Grandiosity
Flight of ideas
Activity increase
Sleep deficit
Talkativeness

31

Cyclothymic disorder

For at least *2 YEARS* (at least *1 YEAR* in children and adolescents) there have been numerous periods with hypomanic symptoms that do not meet criteria for a hypomanic episode and numerous periods with depressive symptoms that do not meet criteria for a major depressive episode.


32

Cyclothymic disorder: During the above 2-year period (1 year in children and adolescents), the hypomanic and depressive periods have been present for at least ??

half the time and the individual has not been without the symptoms for more than 2 months at a time.
*Criteria for a major depressive, manic, or hypomanic episode have never been met*
-The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

33

Bipolar tx:

mood stabilizers
atypical antypsychotics
antidepressants

34

Bipolar tx: mood stabilizers

lithium (Lithobid), valproic acid (Depakene), divalproex sodium (Depakote), carbamazepine (Tegretol) and lamotrigine (Lamictal).

35

Bipolar tx: atypical antypsychotics

olanzapine (Zyprexa), risperidone (Risperdal),
quetiapine (Seroquel), aripiprazole (Abilify), ziprasidone (Geodon), lurasidone (Latuda) or asenapine (Saphris)

36

Bipolar tx: antidepressants

help manage depression. Usually along with a mood stabilizer or antipsychotic.
-can sometimes trigger a manic episode!