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Flashcards in Mood disorders Deck (76):
1

Given the patient's current social and occupational situation he or she emotionally feels:

Dysthymia = Somewhat worse than would be expected.
Depression = Very much worse than would be expected.
Hypomania = Somewhat better than would be expected.
Mania = Very much better than would be expected.

2

DSM-IV-TR categories of primary mood disorders:

1. Major depressive disorder.
2. Bipolar disorder.
3. Dysthymic disorder.
4. Cyclothymic disorder.

3

Secondary mood disorders:

1. Due to general medical condition.
2. Substance-induced mood disorder.

4

Major depressive disorder:

Recurrent episodes of depression, each continuing for AT LEAST 2 WEEKS.

5

Bipolar disorder:

Bipolar I = Episodes of BOTH mania (for at least 1wk) + depression.
Bipolar II = BOTH hypomania (for at least 4 DAYS) + depression.

6

Dysthymic disorder:

Continuing over a 2-year period (1 year in children) with no discrete episodes of illness.

7

Cyclothymic disorder:

Hypomania and dysthymia occurring over a 2-year period (1yr in children) with no discrete episodes of illness.

8

Epidemiology of mood disorders:

NO DIFFERENCES associated with:
1. Ethnicity.
2. Education.
3. Marital status.
4. Income.

9

The lifetime prevalence of mood disorders - Major depressive disorder:

Men = 5-12%.
Women = 10-20%.

10

The lifetime prevalence of mood disorders - Bipolar disorder:

1% overall, no sex difference.

11

The lifetime prevalence of mood disorders - Dysthymic disorder:

6% overall - Up to 3 TIMES MORE COMMON in women.

12

The lifetime prevalence of mood disorders - Cyclothymic disorder:

Less than 1% overall - No sex difference.

13

Classification of mood disorders:

1. Major depressive disorder.
2. Bipolar disorder.
3. Dysthymic disorder and cyclothymic disorder.

14

Major depressive disorder - Characteristics - SWAG:

A mnemonic that can quickly identify depression and differentiate it from normal sadness. If ONE of the following symptoms is present, it is most likely that the patient is depressed:
1. S - Suicidality (having a plan or a means of self-destruction).
2. W - Weight loss (>5% of body weight).
3. A - Anhedonia (loss of pleasure or interest in usually pleasurable activities).
4. G - Guilt (feelings of responsibility for negative life events when little or none exists).

15

Signs and symptoms of depression and mania - Depression - Signs/symptoms with increased likelihood of occurrence (++++):

1. SWAG (suicidality, weight loss, anhedonia, guilt) symptom.
2. Sadness, hopelessness, helplessness, low self-esteem.
3. Reduced energy and motivation.
4. Anxiety (is apprehensive about imagined dangers).
5. Sleep problems (wakes frequently at night and too early in the morning).

16

Signs and symptoms of depression and mania - Depression - Signs/symptoms with increased likelihood of occurrence (+++):

1. Cognitive problems (has difficult with memory and concentration).
2. Change in physical activity (psychomotor retardation or agitation).
3. Decr. or increased (in atypical depression) appetite for food and sex.

17

Signs and symptoms of depression and mania - Depression - Signs/symptoms with increased likelihood of occurrence (++):

1. Poor grooming.
2. Diurnal variation in symptoms (worse in the morning, better in the evening).
3. Suicidal ideation (has thoughts of killing oneself).

18

Signs and symptoms of depression and mania - Depression - Signs/symptoms with increased likelihood of occurrence (+):

1. Suicide (takes one's own life).
2. Psychotic symptoms (has delusions of destruction and fatal illness).

19

Signs and symptoms of depression and mania - Mania - Signs/symptoms with increased likelihood of occurrence (++++):

1. Elevated mood (has strong feelings of happiness and physical well-being).
2. Grandiosity and expansiveness (has feelings of self-importance).
3. Irritability and impulsivity (is easily bothered and quick to anger).
4. Disinhibition (shows uncharacteristic lack of modesty in dress or behavior).
5. Assaultiveness (cannot control aggressive impulses; causes legal problems).
6. Distractibility (cannot concentrate on relevant stimuli).
7. Flight of ideas (thoughts move rapidly from one to another).
8. Pressured speech (seems compelled to speak quickly).
9. Impaired judgement (provides unusual responses to hypothetical questions, eg says she would buy a blood bank if she inherited money).

20

Signs and symptoms of depression and mania - Depression - Signs/symptoms with increased likelihood of occurrence (+++):

Psychotic symptoms (has delusions of power and influence).

21

Masked depression:

As many as 50% of depressed patients seem unaware of or deny depression and thus are said to have "masked depression".

22

Patients with masked depression often visit primary care doctors complaining of ...?

VAGUE PHYSICAL SYMPTOMS.

23

In contrast to patients who have somatoform disorders (physical symptoms resulting from psychological factors), depressed patients show at least ...?

1 SWAG symptom in addition to their physical complaints.

24

Seasonal affective disorder (SAD):

SAD is a subtype of major depressive disorder associated with the winter season and short days.

25

SAD is characterized by ...?

ATYPICAL SYMPTOMS of depression (eg oversleeping and overeating) + a heavy feeling in the limbs ("leaden paralysis").

26

Many patients with SAD improve in response to ...?

Full-spectrum light exposure.

27

Suicide risk - The top 5 risk factors for suicide from higher to lower risk are:

1. Serious prior suicide attempt.
2. Age older than 45.
3. Alcohol dependence.
4. History of rage and violent behavior.
5. Male sex.

28

In bipolar disorder, there are episodes of ...?

BOTH mania and depression (type I) or BOTH hypomania and depression (type II).

29

There is no simple manic disorder because ...?

Depressive symptoms eventually occur.

30

Bipolar disorder - Psychotic symptoms, such as delusions, can occur in ...?

Depression (depression with psychotic features) as well as in mania.

31

In some patients (eg poor patients with low access to health care), a mood disorder with psychotic symptoms can become severe enough to be misdiagnosed as ...?

Schizophrenia.

32

In contrast to schizophrenia and schizoaffective disorder, in which patients are chronically impaired, in mood disorders the patient's mood and functioning ...?

Usually RETURN TO NORMAL between episodes.

33

Dysthymic disorder and cyclothymic disorder:

In contrast to major depressive disorder and bipolar disorder, respectively, dysthymic disorder and cyclothymic disorder are:
1. Less severe.
2. Non episodic.
3. Chronic.
4. Not associated with psychosis or suicide.

34

The biologic etiology of mood disorders includes:

1. Altered neurotransmitter activity.
2. A genetic component, strongest in bipolar disorder.
3. Physical illness + related factors.
4. Abnormalities of the limbic-hypothalamic-pituitary-adrenal axis.

35

Risk factors for suicide - History - Personal history - INCREASED RISK:

1. Serious suicide attempt (about 30% of people who attempt suicide try again and 10% succeed).
2.

36

Risk factors for suicide - History - Personal history - DECREASED RISK:

1. Suicidal gesture, but not a serious attempt.
2. >3mos since previous attempt.
3. Rescue was very likely.

37

Risk factors for suicide - History - Family history - INCREASED RISK:

1. Parent commited suicide.
2. Early loss of a parent through divorce or death.

38

Risk factors for suicide - History - Family history - DECREASED RISK:

1. No family history of suicide.
2. Intact family throughout childhood.

39

Risk factors for suicide - Current, social, psychological, and physical factors - Psychiatric symptoms - INCREASED RISK:

1. Depression.
2. Psychotic symptoms.
3. Hopelessness.
4. Impulsiveness.

40

Risk factors for suicide - Current, social, psychological, and physical factors - Psychiatric symptoms - DECREASED RISK:

1. Dysthymia or no depressive symptoms.
2. No psychotic symptoms.
3. Some hopefullness.
4. Thinks things out.

41

Risk factors for suicide - Current, social, psychological, and physical factors - Psychiatric symptoms - Depth of depression - INCREASED RISK:

1. Initial stages of recovery from deep depression.
2. Recovering patients may have enough energy to commit suicide.

42

Risk factors for suicide - Current, social, psychological, and physical factors - Psychiatric symptoms - Depth of depression - DECREASED RISK:

1. The depth of severe depression.
2. Patients rarely have the clarity of thought or energy needed to plan and commit suicide.

43

Risk factors for suicide - Current, social, psychological, and physical factors - Substance use - INCREASED RISK:

1. Alcohol and drug dependence.
2. Current intoxication.

44

Risk factors for suicide - Current, social, psychological, and physical factors - Substance use - DECREASED RISK:

Little or no substance use.

45

Risk factors for suicide - Current, social, psychological, and physical factors - Physical health - INCREASED RISK:

1. Serious medical illness (eg cancer, AIDS).
2. Perception of serious illness (most patients have visited a physician in the 6 mos prior to suicide).

46

Risk factors for suicide - Current, social, psychological, and physical factors - Physical health - DECREASED RISK:

1. Good health.
2. No recent visit to a physician.

47

Risk factors for suicide - Current, social, psychological, and physical factors - Social relationships - INCREASED RISK:

1. Divorced (particularly men).
2. Widowed.
3. Single, never married.
4. Lives alone.

48

Risk factors for suicide - Current, social, psychological, and physical factors - Social relationships - DECREASED RISK:

1. Married.
2. Strong social support.
3. Has children.
4. Lives with others.

49

Risk factors for suicide - Demographic factors - Age - INCREASED RISK:

1. Elderly (persons age 65 and older, especially men).
2. Middle-aged (over age 55yr in women and age 45yr in men).
3. Adolescents (suicide is the 3rd leading cause of death in those 15-24yr of age; rates increase after neighborhood suicide of a teen or when media depict teenage suicide.

50

Risk factors for suicide - Demographic factors - Age - DECREASED RISK:

1. Children (up to age 15yrs).
2. Young adults (age 25-40yrs).

51

Risk factors for suicide - Demographic factors - Sex - INCREASED RISK:

Male sex (men successfully commit suicide 3 times more often than women).

52

Risk factors for suicide - Demographic factors - Sex - DECREASED RISK:

Female sex (although women attempt suicide 3x more often than men).

53

Risk factors for suicide - Demographic factors - Occupation - INCREASED RISK:

Professionals.

54

Risk factors for suicide - Demographic factors - Occupation - DECREASED RISK:

NON-PROFESSIONALS.

55

Risk factors for suicide - Demographic factors - Specific occupation - INCREASED RISK:

1. Physicians (especially women + psychiatrists).
2. Dentists and veterinarians.
3. Police officers.
4. Attorneys.
5. Musicians.
6. Unemployed.

56

Risk factors for suicide - Demographic factors - Race - INCREASED RISK:

Caucasians.

57

Risk factors for suicide - Demographic factors - Race - DECREASED RISK:

Non-caucasians.

58

Risk factors for suicide - Demographic factors - Religion - INCREASED RISK:

1. Not religious.
2. Jewish.
3. Protestant.

59

Risk factors for suicide - Demographic factors - Religion - DECREASED RISK:

1. Religion.
2. Catholic.
3. Muslim.

60

Risk factors for suicide - Demographic factors - Economic conditions - INCREASED RISK:

Economic recession or depression.

61

Risk factors for suicide - Demographic factors - Sex - DECREASED RISK:

Strong economy.

62

Risk factors for suicide - Lethality of attempt - Plan and means - INCREASED FACTOR:

1. A plan for suicide (eg decision to stockpile pills).
2. A means of committing suicide (eg access to a gun).
3. Sudden appearance of peacefulness in an agitated, depressed patient (he has reached an internal decision to kill himself and is now calm).

63

Risk factors for suicide - Lethality of attempt - Plan and means - DECREASED FACTOR:

1. No plan for suicide.
2. No means of suicide.

64

Risk factors for suicide - Lethality of attempt - Method - INCREASED FACTOR:

1. Shooting oneself.
2. Crashing one's vehicle.
3. Hanging oneself.
4. Jumping from a high place.

65

Risk factors for suicide - Lethality of attempt - Plan and means - DECREASED RISK:

1. Taking pills or poison.
2. Slashing one's wrists.

66

The genetics of bipolar disorder - Approximate occurrence:

1% --> General population.
20% --> Person who has one parent or sibling (or dizygotic twin) with bipolar).
60% --> Person who has 2 parents with bipolar disorder.
75% --> Monozygotic twin of a person with bipolar disorder.

67

The psychosocial etiology of depression and dysthymia can include:

1. Loss of a parent in childhood.
2. Loss of a spouse or child in adulthood.
3. Loss of health.
4. Low self-esteem and negative interpretation of life events.
5. "Learned helplessness" (ie because attempts to escape bad situations in the past have proven futile, the person now feels helpless).

68

Psychosocial factors are NOT directly involved in the etiology of ...?

MANIA or HYPOMANIA.

69

Definitions - The mood or affective disorders are characterized by ...?

A primary disturbance in internal emotional state, causing subjective distress and problems in social and occupational functioning.

70

Management of mood disorders - Overview - Depression is successfully managed ...?

In MOST PATIENTS.

71

Only about ...% of patients with depression seek and receive treatment.

25%.

72

Patients do not seek treatment in part because Americans often believe ...?

That mental illness indicates PERSONAL FAILURE or WEAKNESS.
--> As in many other illnesses, WOMEN are more likely than men to seek treatment.

73

Untreated episodes of depression and mania are usually ...?

Self-limiting + Last approx. 6-12mos and 3mos respectively.

74

The most effective management of the mood disorders is ...?

PHARMACOLOGIC.

75

DDx of depression - Medical conditions:

1. Cancer - Particularly pancreatic + GI.
2. Viral illness (eg pneumonia, influenza, AIDS).
3. Endocrinologic abnormality (Hypothyroidism, diabetes, Cushing).
4. Neurologic illness (PD, MS, HD, dementia, stroke - especially LEFT FRONTAL).
5. Nutritional (B12, folate).
6. Renal or cardiopulmonary disease.

76

DDx of depression - Psychiatric and related conditions:

1. Schizophrenia (particularly after an acute psychotic episode).
2. Adjustment disorder.
3. Anxiety disorder.
4. Normal reaction to a life loss, eg bereavement.
5. Somatoform disorder.
6. Eating disorder.
7. Drug and alcohol abuse.
8. Prescription drug use (reserpine, steroids, anti-HTN, antineoplastics).