Mood Disorders

Question 1

Feelings?

Answer 1

Compelling
‘Source of truth’
binding

Question 2

Mood vs. affect

Answer 2

Mood: subjective (larger order experience -climate)

Affect: objective (moment by moment feelings - weather)

Question 3

Depression Dx?

Answer 3

2+ weeks of: at least one of:

• Depressed mood
• Anhedonia (signature symptom

Question 4

Depressed mood 3 description:

Answer 4

Quality
Reactivity
Diurnal pattern

Question 5

2 types of depression:

Answer 5

1. Neuro-vegetative (biological)
   - psychomotor retardation
2. Cognitive affective symptoms
   - guilt
   - loss of self esteem and worthlessness

Question 6

What more likely to have suicidal ideation?

Answer 6

• Severe depression
• Insomnia
• Worthlessness
• Guilt
• Phase of recovery - so apathetic when depressed, but when treating can increase motivation to complete suicide

Question 7

What is a criteria of severe depression?

Answer 7

Psychotic symptoms

Question 8

Psychotic symptoms in severe depression: 6 kinds of delusions:

Answer 8

Delusions: guilt, persecution, poverty, hyper contrasts, catastrophe, nihilism

Question 9

Why psychotic depression important to Dx or know?

Answer 9

Treatment is different:

Antipsychotic
Antidepressants
ECT

Question 10

How long will you be depressed with moderate depression if untreated?

Answer 10

9 months

Question 11

Postpartum depression, how many and when?

Answer 11

10% women during
4-12 weeks
50% recurrence

Question 12

Depression in older adults factors?

Answer 12

Loss
Organic
Somatic complains
Irritable more than sad

Question 13

What neurological conditions associated with depression?

Answer 13

Parkinson’s
Stroke: frontal lobe

Orbits-frontal dementia

Question 14

What meds can trigger depression?

Answer 14

Corticosteroids
Mono amine depletion
GABA-Ergic drugs: benzos, alcohol
Chemo
OC (rare)
Interferon

Question 15

Psychiatric co-morbidities include these 3 and need parallel treatment

Answer 15

Alcohol/drug abuse
Anxiety
Personality

Question 16

What isn’t depression:

Answer 16

• Grief
• anxiety
• demoralization (loss of competence but still has hedonics)
• adjustment disorder
• delirium (hypo active)
• normal sadness

Question 17

Genes and depression heritability?

Answer 17

40-70%

Question 18

Depression only emotion?

Answer 18

• Brain structure changes

- Functional neurotransmitter changes

Question 19

Interpersonal factors in childhood depression

Answer 19

1. Parental loss + poor parenting
2. chronic depressed mother
3. Cumulative disadvantages
4. Childhood sexual abuse

Question 20

what is Protective for depression in childhood?

Answer 20

Good relationship

Higher IQ

Question 21

Interpersonal factors in adult that is protective?

Answer 21

Married

Confiding in others

Question 22

Environmental factors for depression?

Answer 22

Precipitating
Loss
Humiliation
Entrapment
Danger

Question 23

What environmental factors protective for depression?

Answer 23

Employment/Financial, status
Fresh starts
social capital

Question 24

How to treat mild/mod depression?

Answer 24

Psycho-social

• problem solving
• CBT (introduce alterity)
• exercise
• confiding other
• couple therapy
• lifestyle: sleep, diet, less alcohol)

Question 25

What kinds of pharmacological treatments for depression?

Answer 25

``` SSRIs SNRIs Mirtazipine TCAs Lithium T3 SGAs ```

Question 26

**How long to treat pharma for depression for?

Answer 26

6-12 weeks full dose | Maintain for 6-12 months post recovery in 1st episode.

Question 27

If someone is better from 1st episode depression with pharma, how to do treat?

Answer 27

Treat for 6-12 months after at treatment dose.

Question 28

ECT useful for?

Answer 28

``` Melancholic Psychotic Puerperal Bipolar or mania Prominent suicidality Poor oral intake ```

Question 29

Risk factors for bipolar:

Answer 29

``` Genetic Head injury Organic CNS disease AIDS Season (spring/summer: mania) Circadian rhythm disruption Life events ```

Question 30

Symptoms of mania? 1a and 1b?

Answer 30

1a: elevated mood 1b: irritable mood ``` Subjective less need for sleep Flight of ideas: thoughts moving too fast but still associated connections Talkativeness Distractibility Risky behavioural Increased sexual activity ```

Question 31

What is bipolar I in spectrum disorder?

Answer 31

At least 1 episode of mania. +/- depressive

Question 32

What is bipolar II in spectrum disorder?

Answer 32

Depressive episode + hypo-manic episode

Question 33

What is cyclothymia?

Answer 33

Dysphoric + hypo mania

Question 34

Ppl who are not psychotic when manic are what when depressed

Answer 34

Not psychotic

Question 35

Mania Dx conventions?

Answer 35

Mania: >1week Hypo mania: >2-4 days Rapid cycling: >4episodes per year Mixed state 1-2 weeks

Question 36

Clinical pattern of bipolar:

Answer 36

Starts in Adolescence: brief, mild - median duration 4.5-7 months - kindling - 2x depressive episodes of unipolar pts

Question 37

Mania or depression

Answer 37

3x longer in depression than manic

Question 38

Bipolar vs. depression, who gets more episodes of depression

Answer 38

Bipolar: 2x more likely to get depressive episode.

Question 39

DDx for bipolar?

Answer 39

1. Schizophrenia 2. ORganic: orbito-frontal 3. Drug induced psychosis: cocaine, cannabis etc.

Question 40

How to treat bipolar?

Answer 40

- Mood stabilizers - lithium - SGAs-second Gen, anti - antidepressants - ECT

Question 41

If suicidal bipolar, how to treat?

Answer 41

Clozapine and | Lithium

Question 42

Primary indication for clozapine?

Answer 42

Treatment resistant schizophrenia

Question 43

Dysthymia is?

Answer 43

Chronic low mood

Question 44

Cyclothymia?

Answer 44

Mild mania | Mild depression

Question 45

Hyperthymia?

Answer 45

Slightly happier than normal all the time.

Question 46

What is an emotion

Answer 46

``` a Complex action: facial expression Postural Visceral Thoughts ```