Mood Disorders

Question 1

_______% of patients with a mood disorder have a first-degree relative with a mood disorder

Answer 1

10-25

Question 2

_____% of patients with bipolar disorder have a first-degree relative with a mood disorder

Answer 2

50%

Question 3

________ is a NT involved in pathogenesis of depression in that there is down regulation of beta receptors leading to abnormal noradrenergic function

Answer 3

Norepinephrine

Question 4

_______ is a NT that is decreased in depression, but increased in mania

Answer 4

Dopamine

Question 5

______ is an inhibitory NT that is the site of action for anxiolytic agents like benzodiazepines

Answer 5

GABA

Question 6

_____ is an excitatory NT involved in dementia; its _____ receptor is involved in current antidepressant studies

Answer 6

Glutamate; NMDA

Question 7

What are some life and environmental stress factors that contribute to development of mood disorders?

Answer 7

Death of a parent before age 11

Death of a spouse or child

Unemployment

[note that these types of events often precede first mood episode rather than subsequent episodes]

Question 8

A major depressive episode requires at least _____ criteria for a _________ period with at least either (1) ______ mood or (2) loss of __________

Answer 8

5; 2 week; depressed; interest or pleasure

Question 9

List items included in diagnostic criteria for major depressive disorder

Answer 9

Depressed mood + [SIG E CAPS]

Sleep disturbance
loss of Interest (anhedonia)
Guilt or feelings of worthlessness

Energy loss and fatigue

Concentration problems
Appetite/weight changes
Psychomotor retardation or agitation
Suicidal ideation

Question 10

A manic episode is defined as abnormally and persistently elevated, expansive, or irritable mood lasting at least _______ with at least _____ criteria

Answer 10

1 week; 3

Question 11

Diagnosis of a manic episode requires hospitalization or marked functional impairment of at least 3 criteria. What are the criteria?

Answer 11

[DIG FAST]

Distractibility
Impulsivity/Indiscretion (hedonistic)
Grandiosity

Flight of ideas
psychomotor Agitation/goal-directed Activity
decreased need for Sleep
Talkativeness or pressured speech

Question 12

______ _____ = similar to manic episode but is less severe; episodes only need to last ______ and must not include psychotic features; _____(are/are not) associated with social/occupational impairment

Answer 12

Hypomanic episode; 4 days; are not

Question 13

The diagnosis of major depressive disorder requires the presence of ____ or more major depressive episodes and the ABSENCE of any _____, _____, or _____ episodes

Answer 13

One; manic; hypomanic; mixed

Question 14

T/F: treatment of bereavement usually does not include antidepressants

Answer 14

True

Question 15

Treatment for major depressive disorder

Answer 15

CBT and SSRIs are first-line

Other options: TCAs, MAOIs, trazodone, buproprion, SNRIs, and mirtazapine

Hospitalization

ECT used for treatment-resistant depression; newer option is Transcranial Magnetic Stim, but is expensive and time consuming

Question 16

Treatment option for MDD that produces dissociative anesthesia as an NMDA antagonist; results in 50% reduction in suicidal thoughts in 24 hours

Answer 16

Ketamine

Question 17

Depressed mood for most of the day (at least 2 years in duration for adults and 1 year for children) that has not been severe enough to meet criteria for major depressive episode; during the 2 years, cannot be w/o sx for >2 mo at a time

Answer 17

Persistent depressive disorder (Dysthymia)

Question 18

Persistent depressive disorder (dysthymia) requires continuous symptoms for at least _____ for adults and ______ for children

Answer 18

2 years; 1 year

Question 19

Treatment for persistent depressive/dysthymic disorder

Answer 19

Can be more difficult to treat

Pharmacology: SSRIs, SNRIs, MAOIs

CBT

Question 20

Formerly known as seasonal affective disorder. Lasting >2 years with >2 major depressive episodes associated with seasonal pattern and absence of nonseasonal depressive episodes. Atypical symptoms common (hypersomnia, hyperphagia, leaden paralysis)

Answer 20

MDD with seasonal pattern

Question 21

Mood instability with anxiety, depression, and irritability occurring the week before menses and consistent pattern over the year

Answer 21

Premenstrual dysphoric disorder (PMDD)

Question 22

Treatment for PMDD

Answer 22

Exercise, diet, relaxation therapy

SSRIs may be used — Sertraline, fluoxetine, paroxetine. Treat during cycle or 2 weeks preceding menses

Question 23

Must have at least one manic or mixed episode for diagnosis, but a major depressive episode is not required for diagnosis

Answer 23

Bipolar I

Question 24

Which has worse px, bipolar I or MDD?

Answer 24

Bipolar I

Question 25

Which is more prevalent, bipolar I or bipolar II?

Answer 25

Bipolar II

Question 26

Define bipolar II

Answer 26

At least one major depressive episode and one hypomanic episode in the absence of any manic or mixed episodes

Question 27

Treatment for bipolar disorders

Answer 27

Mood stabilizers are 1st line choice — lithium, valproic acid, or carbamazepine Other options include Lamotrigine (for bipolar with depression) or second-generation antipsychotics (olanzapine, risperidone, ziprasidone, aripiprazole, quetiapine, lurasidone, cariprazine, asenapine)

Question 28

Mood disorder characterized as dysthymic disorder with intermittent hypomanic periods; occurs in patient experiences repeated episodes of hypomania and depression over the last 2 years, but not severe enough to meet criteria for MDD

Answer 28

Cyclothymic disorder

Question 29

Treatment for cyclothymic disorder

Answer 29

Mood-stabilizing drugs and supportive psychotherapy [Antidepressants frequently precipitate manic symptoms]

Question 30

Psychological and somatic symptoms of anxiety disorders

Answer 30

Psychological — apprehension/worry, sense of doom or panic, hypervigilence, difficulty concentrating, derealization (world seems strange) Somatic — HA, dizziness, lightheaded, palpitations, lump in throat, restless, SOB, dry mouth, sweating

Question 31

Diagnostic categories of anxiety

Answer 31

Separation anxiety disorder Panic disorder Agoraphobia GAD OCD Specific phobias/social phobias PTSD

Question 32

2 major criteria for panic disorder

Answer 32

1. Recurrent unexpected panic attacks 2. At least one attack followed by 1+ month of at least one of the following: persistent concern about additional attacks, worry about implications of attack or its consequences, significant change in behavior related to the attacks

Question 33

T/F: diagnosis of panic disorder requires the absence of agoraphobia

Answer 33

False — panic disorder occurs in the presence or absence of agoraphobia

Question 34

A panic attack is a discrete period of intense fear or discomfort, in which ____ or more criteria develop abruptly and reach a peak within ____ minutes and usually last _______.

Answer 34

4; 10; <25 mins

Question 35

A panic attack is a discrete period of intense fear or discomfort, in which 4 or more criteria develop abruptly and reach a peak within 10 minutes and usually last <25 mins. What are the criteria?

Answer 35

``` Palpitations Sweating Trembling/shaking Sensation of SOB Chest pain Dizzy/unsteady/lightheaded Fear of losing control/going crazy/dying Paresthesias Chills or hot flashes ```

Question 36

_____ are 2-3x more likely to be affected by panic disorder and the average age of presentation is 25 y/o. There is a strong genetic component in that ____% of all pts have at least one affected relative

Answer 36

Women; 50%

Question 37

Anxiety about being in situations from which escape might be difficult or embarrassing or for which help may not be available in the event of panic

Answer 37

Agoraphobia

Question 38

A persistent fear of one or more social or performance situations in which the person is exposed to unfamiliar people or a possible scrutiny by others; the individual fears that he or she will will act in a way (or show anxiety symptoms) that will be embarrassing and humiliating; typically lasts 6+ months

Answer 38

Social phobia (social anxiety disorder)

Question 39

GAD consists of excessive, difficult-to-control anxiety and worry (apprehensive expectation), lasting for most of the day about a number of events or activities. The anxiety and worry are associated with at least _____ criteria persisting for more days than not for at least ________

Answer 39

3; 6 months

Question 40

The anxiety and worry of GAD are associated with at least 3 criteria persisting for more days than not for at least 6 months. What are the criteria?

Answer 40

Restlesness or feeling on edge Easily fatigued Difficulty concentrating Irritability Muscle tension Sleep disturbance

Question 41

What is the difference between obsessions and compulsions?

Answer 41

Obsessions = recurrent and persistent thoughts, impulses, or images experienced as intrusive and inappropriate and causing marked anxiety or distress; recognized as a product of ones own mind Compulsions = repetitive behaviors or mental acts that the person feels drive to perform; aimed at preventing or reducing distress or preventing some dreaded event/situation

Question 42

T/F: Hoarding disorder, trichotillomania (hair pulling), and excoriation disorder (skin picking) are related to OCDq

Answer 42

True

Question 43

What is the major difference between OCD and obsessive-compulsive personality disorder?

Answer 43

OCD — they know their compulsions and obsessions are not reasonable (most of the time) OCPD — they don’t perceive they have a problem

Question 44

What are some types of obsessions seen in OCD?

Answer 44

Contamination — fear of dirt, germs, illness, etc Safety/harm — e.g., being responsible for a fire Unwanted acts of aggression (e.g., unwanted impulse to harm a loved one) Unacceptable sexual or religious thoughts Need for symmetry or exactness

Question 45

What are some types of compulsions seen in OCD?

Answer 45

Excessive cleaning Checking, ordering, and arranging rituals Counting; repeating routine activities Some are performed as unobservable mental rituals

Question 46

Pts with PTSD persistently re-experience traumatic event, persistently avoid stimuli associated with the trauma, show persistent symptoms of increased arousal such as difficulty sleeping, irritability, difficulty concentrating, and hypervigilence. They also show negative cognitions — what are some examples?

Answer 46

Persistent and distorted sense of blame of self or others Estrangement from others Markedly diminished interest in activities Inability to remember key aspects of event

Question 47

PTSD criteria include duration of disturbance/symptoms is more than ________; clinically significant distress that impairs function

Answer 47

1 month

Question 48

Treatment for PTSD

Answer 48

SSRIs Cognitive processing therapy

Question 49

T/F: benzodiazepines are often helpful for PTSD pts who experience panic symptoms

Answer 49

False — PTSD pts have an increased risk of substance abuse, so addictive meds should be avoided

Question 50

Iatrophobia

Answer 50

Fear of doctors

Question 51

Acrophobia

Answer 51

Fear of heights

Question 52

Psychotherapy options for anxiety include supportive therapy, psychodynamic psychotherapy, and CBT. What are some psychopharmacology options?

Answer 52

``` SSRIs SNRIs TCAs MAOIs Buspirone Benzodiazepines Antispychotics ```