Mood Disorders I and II Flashcards

Question

Persistent Depressive Disorder

Answer 1

* accounts for (2-3%) * 2 years of duration * less common and less responsive to therapy * depressed mood for most of the day on more days than not- course tends to be non-remitting * TWO of the following Six (lots of similarities to MDD) * poor appetite -or- overeating * low energy/fatigue * insomnia -or- hypersomnia * low self-esteem * poor concentration -or- difficult decision making * feelings of hopelessness * Has never been free of symptoms for \>2 mo, no signs of other significant mental disorder that would explain symptoms * can have Major Depressive Disorder on top of this disorder

Answer 2

* In the majority of menstrual cycles at least 1 of the following need to be present during the final week before start of menstruation: * Marked affective lability * Marked irritability and anger or interpersonal conflicts * Marked depressed mood, feelings, or hopelessness * Marked anxiety, tension, and/ or feeling on edge * At least 1 of the following also needs to be present * Decreased interest * Poor concentration * Lethargy * Change in appetite * Hypersomnia or insomnia * Sense of being out of control * Physical symptoms-breast tenderness, bloating, muscle pain * Must have a total of 5 or more of the above * Causes significant distress or impairment * Not an exacerbation of another similar disorder- i.e. Major Depression

Answer 3

* severe type of depression * MD but also: * lack of reactivity of any pleasure situation * early AM mood wordse * early morning awakening * marked agitation or retardation * excessive guilt * **\*\*use of ANTI-depressants essential** * DST usually positive-clear HPA axis dysfxn

Answer 4

* oversleeping * overeating * leaden paralysis * interpersonal sensitivity * mood reactivity-leading to roller-coaster type of mood

Answer 5

* MDD features but also presence of psychotic element * *NIHILSM*-there is no future-the world will end * *DELUSIONS*-"I am bad", "I have caused others to be poisoned", "I have cancer in my bowel-I am rotting from the inside" * *HALLUCINATIONS*-usually negative; usually **auditory** * **use of ANTI-psychotic or ECT essential** * newer agents (SSRIs) may not work as well * DO NOT confuse with schizophrenia * be careful to rule out Bipolar

Answer 6

* 20% of ppl at this latitude have a seasonal mood fluctuation * sxs similar to atypical depression but pts tend to become hyper in the summer * worst pt of yr is Oct-Feb * light therapy helps 50% (ANTI-depressants just as effective)

Answer 7

* Bereavement not classified as a psychiatric disorder * For majority of ppl its a nml life rxn – it is expected that someone will feel empty and grieve the loss. * may have depressed mood, irritable, take some time off, not sleep well, etc. – * These symptoms come in waves but the indiv can still experience pleasure & joy. * grieving & mourning is cultural based- expectations are that by 3 mo. many of the symptoms have resolved and the person moves on with their life. * However, losses are a precipitant of MDD and one should not hesitate to tx as an MDD if symptoms are severe enough. * Complicated (pathological) grief often involves many symptoms of PTSD on top of MDD and bereavement * these individuals get stuck on the loss and can’t progress * aggressive tx is indicated * Stronger (abnml) signals that indicate a more severe condition: * guilt about life areas outside of the death * worthlessness psychomotor retardation * sustained suicidal ideation * prolonged fxnl impairment

Answer 8

* numbeness-hours to days (seldome wks) * depression-few wks to \<1 yr * exacerbation son holidays, birthdays, other memorable events * insomnia, restlessness, irritability * some days good, some bad * recovery-usually \<6 months * accept the loss and return to a pre-morbid level of functioning which might include previous or new roles * most ppl start to feel better 6-10 wk after the death

Answer 9

* most ppl are resilient and do fine * if concerned about MDD consider: * past hx * intensity and duration * pervasiveness of symptoms * dont wait to normalize-longer the delay to tz the depression the worse the prognosis

Answer 10

* some signs of depression that cause clinical concern (significant emotional or behavioral disturbances) in response to **an acute stressor that occurred within 3 months of the onset of symptoms**. * does NOT meet criteria for other (more significant) disorders * once the stressor is removed the symptoms should abate within 6 months * can be depressed/anxious/behavioral in nature * Usually brief therapy or social interventions are all that is needed

Answer 11

* diagnosis often missed because of absence of sadness * high risk of acting out and suicidal or homicidal potential * seen often in **ELDERLY** and **ADOLESCENCE** * watch for substance induced

Answer 12

* often masked depression * irritable, angry, agitated, (more common than sadness), dont care * often somatic in presentation to point of delusional dementia * **cognitive changes often confused with dementia** * new incident rate increases past age 65 * **suicide rate highest in elderly males** * highest growing population * misconception that it is a part of aging or is not treatable * less likely to seek out help * response rate to intervention is just as good as adults

Answer 13

* high risk for impulsive actions * often missed because of teenage angst misconception * teens aware of what depression is-they dont trust adults * high risk suicide group * tx intervention available-more controversial and variable (potentially harmful) * most severe mental illnesses start now * irritability often prominent * sadness present but hidden by irritability * acting out behavior * impulsivity/recklessness * substance experimentation, change in friends, grades, behaviors * withdrawn

Answer 14

* Individuals with Bipolar Disorder suffer a life-long illness that can devastate their lives & their families’ lives. * classic forms of Bipolar I are relatively uncommon (0.6-0.8% of the general population) * if Bipolar variants are included the prevalence may be as high as 4-6% of the pop = significant national health issue. * To be diagnosed you must have experienced **at least one Manic episode**, although most commonly there will be episodes of Major Depression and other mood states in the hx. * Diagnosis is often ignored or missed because of lack of good hx taking * missing diagnosis leads to morbidity and delay of tx (**avg=5 yrs**) * tx are very helpful if applied

Answer 15

* A. A distinct period of abnormally and persistent elevated, expansive, or irritable mood present for most of the day for **at least 1 week** duration * B. During the period of mood disturbance **at least 3** of the following are * present (FOUR if the mood is *only irritable*) * 1. *Inflated self-esteem or grandiosity* * 2. *Decreased need for sleep* * 3. More *talkative* than usual or pressure to keep talking * 4. Flight of Ideas or subjective experience of *racing thoughts* * 5. *Distractibility* * 6. Increase in *goal-directive activities* or psychomotor agitation * 7. Reckless behaviors in pleasurable areas (have consequences)– buying, speeding, sexual indiscretions, foolish business ventures * C. *Marked impairment in functioning* in job, social activities, or relationships with others -or- there are psychotic features * D. Symptoms not caused by a substance or medical condition

Answer 16

* Individuals usually cycle clearly f/m Mania to Depression over the course of wks to mos. * Some pts will end up with a **Mixed Bipolar state** where they will have symptoms of *BOTH mania and depression at the same time*. * Often these individuals are very refractory to treatment. * a cohort of bipolar individuals: * 40-45% of time spent in a depressive phase * 5-10% hypomanic or manic phase * 45% euthymic state * 2/3 of pts never make it back to their pre-morbid level of functioning. * Even when indivs are euthymic there is evidence of brain fxn abnormalities. * math, reasoning, and informational processing abilities are impaired. * Verbal memory, attn, and executive functioning \< baseline. * Life span decreased by 8-10 yrs primarily due to metabolic syndrome co-morbidities and a 15-20x higher risk of suicide. * Their insight into their illness is always suspect leading to issues of substance abuse, non-compliance with meds/tx, and potentially challenging life courses

Answer 17

* Bipolar I: 0.6-0.8% lifetime prevalence * Bipolar II: 0.5-0.8% lifetime prevalence * Bipolar spectrum: 4-6% lifetime prevalence (controversial) * .......................................... * bipolar secondary to medical conditions (depression) or substances * M=W * **\*\*higher socioeconomic** * onset late adolescence, early adulthood * strong genetics: * MZ twins: 65-80% * DZ twins: 10-15% * 1 rent: 10% * 2 rents: 50% * much greater chance of becoming psychotic * pathophys of depressed phase looks v. similar to MDD on neuroimaging

Answer 18

* Early age onset (before age 20) * Psychotic Depression * 1st episode of depression is postpartum especially if psychotic * Rapid onset and offset of depressive symptoms * Recurrent depression with \> 5 episodes * non-responsive to usual intervention * Bipolar FHx * Seasonal Mood Disorder * Atypical Depression * Hypomania associated w/ ANTI-depressants * Repeated loss of efficacy of ANTI-depressants over time * Trait mood lability, hyperthymic temperament * Depression w/ mixed mood states * many anxious or mixed hyper features-racing, irritable, hostile * Bipolar symptoms (hypomania) can at time be imitated by substances (i.e. cocaine, caffeine, prednisone) or general medical conditions (i.e. hyperthyroidism, closed head injury) * good medical work-up is always a first step to diagnosis.

Answer 19

* Bipolar I: a manic episode (depressive episode is not needed, although usually occurs) * Bipolar II: hypomanic symptoms-at least 4 days in a row; at least 3 symptoms on mania, but not severe enough to cause impairment in functioning or hospitalization * no psychosis, must hv a hx of MDD * Cyclothymic Disorder-2 yr duration * hypomaniac symptoms at times, but depression never to point of MD or BPI or BPII criteria * (BP unspecified:) * potential pts who have some symptoms of mania and hypomania at times, but never enough to meet full criteria * anyone with significant mood fluctuations and irritabilit that are not induced by substances

Answer 20

* neurodegenerative process even when the mood is stable-evidence of cognitive changes in verbal memory, attn, and executive functioning * in depression the neuroimaging looks similar to MD, but **mania involves activation of many areas** * with age there is a cerebral atrophy and the brains look more similar to schizophrenia * pts with bipolar have enlarged ventricles and increased white matter HYPERdensities

Answer 21

* use of anticonvulsant leads to theories on calcium or sodium gate abnormalities and stabilization of neuronal pathways * some evidence of a specific gene defect associated with chrom 18q or 22q in linkage studies

Answer 22

* only 1/3 recover at 1 yr out * most bipolar will gravitate to the depressive end of the spectrum * only 50% were working at 3 yrs after the diagnosis * impulsivity, addictions, distractibility lead to high co-morbidity and potential suicide * **\*\*medications are essential along with support**

Answer 23

* 10th leading cause of death in the US * \>43k ppl in 2013 in US * over 460k suicide attempts documented * devastating action that effects both families of the victim (guilt, anger, loss, shame) and for HC providers * major emphasis in clinical practice to prevent suicide-lots of screening for this and moos disorders

Answer 24

* 12.9/100,000 per yr in the US * **Males – 19.9** * Females-5.5 * Caucasions-14.1 * Asians-6.2 * African-American-5.1 * Hispanics-5.9 * Adolescents- 10.5(but often give the least warning and most impulsive) * **Elderly- 17.6** (often sudden and told of a terminal disease) * Middle age(45-64)- 18.6 – now the top risk group demographically * **Veterans - 34.9** – transition back makes them vulnerable * \>90% of the time there is the presence of a mental disorder * **bipolar (15x nml)**\>Schizophrenia\>MDD * anxiety disorders, eating disorders, and substance use disorders also high on the list * **greatest risk of suicide is within inthe 1st yr of diagnosis**

Answer 25

* suicide ideation * suicide plan or intent * suicide attempt * completed suicide * self harm-no desire to die, but instead an attempt to relieve pain or feel smthg real; overlap exists and needs to be explored * 34% of those with suicide ideation think of plan * 72% of those with a plan try to attempt * 51% firearms * 25% suffocation- usually hanging * 17% poisoning * There are probably many more deaths due to suicide that are not documented- single passenger accidents, drowning, accidental OD, stigma preventing MD from listing true reason on death certificate because of the family desire or insurance reasons. * 3F:1M attempted suicide * 4M:1F successful suicide

Answer 26

* relatively common symptom (20% of adolescence will experience this at some pt; 10% of adults in any given year) * usually present when someone is under a lot of stress and feels there is no way out. * illustrated by statements such as “I wish I were dead”, “The world would be a better place without me”, "I wouldn’t mind if I developed cancer and died”. * These thoughts are often fleeting but can begin to persist on a daily basis.

Answer 27

* Thoughts have moved to thinking about how someone would commit suicide. * Looking on websites, asked others, have begun to secure the means to commit suicide or thought out when/how

Answer 28

* actual carrying out of an act that could end one’s life. * The degree to which the attempt might be lethal depends a lot on the means and the place of action. * ratio of attempts:completions=12:1. * 460k attempts/yr in the US that are evaluated in the ED. * Determining whether someone really wanted to die vs just relieve pain or get help is essential in psychiatric triage.

Answer 29

* **\*\*70% who die decide in last 10 minutes of life (impulsive decision)** * currently has a feasible plan in mind * x hx of prior attempts * x psychosis (especially command hallucinations) * x high anxiety * x impulsivity * x presence of a mental disorder * x substance abuse (especially if intoxicated) * x hopelessness * x lack of support * x Fhx of completed suicide * x significant negative life event in the last 3 mo * x presence of guns in the house

Answer 30

* Lower serotonin receptor numbers * Lower serotonin levels in the CNS * Both of these are done post mortem=useless * some recent PET scans claim that they can identify which individuals are more likely to resort to suicide attempts * Lack of effective coping strategies, presence of impulsivity also have strong correlation with attempts. * Most ppl who call or show up in the ED for suicidal thoughts are wanting to live and are asking for help.

Answer 31

* 1. Ask- you will never put the thought of suicide into someone’s mind * 2. Use behavioral incidents (as taught in interviewing skills) and appropriate gates– **details are important in such a sensitive area** * ****“What exactly were you thinking” * “Did you actually go out and buy a gun?" * "What did you plan to do with it?” * 3. Do a risk analysis based on each patient’s unique situation * 4. Remove the means; triage the pt and make sure theyre safe * 5. Explore each person individually for risk analysis-combination of risks and protective measures * support, faith, or religion, on medication, having children

Mood Disorders I and II Flashcards

(60 cards)