Mood Disorders - Schneck

Question 1

What is the prevalence of depression?

Median age of onset?

Answer 1

Lifetime prevalence of ANY mood disorder: 20%
Lifetime prevalence of Depression: 17%

More “years of healthy life lost” due to depression than any other cause (EtOH, Drugs, road accidents….COPD way at the bottom)

Median age: 33 y/o

Question 2

What is the heridability of Bipolar and Major Depressive Disorder?

Answer 2

Bipolar is MORE heridable (67-80%) than MDD (~40%)

First relative Bipolar increases risk 9-10x, MDD 2-3x

Concordance rate bipolar disorder between monozygotic twins =57%, between dizygotic twins 14%

Question 3

What is the mnemonic for the signs and symptoms of depression?

Answer 3

SIGECAPS

Sleep (insomnia/hypersomnia)
Interest (diminished)
Guilt (excessive, without cause)
Energy (diminished)
Concentration (decreased)
Anhedonia
Psychomotor (increased or decreased)
Suicidal ideation (thoughts, plans, attempts)

Question 4

What is the “stress hypothesis” of depression? Describe (briefly) the proposed chain of events.

Answer 4

Stress activates the HPA axis. The end result is release of cortisol from the adrenal glands. Prolonged release of glucocorticoids (steroids) damages hippocampal neurons (decreased dendritic branching). The hippocampus generally has an inhibitory affect on the HPA axis, so a vicious cycle is created.

This is a partial theory, and cannot account for all aspects of depression.

Question 5

Diagnostic criteria for depression (eg how many symptoms, how long).

Answer 5

5 or more symptoms have persisted for 2 weeks or more, are a change from previous function, and patient experiences sad mood or anhedonia

Question 6

Your friend Jenny has had one episode of MDD. What is her lifetime risk of another MDD episode? If she had had 2? 3?

Answer 6

1 episode: 50%
2 episodes: 66%
3 episodes: 90%

Question 7

Mnemonic for mania. Go.

Answer 7

DIGFAST

Distractability
Insomnia
Grandiosity
Flight of ideas
Activity (increased)
Speech
Thoughtlessness

[**These fall into 4 broader categories 1) Manic mood 2) Psychotic symptoms 3) Dysphoric mood 4) cognitive symptoms]

Question 8

DSM-5 criteria for manic episode.

Answer 8

A distinct period of abnormally & persistently elevated, expansive or irritable mood, and persistently increased goal-directed activity or energy

lasting at least 1 week

PLUS 3 or more symptoms (if euphoric)

OR

4 or more symptoms (if irritable)

Question 9

Bipolar I diagnostic criteria

Answer 9

ONLY have to have MANIA

(Bipolar I…only one)

[Bipolar I defined by the presence of at least 1 manic episode with or without a hypomanic or depressive episode - firstaid]

Question 10

Bipolar II diagnostic criteria

Answer 10

HYPOmania and MDD

(Bipolar II…there are two)

37:1 time depressed: time hypomanic

Question 11

Suicide #s:

11th = \_\_\_\_\_?
2nd = \_\_\_\_\_?
4:1 = \_\_\_\_\_?
75% = \_\_\_\_\_?
2-3x = \_\_\_\_\_?

Answer 11

11th cause of death all ags. 
2nd cause of death 25-34 y/o
4:1 male:female successful attempts
75% are successful the 1st time
2-3x more women attempt suicide than men

Question 12

What distinguishes atypical depression?

Answer 12

mood reactivity (can put on a “happy face”, or respond briefly to positive circumstances)

leaden paralysis

reverse neurovegetative symptoms (increased
appetite, weight gain, hypersomnia)

Question 13

What distinguishes psychotic depression?

Answer 13

auditory hallucinations, nihilistic delusions

Question 14

What distinguishes melancholic depression?

Answer 14

mood worse in the morning, early morning awakening, anorexia, weight loss,
guilt, psychomotor retardation.

Question 15

What distinguishes seasonal affective depression?

Answer 15

Mood typically worsens in the fall and winter, improves in the spring and summer.

Question 16

Dysthymia and hypomania; milder form of bipolar disorder lasting at least 2 years.

Answer 16

Cyclothymic disorder

[firstaid]

Question 17

Hypomanic episode

Answer 17

Like manic episode except mood disturbance is not severe enough to cause marked impairment in social and/or occupational functioning or to necessitate hospitalization. No psychotic features. Lasts at least 4 consecutive days.

Question 18

___ are the most common cause of medication based manias and hypomanias.

Answer 18

Steroids