week 7: mood disorders & 3 D's

Question 1

key point when differentiating/diagnosing mood disorders

Answer 1

interference in clients ADLs

overall QOL

Question 2

what is anhedonia?

Answer 2

loss of pleasure for things in your life that used to bring you pleasure

Question 3

what 2 things are experienced in bipolar affective disorder

Answer 3

• depressed mood
• mania

cycle between the two!

Question 3

what 2 things are experienced in major depressive disorder

Answer 3

• depressed mood
• anhedonia

Question 4

Major depressive disorder: DSM 5

Answer 4

5 or more symptoms INCLUDING depressed mood AND/OR anhedonia
- most of the day, nearly everyday for 2 weeks or more

hx of 1 or more depressive episodes, NO hx of mania

Question 5

Major depressive disorder: symptoms

Answer 5

+/- in appetite, 5% weight change in a month is significant
- sleep changes
- psychomotor agitation or retardation
- fatigue/energy loss
- feelings of worthlessness/guilt
- poor concentration
- recurrent suicidal ideation/past attempt

Question 6

major depressive disorder: categorization of depressive episodes

Answer 6

mild
- symptoms present, result in minor impairment of functioning

moderate
- symptoms & impairment in between mild & severe

severe
- seriously distressing, unmanageable, large interference

Question 7

major depressive disorder: subtypes (2)

Answer 7

peripartum onset
- perinatal (during pregnancy), postpartum (within 3-4 weeks post)

seasonal depression
- annually during fall/winter

Question 8

MDD: MSE (mood/affect)

Answer 8

mood:
- sustained period of low mood
- sadness, hopelessness
- loss of interest
- ANHEDONIA

affect:
- flat
- constricted
- teary

Question 9

MDD: pharmacological interventions

Answer 9

• SSRIs (pram/xetine)
• SNRIs (axine)
• TCAs (ipyline/ipramine)
• MAOIs

Question 10

MDD: non-pharmacological interventions (3)

Answer 10

psychotherapy
- CBT, group therapy

electroconvulsive therapy (ECT)

transcranial magnetic stimulation (TMS)

Question 10

what is ECT?

Answer 10

electrical current is passed through the brain, intentional seizure
- administer anesthetic/paralytics prior

Question 11

when would ECT be used (3)?

Answer 11

• marked vegetative symptoms or catatonia
• treatment resistant BPD
• experiencing acute suicidality

Question 12

what is TMS?

Answer 12

MRI strength magnetic pulses used to stimulate focal areas of the cerebral cortex

Question 13

when would TMS be used?

Answer 13

• MDD (schizophrenia, anxiety disorders being explored)

Question 14

difference between recurrent depressive disorder & depressive disorder

Answer 14

recurrent fluctuates between normal mood to severe depression

depressive disorder is only depression

Question 15

BPD: classifications - bipolar 1 disorder

Answer 15

one or more manic episodes w/ depressive component

Question 16

BPD: classifications - bipolar 2 disorder

Answer 16

periods of major depression accompanied by at least one incidence of hypomania

Question 17

BPD: classifications - cyclothymic disorder

Answer 17

mild form of BPD where mood swings from short period of mild depression and hypomania for at least 2 years

Question 18

BPD chart: bipolar 1, bipolar 2, cyclothymic (whats the range)

Answer 18

bipolar 1 - full range between mania and major depression

bipolar 2 - range between hypomania and major depression

cyclothymic - range between hypomania and minor depression

Question 19

genetics & BPD

Answer 19

not guaranteed pass between parent & child (hereditary)

Question 20

co-occuring disorders (4)

Answer 20

• psychosis
• anxiety disorders, ADHD
• substance use
• eating disorders (binge eating or bulimia)

Question 21

manic/hypomanic episode: DSM 5 - description (2)

Answer 21

period of abnormally elevated, expansive, or irritable mood AND abnormally increased goal-directed activity or energy

Question 22

manic/hypomanic episode: DSM 5 - symptoms

Answer 22

three or more of following symptoms

• Inflated self-esteem or grandiosity
• Decreased need for sleep
• More talkative
• Flight of ideas
• Distractibility
• Increase in goal-directed activity or psychomotor agitation
• Excessive involvement in activities that have a high potential for painful consequences

Question 23

manic vs hypomanic episode (3)

Answer 23

hypomanic is just less severe manic - cause marked impairment in functioning - episode not due to psychologic effects of a substance - lasts at least 7 days hypomanic - cause change in functioning thats uncharacteristic - episode not due to psychologic effects of a substance - lasts at least 4 days

Question 24

manic episode: MSE (mood/affect)

Answer 24

mood: mood swings, feelings of euphoria, extreme irritability affect: labile affect, full range of emotions, exaggerated

Question 25

manic episode: MSE (insight/judgement)

Answer 25

compromised insight into impact of behaviours & diagnosis on behavioural choices engage in high-risk behaviours w/ lack of consideration for consequences KEY: lack impulsive control

Question 26

depressive/minor depressive episode: DSM 5

Answer 26

5 or more of the following symptoms - depressed mood most of everyday - loss of interest in almost all activities - significant weight loss or +/- appetite - engaging in purposeless movements (pacing around room) - fatigue/loss of energy - feelings of worthlessness/guilt - decreased ability to think/concentrate - recurrent thoughts of death, suicidal ideation w/o plan, or attempt

Question 27

depressive vs minor depressive episodes: DSM 5

Answer 27

depressive is 5 or more of the symptoms in a 2 week period minor depressive episode is 2-4 of the symptoms in a 2 week period

Question 28

priority care issues

Answer 28

safety: protect patient from poor judgement/increased impulsivity & increased suicide risk monitor electrolytes and thyroid function - change in eating habits assess effects of medication

Question 29

pharmacological treatment 2 goal & corresponding meds

Answer 29

prevent mood cycling - lithium (mood stabilizer) treat symptomology - antipsychotics - anticonvulsants - antianxiety - antidepressants

Question 30

non-pharmacological interventions

Answer 30

- decrease stimuli - monitor sleep - nutrition/hydration - limit setting, redirect behaviour - maintain safety - psychotherapy - ECT (last resort)