Week 8.3

Question 1

How do we assess someone’s mood?

Answer 1

it must be self-reported

Question 2

What is a euthymic mood?

Answer 2

a normal mood with appropriate valence and moderate variability

Question 3

What are the clinical features of depression?

Answer 3

• persistent sad or irritable mood
• anhedonia
• significant weight or appetite change
• difficulty sleeping or oversleeping
• psychomotor retardation
• difficulty concentrating
• recurrent thoughts of death/suicide

Question 4

What are the three depressive disorders?

Answer 4

• major
• persistent (dysthymic)
• NOS

Question 5

What are the criteria for MDD?

Answer 5

• five or more symptoms

- duration of two weeks

Question 6

Post-partum depression typically begins when?

Answer 6

within the first four weeks of delivery

Question 7

How does PDD compare to MDD?

Answer 7

it is longer but less severe

Question 8

What are the criteria for PDD?

Answer 8

• two or more symptoms

- last for two years or more

Question 9

What are the criteria for DD NOS?

Answer 9

symptoms insufficient to meet criteria for MDD or PDD

Question 10

Depression is linked to what cardiovascular issues?

Answer 10

• hypertension

- MI

Question 11

How does the risk of suicide change with age?

Answer 11

• increases throughout life for caucasians

- peaks between 25-35 for AA and Native Americans

Question 12

What are some risk factors for suicide in depressed patients?

Answer 12

• alcohol or other substance use
• chronic illness
• social isolation
• previous attempts
• family history

Question 13

Which brain structure is key to the pathogenesis of depression?

Answer 13

the hypothalamus

Question 14

How does the HPA play a role in depression?

Answer 14

hyper-secretion of cortisol is believed to contribute

Question 15

Most of the physical symptoms of depression come from what mechanism?

Answer 15

excessive cortisol release

Question 16

What is the dexamethasone suppression test?

Answer 16

• used to assess the HPA axis

- should see a decrease in ACTH and cortisol after

Question 17

What anatomic change has been associated with depression?

Answer 17

hippocampal atrophy

Question 18

What role do cytokines appear to play in depression?

Answer 18

• up regulate subcortical functioning, making us more sensitive to stress
• down regulate cortical functioning that would regulate and decrease this

Question 19

What are the three major bipolar mood disorders?

Answer 19

• bipolar I
• bipolar II
• cyclothymic disorder

Question 20

Criteria for Bipolar I

Answer 20

• manic episode lasting one week

- three or more characteristic symptoms

Question 21

What are the characteristic symptoms of bipolar disorder?

Answer 21

• inflated self-esteem
• decreased need for sleep
• distractibility
• pressured speech

Question 22

What is Bipolar II?

Answer 22

a milder, shorter form of bipolar mood disorder with three symptoms lasting 4 days

Question 23

What are the criteria for cyclothymic disorder?

Answer 23

• two years (1 if adolescent) of numerous hypomanic episodes and depressive episodes not meeting criteria for MDD
• not without symptoms for more than two months

Question 24

What is a mixed manic episode?

Answer 24

one with symptoms of depression and mania

Question 25

What is the kindling effect?

Answer 25

as a person ages, episodes of mania become more frequent, shorter, and more severe

Question 26

What are the major complications of bipolar mood disorder?

Answer 26

- suicide - social or financial devastation - catatonia

Question 27

Describe the neuroanatomic changes associated with bipolar mood disorder.

Answer 27

- frontotemporal hyper-intensities | - alterations to the neuronal phospholipid membranes causing them to depolarize more

Question 28

What NT changes are seen in those with bipolar mood disorder?

Answer 28

- elevated NE - elevated glutamate - chronic HPA activation

Question 29

The kindling effect of bipolar disorder is often attributed to what mechanism?

Answer 29

chronic activation of the HPA axis and the effects of chronic steroids

Question 30

How can bipolar disorder with psychosis be differentiated from schizophrenia?

Answer 30

- bipolar is more cyclic in course | - bipolar has fewer negative symptoms

Question 31

The mental status exam for assessing mood includes what four basic features?

Answer 31

- presentation and behavior - cognitive status - emotional functioning - thought processes and content

Question 32

What two questions can be quickly used in the primary care setting to assess for depression?

Answer 32

- felt down, depressed, or hopeless | - felt little interest or pleasure in doing things

Question 33

Antidepressants have a black box warning for what?

Answer 33

suicide

Question 34

Depression is commonly comorbid with what other disorder?

Answer 34

anxiety

Question 35

How do tricyclics work?

Answer 35

block reuptake of NE and serotonin

Question 36

How do MAOIs work?

Answer 36

block metabolism of NE and DA

Question 37

How do SSRIs work?

Answer 37

block reuptake of serotonin

Question 38

How do SNRIs work?

Answer 38

block reuptake of NE

Question 39

Electroconvulsive therapy is indicated for which patients?

Answer 39

those with depression and... - psychosis - high suicide risk - comorbid medical risks

Question 40

What is the primary treatment for bipolar disorder?

Answer 40

lithium

Question 41

What are the major disadvantages of lithium?

Answer 41

- it takes a long time to build the necessary steady state levels in the blood - therapeutic doses are near toxic

Question 42

Name four drugs used in the treatment of bipolar mood disorders.

Answer 42

- lithlium - valproic acid - carbamazepine - lamotrigine

Question 43

Lithium has what advantages?

Answer 43

- shortens episodes - prolongs remission (is prophylactic) - lowers suicide potential

Question 44

Advantages of valproic acid?

Answer 44

better tolerated by elderly, patients with CNS damage, rapidly cycling patients

Question 45

Why is psychotherapy given before onset of an episode of bipolar disorder?

Answer 45

because the therapy focuses primarily on prevention (e.g. sleep hygiene)