Term
| Major Depressive Disorder |
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Definition
diagnosedinpatientswhohavesuffered at least one MDE
• Periodlastingatleasttwoweeks,withfiveor more of the following symptoms: depressed mood, anhedonia, insomnia or hypersomnia, change in appetite or weight, psychomotor retardation or agitation, low energy, poor concentration, thoughts of worthlessness or guilt, and recurrent thoughts about death or suicide |
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Term
| Mnemonic for Major Depressive Disorder |
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Definition
SIGECAPS
S=sleep
I=lack of interest
G=guiltiness/worthlessness
E=lack of energy
C=lack of concentration
A=lack of appetite
P=psychomotor retardation
S=suicidal thinking |
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Term
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Definition
• Ask all depressed patients about SI
• If positive, ask about the specific nature of the ideation, intent, plans, available means (e.g., firearms), and actions
• Assess the patient for risk factors for suicide: history of suicide attempts, comorbid psychiatric and general medical illnesses, and family history of suicidal behavior |
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Term
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Definition
• Must cause significant distress in social, occupational, or other important areas of functioning
• Not attributable to the physiological effects of a substance or to another medical condition
• Not better explained by another condition (e.g., schizoaffective disorder, bipolar) |
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Term
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Definition
• ~7%intheUSinagivenyear
• Females experience 1.5- to 3-fold higher rates than males beginning in early adolescence
• The lifetime prevalence in developed countries (United States and Europe) approximately 18 percent |
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Term
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Definition
• Major depressive disorder may first appear at any age, but the likelihood of onset increases markedly with puberty.
• In the United States, incidence appears to peak in the 20s; however, first onset in late life is not uncommon
• Prevalence in 18-29 year-olds x 3 higher than 60 years or older |
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Term
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Definition
• Current research suggests that MDD is caused by a combination of genetic, biological, environmental, and psychological factors
• Neuroanatomical, neuroendocrinological, and neurophysiological evidence
• Heritability is approximately 40%, and the personality trait neuroticism accounted for a substantial portion of this genetic liability
• No biomarker has yielded results of sufficient sensitivity and specificity |
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Term
| MDD With atypical features |
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Definition
Feelsbetterinpositive events
• Significantweightgainorincreaseinappetite.
• Hypersomnia
• Heavy,leadenfeelingsinarmsorlegs
• Long-standing pattern of interpersonal rejection sensitivity |
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Term
| MDD with psychotic features |
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Definition
| Delusions and/or hallucinations are present |
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Term
| MDD with seasonal pattern |
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Definition
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Term
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Definition
• disruptive mood dysregulation disorder (behavioral outbursts in children up to age 12 not characteristic of age)
• persistent depressive disorder (dysthymia)
• premenstrual dysphoric disorder (begins sometime following ovulation and remits within a few days of menses and has a marked impact on functioning
• substance/medication-induced depressive disorder |
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Term
| Differential Diagnosis for depression |
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Definition
• Depressive disorder due to another medical condition (e.g., multiple sclerosis, stroke, hypothyroidism).
• Bipolar disorder
• Adjustment disorder with depressed mood
• Sadness |
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Term
| Comorbidity for depression |
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Definition
• Substance-related disorders
• Anxiety/panic disorder
• Obsessive-compulsive disorder
• Anorexia nervosa, bulimia nervosa • Borderline personality disorder |
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Term
| Neurocognitive Function with depression |
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Definition
• Canhaveimpairedabilitytothinkand concentrate
• Theymayappeareasilydistractedorcomplain of memory difficulties. Those engaged in cognitively demanding pursuits are often unable to function
• Inchildren,aprecipitousdropingradesmay reflect poor concentration
• In elderly individuals, memory difficulties maybe the chief complaint and may be mistaken for early signs of a dementia (“pseudodementia”) |
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Term
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Definition
• Therapy plus medication is the gold standard for moderate to severe
• SSRI (e.g., prozac and lexapro)
• SNRI (e.g., effexor and cymbalta)
• Atypical (e.g., wellbutrin and remeron)
• TCA
• MAOI |
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Term
| Response to MDD treatment |
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Definition
• 2-3 weeks usual before effects
• 6-12 weeks likely trial
• The results from a large-scale long-term study (STAR*D) found a 37% remission among 3671 outpatients who were treated with citalopram, and a remission rate of 67% after all txs
• If>2 trials fail, combination rx can be tried(e.g., antipsychotic and antidepressants), TCA, MAOI, ECT, ketamine |
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Term
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Definition
• Significant functional impairment
• Bipolar I people go through cycles of major depression and mania
• Bipolar II similar to Bipolar I except that people have hypomanic episodes, a milder form of mania |
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Term
| DSM-5 Criteria for Manic Episode |
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Definition
A. A distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased activity or energy, lasting at least one week and present most of the day, nearly every day (or any duration if hospitalization is necessary).
B. During the period of mood disturbance and increased energy or activity, three (or more) of the following symptoms (four if the mood is only irritable) are present to a significant degree and represent a noticeable change from usual behavior:
1) Inflated self-esteem or grandiosity.
2) Decreased need for sleep (eg, feels rested after only three hours of sleep). 3) More talkative than usual or pressure to keep talking.
4) Flight of ideas or subjective experience that thoughts are racing.
5) Distractibility (ie, attention too easily drawn to unimportant or irrelevant external stimuli), as reported or observed.
6) Increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation (ie, purposeless non-goal-directed activity). 7) Excessive involvement in activities that have a high potential for painful consequences (eg, engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investments).
C. The mood disturbance is sufficiently severe to cause marked impairment in social or occupational functioning or to necessitate hospitalization to prevent harm to self or others, or there are psychotic features.
D. The episode is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication, other treatment) or to another medical condition.
NOTE: A full manic episode that emerges during antidepressant treatment (e.g., medication,
electroconvulsive therapy) but persists at a fully syndromal level beyond the physiological effect of that treatment is sufficient evidence for a manic episode and, therefore, a bipolar I diagnosis. |
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Term
| DSM-5 Criteria for Hypomanic Episode |
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Definition
A. A distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased activity or energy, lasting at least four consecutive days and present most of the day, nearly every day.
B. During the period of mood disturbance and increased energy and activity, three (or more) of the following symptoms (four if the mood is only irritable) have persisted, represent a noticeable change from usual behavior, and have been present to a significant degree:
1) Inflated self-esteem or grandiosity.
2) Decreased need for sleep (e.g., feels rested after only three hours of sleep).
3) More talkative than usual or pressure to keep talking.
4) Flight of ideas or subjective experience that thoughts are racing.
5) Distractibility (ie, attention too easily drawn to unimportant or irrelevant external stimuli), as reported or observed.
6) Increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation.
7) Excessive involvement in activities that have a high potential for painful consequences (eg, engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investments).
C. The episode is associated with an unequivocal change in functioning that is uncharacteristic of the individual when not symptomatic.
D. The disturbance in mood and the change in functioning are observable by others.
E. The episode is not severe enough to cause marked impairment in social or occupational functioning or to necessitate hospitalization. If there are psychotic features, the episode is, by definition, manic.
F. The episode is not attributable to the physiological effects of a substance (eg, a drug of abuse, a medication, or other treatment).
NOTE: A full hypomanic episode that emerges during antidepressant treatment (eg, medication, electroconvulsive therapy) but persists at a fully syndromal level beyond the physiological effect of that treatment is sufficient evidence for a hypomanic episode diagnosis. However, caution is indicated so that one or two symptoms (particularly increased irritability, edginess, or agitation following antidepressant use) are not taken as sufficient for a diagnosis of a hypomanic episode, nor necessarily indicative of a bipolar diathesis. |
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Term
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Definition
DIGFAST
Distractible
Increased activity/psychomotor agitation
Grandiosity/Super-hero mentality
Flight of ideas or racing thoughts
Activities that are dangerous or hypersexual
Sleep decreased
Talkative or pressured speech |
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Term
| DSM-5 Criteria for Bipolar Major Depression |
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Definition
• Criteria the same as MDD
• Period lasting at least two weeks, with five or more of the following symptoms: depressed mood, anhedonia, insomnia or hypersomnia, change in appetite or weight, psychomotor retardation or agitation, low energy, poor concentration, thoughts of worthlessness or guilt, and recurrent thoughts about death or suicide |
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Term
| specifying bipolar disorder |
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Definition
Bipolar I with ...anxious distress, mixed features, rapid cycling, melancholic features, atypical features, psychotic features, catatonia, peripartum onset, seasonal pattern
Individuals with bipolar I disorder who have multiple (four or more) mood episodes (major depressive, manic, or hypomanic) within 1 year receive the specifier “with rapid cycling.” |
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Term
| DSM-5 Criteria for Cyclothymic Disorder |
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Definition
• For at least 2 years (at least 1 year in children and adolescents) there have been numerous periods with hypomanic symptoms that do not meet criteria for a hypomanic episode and numerous periods with depressive symptoms that do not meet criteria for a major depressive episode.
• During the above 2-year period (1 year in children and adolescents), the hypomanic and depressive periods have been present for at least half the time and the individual has not been without the symptoms for more than 2 months at a time.
• Criteria for a major depressive, manic, or hypomanic episode have never been met.
• The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. |
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Term
| Epidemiology of Bipolar Disorder |
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Definition
• Prevalence: 1% of population
• Adults = Adolescents
• Males = Females
• 2-3 million American adults are diagnosed with bipolar disorder |
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Term
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Definition
• Mean age 18 years for bipolar I disorder
• Onset occurs throughout the life cycle, including first onsets in the 60s or 70s
• However, manic symptoms (e.g., sexual or social disinhibition) in late mid-life or late- life should prompt consideration of medical conditions (e.g., frontotemporal dementia) and substance ingestion or withdrawal. |
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Term
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Definition
• Signsandsymptomssuchasirritability,anxiety, mood lability (“mood swings”), agitation, aggressiveness, sleep disturbance, and hyperactivity may precede onset of diagnosable bipolar disorder, but the proportion of patients varies widely across studies
• In addition, the same features can occur during the prodrome of other psychiatric disorders. |
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Term
| Characteristics of Bipolar |
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Definition
• Themoodepisodeatonsetofbipolardisorderis usually major depression. In a study of 2308 patients, the first lifetime episode was:
• Majordepressionin54percent
• Maniain22percent
• Mixedin24percent
• Morethan90%ofindividualswhohaveasingle manic episode go on to have recurrent mood episodes.
• Approximately60% of manic episodes occur immediately before a major depressive episode |
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Term
| Pediatric-Onset Bipolar Disorder |
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Definition
• Can be difficult to dx-must take into account developmental age
• Bipolar symptoms in children may be vaguer and shorter lived than in adolescents and adults
• Usually presents with MDD
• A study found of that out of children with
MDD, 48.6% (N=35) developed bipolar
disorder by mean age 20.7 years |
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Term
| Pathophysiology of Bipolar Disorder |
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Definition
• Unknown etiology-likely multifactorial
• Brain Structure and Functioning: Some studies show how the brains of people with bipolar disorder may differ from the brains of healthy people or people with other mental disorders.
• Genetics: Some research suggests that people with certain genes are more likely to develop bipolar disorder than others. But genes are not the only risk factor for bipolar disorder. Studies of identical twins have shown that even if one twin develops bipolar disorder, the other twin does not always develop the disorder, despite the fact that identical twins share all of the same genes. Schizophrenia and bipolar disorder likely share a genetic origin, reflected in familial co-aggregation
• Family History: Bipolar disorder tends to run in families. |
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Term
| Epidemiology of Bipolar Disorder |
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Definition
• 50% Relatives with bipolar disorder
• 30-70% Identical twins
• 75% Both parents bipolar
• 70-90% Have other disorders |
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Term
| Comorbidity/DDx for biolar |
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Definition
• Often very complicated; it mimics many other disorders and has comorbidity (presents with other disorders)
• Alphabet soup diagnosis
• Patients with bipolar disorder commonly manifest comorbid psychiatric disorders, including:
• Anxiety disorders-75%
• Substance use disorders-52% (BP1) or 37% (BP2)
• Personality disorders-51%
• Attention deficit hyperactivity disorder (ADHD)-31%
• Intermittent explosive disorder-29%
• OCD-14%
• Eating disorders-3-9% |
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Term
| Other Medical Diagnoses to consider w bipolar |
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Definition
• It is important to first rule out the possibility of any other organic diagnosis:
• Thyroid disorder
• Seizure disorder
• Multiple sclerosis
• Infectious, toxic, and drug-induced disorders |
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Term
| Neurocognitive Function bipolar |
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Definition
• Multiple studies using standardized tests demonstrate that neuropsychological function in bipolar patients is impaired during euthymia as well as mood episodes. As an example, a meta- analysis of 45 observational studies compared 1423 euthymic bipolar patients with 1524 healthy controls, and found several deficits in patients, including impaired.
• Attention
• Verbal memory
• Executive function (e.g., planning, concept or set shifting, and response inhibition)
• Information processing speed
• A meta-analysis of 20 observational studies (650 euthymic bipolar patients and 607 healthy controls) found statistically significant, clinically large deficits in theory of mind, as well as clinically small to moderate impairments in emotion processing. |
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Term
| Suicide Risk Factors for bipolar |
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Definition
• 22% of adolescents with completed suicides had bipolar disorder
• Family history of suicide
• Substance abuse i.e. adolescent with impulse control disorder, depression, suicidality, substance use and access to a weapon is potential for lethality |
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Term
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Definition
• Lithium-reduces the risk of relapse by approximately 30 percent. Reduces SI.
• Anticonvulsants
• Valproate (depakote)-also reduces the risk
30%
• Lamotrigine- reduces the risk 16%; better for dep sx.
• Others: carbamazepine, oxcarbazepine
• Antipsychotics (Quetiapine)- good with dep sx. Others: arpiprazole, olanzapine, risperidone.
• Antidepressants?
• Combination of above if first tx is ineffective |
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