Term
| What is the difference between mood disorders and mood episodes? |
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Definition
-Mood episodes are distinct periods of time in which some abnormal mood is present.
-Mood disorders are defined by their patterns of mood episodes (i.e. alternating with manic periods) |
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Term
| What are the criteria for diagnosing a major depressive episode? |
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Definition
-Patients should have 5 (must include anhedonia or depressed mood) of the following for at least a 2 week period:
SIG E CAPS
Sleep disturbances
Loss of interest (anhedonia)
Depressed mood (not in the mnemonic)
Guilt or worthlessness
Decreased energy or fatigue
Concentration reduced
Appetite decreased (or increased in atypical depression)
Psychomotor agitation or retardation (slowness or restlessness)
Suicidal ideation
-Sxs cannot be due to substance abuse or medical conditions and must cause social or occupational impairment |
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Term
| What is the lifetime risk of suicide in a patient with hospitalized for a major depressive episode? |
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Definition
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Term
| A period of abnormally and peristently elevated, expansive, or irritable mood |
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Definition
| Manic episode
-must have for 1 week 3 of the following criteria (4 if mood is irritable)
DIG FAST
Distractibility
Insomnia
Grandiosity
Flight of ideas or racing thoughts
Agitation, increase in goal directed activity (socially, at work, or sexually)
Speech (pressured) or more talkative
Thoughtlessness (excessive involvement in pleasurable activities, i.e. shopping sprees, sexual indiscretions)
-cannot be due to substance abuse or other medical condition and must cause social or occupational impairment |
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Term
| What is the disorder when criteria are met for both manic episode and major depressive episode for nearly every day for at least 1 week? |
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Definition
Mixed episode
PSYCHIATRIC EMERGENCY
-irritability is the predominant sx
-Poor response to lithium, but respond to anti-convulsants |
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Term
| What is a hypomanic episode? |
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Definition
-distinct period of elevated, expansive or irritable mood that includes 3 of manic episode (4 if mood is irritable) lasting for at least 4 days with no marked impairment in functioning.
-does not require hospitalization
-NO PSYCHOTIC FEATURES |
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Term
| Patient with psychotic features and manic sxs without significant life impairment; can this be hypomania? |
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Definition
| NO! Hypomania by definition never contains psychotic features. |
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Term
| What are some common medications that cause mania? |
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Definition
Corticosteroids
Sympathomimetics (b2-agonists)
Dopamine agonists
Antidepressants
Bronchodilators
Levodopa |
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Term
| 65 year-old widow has been "not taking care of herself". Lately, she wakes up earlier than she normally does and sits around all day "doing nothing". She stopped attending bingo and says there's nothing left to life now. |
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Definition
Major Depressive Disorder
-marked by episodes of depressed mood ass'd with loss of interest in daily activities
-Criteria:
At least one major depressive episode
No history of manic or hypomanic episode |
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Term
| What sleep abnormalities are present in MDD? |
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Definition
-Multiple awakenings
-Initial and terminal insomina (hard to fall sleep and early morning awakenings)
-Hypersomnia
-REM sleep shifted to earlier in the night and decreased stage 3 and 4 sleep |
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Term
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Definition
-Decreased brain and CSF serotonin and 5-HIAA (primary metabolite of serotonin)
-Drugs that increase the availability of serotonin, NE, and dopamine alleviate the sxs
-high cortisol (dexameth suppression test does not suppress cortisol)
-Abnl thyroid axis |
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Term
| autonomic instability, hyperthermia, seizures, coma or death may result |
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Definition
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Term
| Prognosis and treatment of patient with MDD |
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Definition
Prognosis: Episodes are Self-limited and last between 6-13 months. 50% of patients will have a recurrent episode in the first 2 years. 75% are treated successfuly with medical therapy
1st line:
SSRIs
Wellbutrin
2nd-3rd line:
TCAs
MAOI's
Stimulants
Antipsychotics |
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Term
| Useful treatment in atypical depression? |
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Definition
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Term
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Definition
| sexual, headache, GI dysfunction, rebound anxiety |
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Term
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Definition
| anticholinergic effects (blind as a bat, mad as a hatter), orthostatic hypotension, weight gain, lethal in overdose |
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Term
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Definition
-Tyramine crisis causing severe hypertension
-risk of serotonin syndrome when combined with SSRI's
-orthostatic hypotension |
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Term
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Definition
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Term
| What are the criteria for bipolar I disorder? |
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Definition
| Only requirment is the occurence of 1 manic or mixed episode; between manic episodes depression or other mood disorders may be present by are not required |
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Term
| Is bipolar disorder hereditary? |
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Definition
| First-degree relatives of patients with BD are 8 to 18 times more likely to develop the illness |
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Term
| How do you treat bipolar disorder |
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Definition
-Untreated will last for 3 months
-Pharm:
MOOD STABILIZERS
Lithium
AED: (Carbamazepine, Valproic acid are especially good for rapid cycling bipolar or mixed episodes)
Olanzepine (typical antipsychotic) |
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Term
| Occurence of four or more mood episodes in 1 year (major depressive, manic, mixed) |
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Definition
Rapid cycling disorder
Tx of rapid cycling bipolar disorder=
AED |
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Term
| Hypomanic episodes + depressive symptoms |
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Definition
| Bipolar II disorder
Criteria: history of one or more MDE and at least 1 hypomanic episode
-IF THERE HAS BEEN A FULL MANIC EPISODE, EVEN IN THE PAST, THE DIAGNOSIS IS NOT BIPOLAR II DISORDER, BUT BIPOLAR I; SIMILARLY, THERE COULD NOT HAVE BEEN ASSOCIATED PSYCHOSIS WITH THE MANIA OR IT CANNOT BE HYPOMANIA
-Tx the same as bipolar I disorder |
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Term
| What are some lithium side effects? |
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Definition
| weight gain, termor, fatigue, arrhythmias, seizures, hypothyroidism/goiter, leukocytosis, coma, polyuria/polydipsia, alopecia |
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Term
| 28 year-old woman with sadness. Doesn't remember the last time she did something fun. She denies any suicidal thoughts or having any other symptoms. |
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Definition
Dysthymia
-chronic, mild depression vs. episodic depression in MDD
-Criteria:
1. Depressed mood for the majority of time of most days for 2 years (1 year in kids)
2. 2 of CHASES
-poor concentration, hopelessness, appetite (up or down), somnia (hypo or hyper), energy (low or fatigue), self-esteem (low)
3. During the 2 year period, pt has not been without the sxs for >2 months at a time and no major depressive episode within the 2 years
-also, pt must have never had any manic or hypomanic episode (would make the dx of bipolar or cyclothymic d/o respectively) |
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Term
| What is the mnemonic for dysthymia |
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Definition
CHASES DDs
sxs (chases) and 2 years of depression and 2 listed criteria |
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Term
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Definition
-Cognitive therapy and insight-oriented psychotherapy
-COncurrent antidepressant medications (SSRIs, TCAs, MAOIs) |
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Term
| 28 year-old graduate student with "ups and downs". Further questioning reveals that over 2 years, she has had episodes of extreme happiness in which she would party every day + "tons of evergy." She also describes being "down in the dumps at times for no apparent reasons." |
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Definition
Cyclothymic disoder (alternating periods of hypomania and periods of mild-moderate depressive sxs)
-Criteria:
numerious periods with hypomanic sxs and periods of depressive sxs for at least 2 years
-Patient never sx free for >2 months during those 2 years
-No hx of MDE or manic episode
Tx: antimanic agents as used to treat bipolar disorder |
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Term
| Prognosis in patients with cyclothymia |
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Definition
| chronic course, 33% are eventually diagnosed with bipolar disorder |
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