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Flashcards in Mood Disorders Deck (63)
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1

What is the essential feature of major depressive disorder?

a clinical course that is characterized by one or more major depressive episodes without a history of manic, mixed, or hypomanic episodes

2

What is criterion B for major depressive disorder?

not better accounted for by schizoaffective disorder, are not superimposed on schizophrenia, schizophreniform disorder, delusional disorder, or psychotic disorder NOS

3

If the full criteria are met for a major depressive episode, which specifiers may be used to describe the clinical status of the episode?

  • mild, moderate, severe without psychotic features
  • severe with psychotic features
  • chronic
  • with catatonic features
  • with melancholic features
  • with atypical features
  • with postpartum onset

4

If the full criteria for major mood episode are NOT currently met, which specifiers may be used to describe the current clinical status of the major depressive disorder?

  • in partial remission/in full remission
  • chronic
  • with catatonic features
  • with melancholic features
  • with atypical features
  • with postpartum onset

5

Which specifiers may be used to indicate the pattern of episodes and the presence of interepisode symptoms?

  • longitudinal course specifiers (with and without full interepisode recovery)
  • with seasonal pattern

6

What are associated descriptive features of major depressive disorder?

  • high mortality (15% w/severe commit suicide)
  • increase in death rates over 55
  • more pain and physical illness in medical settings
  • may be preceded by dysthymic disorder (10-25%)
  • co-occurs with substance disorders, panic disorder, OCD, anorexia, bulimia, borderline PD

7

Who are the people getting major depressive disorder?

  • twice as common in adolescent/adult females as males
  • atypical features more common in young patients
  • melancholic features more common in older patients

8

Does major depressive disorder generally get better or worse with age?

worse

  • episodes of remission last longer early in course of MDD
  • 60% with one episode will have another
  • 70% with two will have another
  • 90% with three will have another

9

What portion of people with MDD will experience remission of major depressive episodes?

about 2/3

The other third will experience partial remission or no remission at all.

10

A year after the diagnosis of major depressive disorder, what does the patient population look like with regard to symptoms?

  • 40% of individuals still have symptoms sufficiently severe to meet criteria for full major depressive episode
  • 20% continue to have some symptoms, but don't meet full criteria
  • 40% have no mood disorder

The severity of the first major depressive episode appears to predict persistence.

11

What other disorders might be confused with major depressive disorder?

  • mood disorder due to a general medical condition
  • substance-induced mood disorder
  • dysthymic disorder
  • schizoaffective disorder
  • schizophrenia/delusional disorder/psychotic NOS
  • dementia

12

What are the differences between major depressive disorder and dysthymic disorder?

differentiated by severity, chronicity, and persistence

MDD: Depressed mood must be present most of the day, nearly every day, for at least two weeks. 1+ discrete major depressive episodes, distinguished from person's major functioning.

Dysthymic: depressed mood must be present more days than not over period of two years. Chronic, less severe symptoms present for many years. Must have been present first for dual diagnosis.

13

What is the essential feature of dysthymic disorder?

a chronically depressed mood that occurs for most of the day more days than not for at least two years

14

What is the difference in dysthymic disorder diagnosis in children vs. adults?

Children only need to have depressed mood for one year, not two.

15

What is criterion B of dysthymic disorder?

presence, while depressed, of two or more of the following:

  1. poor appetite or overeating
  2. insomnia or hypersomnia
  3. low energy or fatigue
  4. low self-esteem
  5. poor concentration or difficulty making decisions
  6. feelings of hopelessness

16

What is criterion C for dysthymic disorder?

During the two-year period (1 for children/adolescents) of the disturbance, the person has never been without the symptoms in criterion A and B for more than two months at a time.

17

What is criterion D of dysthymic disorder?

No major depressive episode has been present during the first two years od the disturbance (1 for kids/ados); i.e., the distrubance isn;t better accounted for by chronic major depressive disorder or major depressive disorder in partial remission.

18

What is criterion E of dysthymic disorder?

There has never been a manic episode, a mixed episode, or a hypomanic episode, and the criteria have never been met for cyclothymic disorder.

19

What are criteria F and G of dysthymic disorder?

F. The disturbance does not occur exclusively during the course of a chronic psychotic disorder, such as schizophrenia or delusional disorder

G. The symptoms are not due to the direct physiological effects of a substance or general medical condition.

20

What is criterion H of dysthymic disorder?

The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

21

What are the specifiers for dysthymic disorder?

  • early onset (if before 21)
  • late onset (if 21 or older)
  • For most recent two years of dysthymic disorder, specify if "with atypical features"

22

What other disorder is frequently superimposed on dysthymic disorder?

major depressive disorder

  • this is often the reason patients with dysthymic disorder seek treatment
  • up to 75% of clinical patients with dysthymic disorder will develop MDD within five years

23

In children, do boys or girls get dysthimic disorder more?

They're both affected equally, and often result in impaired school performance and social interaction. Children and adolescents with dysthymic disorder are often cranky and irritable, as well as depressed.

24

In adulthood, do men or women develop dysthymic disorder more commonly?

women

Women are two to three times more likely to develop dysthymic disorder than men.

25

How can dysthymic disorder be differentiated from major depressive disorder?

  • onset: which one came first
  • duration: DD must last at least two years
  • severity: DD is generally less severe
  • persistence: DD is fairly chronic, not discrete mood episodes like in MDD

26

How can dysthymic disorder be distinguished from the mood symptoms that accompany psychotic disorders?

A separate diagnosis of dysthymic disorder is not made if the mood symptoms only occur during the course of the psychotic disorder (including residual phases).

27

How can dysthymic disorder be differentiated from the personality disorders?

it doesn't have to be

Dysthymic disorder is commonly associated with borderline, histrionic, narcissistic, avoidant, and dependent personality disorders, but they can coexist and both diagnoses can be made.

28

What is the essential feature of bipolar I disorder?

A clinical course that is characterized by the occurrence of one or more manic episodes or mixed episodes. Often individuals have also had one or more major depressive episodes.

29

In addition to the essential feature of bipolar I disorder, what are other requirements for diagnosis?

  • not substance-induced or due to a general medical condition
  • not better accounted for by schizoaffective disorder and are not superimposed on schizophrenia, schizophreniform, delusional disorder, or psychotic disorder NOS.

30

Bipolar I disorder is subclassified in the fourth digit of the code according to whether the individual is experiencing a _______ or whether the disorder is _______.

first episode; recurrent