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Psychiatry > Mood Disorders > Flashcards

Mood Disorders Flashcards

1
Q

What is the definition of mood?

What do patients with mood disorders experience?

Mood disorders have also been called….

A
  • Mood - description of one’s internal emotional state
  • Patients with mood disorders experience an abnormal range of moods and lose some level of control over them
  • Mood disorders = affective disorders
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2
Q

Mood disorders vs. Mood Episodes

A
  • Mood episodes
    • Distinct periods of time in which some abnormal mood is present
  • Mood disorders
    • Defined by patterns of mood episodes
  • Some may have psychotic features (delusions or hallucinations)
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3
Q

What are the 4 types of mood episodes?

A
  • Major depressive episode
  • Manic episode
  • Mixed episode
  • Hypomanic episode
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4
Q

What are the 5 types of main mood disorders?

A
  • Major depressive disorder (MDD)
  • Bipolar I disorder
  • Bipolar II disorder
  • Dysthymic disorder
  • Cyclothymic disorder
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5
Q

How is Major Depressive Episode defined by DSM-IV criteria?

A

Must have at least 5 of the following symptoms (must have either #1 or #2) for at least a 2-wk period:

  • Depressed mood
  • Anhedonia (loss of interest in pleasurable activites)
  • Change in appetite or body weight (increased or decreased)
  • Feelings of worthlessness or excessive guilt
  • Insomnia or hypersomnia
  • Diminished concentration
  • Psychomotor agitation or retardation (restlessness or slowness)
  • Fatigue or loss of energy
  • Recurrent thoughts of death or suicide

*symptoms must not be due to substance use or medical conditions, must cause social/occupational impairment*

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6
Q

What is the acronym for symptoms of major depression?

A

SIG E CAPS

  • Sleep
  • Interest
  • Guilt
  • Energy
  • Concentration
  • Appetite
  • Psychomotor activity
  • Suicidal ideation
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7
Q

A person who has been previously hospitalized for a major depressive episode has a ___% risk of commiting suicide later in life.

A

15%

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8
Q

How is Manic Episode defined by DSM-IV criteria?

A

A period of abnormally & persistently elevated, expansive or irritable mood, lasting at least 1 wk and including at least 3 of the following (4 if mood is irritable)

  • Distractibility
  • Inflated self-esteem or grandiosity
  • Increase in goal-directed activity (socially, at work, or sexually)
  • Decreased need for sleep
  • Flight of ideas or racing thoughts
  • More talkative or pressured speech (rapid & uninterruptible)
  • Excessive involvement in pleasurable activities that have a high risk of negative consequences (ex: buying sprees, sexual indiscretions)

*symptoms can’t be due to substance use or medical conditions, must cause social or occupational impairment, 75% of patients have psychotic symptoms*

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9
Q

What is the acronym for symptoms of mania?

A

DIG FAST

  • Distractability
  • Insomnia
  • Grandiosity
  • Flight of ideas
  • Activity/agitation
  • Speech (pressured)
  • Thoughtlessness
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10
Q

What is the definition of a mixed episode?

A
  • Criteria are met for both manic episode and major depressive episode
  • These criteria must be present nearly every day for at least 1 week
  • Psychiatric emergency
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11
Q

What is the definition of a hypomanic episode?

A

Distinct period of elevated, expansive or irritable mood that includes at least 3 of the symptoms listed for the manic episode criteria (4 if mood is irritable)

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12
Q

What are the fundamental differences between mania and hypomania?

A
  • Mania
    • Lasts at least 7 days
    • Causes severe impairment in social or occupational functioning
    • May necessitate hospitalization to prevent harm to self or others
    • May have psychotic features
  • Hypomania
    • Lasts at least 4 days
    • No marked impairment in social or occupational functioning
    • Does not require hospitalization
    • No psychotic features
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13
Q

What are medical causes of a depressive episode?

A
  • Cerebrovascular disease
  • Endocrinopathies
    • Cushing’s syndrome, Addison’s disease, hypoglycemia, hyper/hypothyroidism, hyper/hypocalcemia
  • Parkinson’s disease
  • Viral illness (mononucleosis)
  • Carcinoid syndrome
  • Cancer (lymphoma & pancreatic carcinoma)
  • Collagen vascular disease (SLE)
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14
Q

What are the medical causes of a manic episode?

A
  • Metabolic (hyperthyroidism)
  • Neurological disorders
    • Temporal lobe seizures
    • Multiple sclerosis
  • Neoplasms
  • HIV infection
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15
Q

What are some causes of medication/substance-induced depressive episodes?

A
  • EtOH
  • Antihypertensives
  • Barbiturates
  • Corticosteroids
  • Levodopa
  • Sedative-hypnotics
  • Anticonvulsants
  • Antipsychotics
  • Diuretics
  • Sulfonamides
  • Withdrawal from psychostimulants (cocaine, amphetamines)
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16
Q

What are some causes of medication/substance-induced mania?

A
  • Corticosteroids
  • Sympathomimetics
  • Dopamine
  • Agonists
  • Antidepressants
  • Bronchodilators
  • Levodopa
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17
Q

What is the DSM-IV criteria for major depressive disorder?

A
  • At least one major depressive episode
  • No history of manic or hypomanic episode
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18
Q

What is seasonal affective disorder?

A
  • Subtype of MDD
  • Major depressive episodes occur only during winter months (fewer daylight hours)
  • Patients respond to treatment with light therapy
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19
Q

Major depressive disorder

  • Lifetime prevalence: ___%
  • Average age of onset is ___
  • Women vs. men?
  • SES differences?
  • Prevalence in elderly from ___ to ___%.
A
  • Lifetime prevalence: 15%
  • Average age of onset is 40
  • 2x as prevalent in women than men
  • No ethnic/SES differences
  • Prevalence in elderly from 25-50%
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20
Q

What are some sleep problems associated with major depressive disorder?

A
  • Multiple awakenings
  • Initial and terminal insomnia
    • Hard to fall asleep and early morning awakenings
  • Hypersomnia
  • Rapid eye movement (REM) sleep shifted to earlier in night and stages 3 & 4 decreased
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21
Q

What are 4 likely etiologies of major depressive disorder?

A
  • Abnormalities of serotonin/catecholamines
  • Other neuroendocrine abnormalities
  • Psychosocial/life events
  • Genetic predisposition
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22
Q

Etiology of MDD

Abnormalities of serotonin & catecholamines

A
  • Decreased brain & CSF levels of serotonin and its main metabolite 5-HIAA are found in depressed patients
  • Abnormal regulation of beta-adrenergic receptors has also been shown
  • Drugs that increase availability of serotonin, NE & dopamine often alleviate symptoms of depression
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23
Q

Etiology of MDD

Other neuroendocrine abnormalities

A
  • High cortisol
    • Hyperactivity of hypothalamic-pituitary-adrenal axis as shown by failure to suppress cortisol levels in dexamethasone suppression test
  • Abnormal thyroid axis
    • Thyroid disorders associated w/ depressive symptoms
    • 1/3 MDD patients who have otherwise normal thyroid levels show blunted response of TSH to infusion of TRH
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24
Q

Etiology of MDD

Psychosocial/life events

A
  • Loss of a parent before age 11 is associated with the later development of major depression
  • Stable family and social functioning have been shown to be good prognostic indicators in the course of major depression
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25
Q

Etiology of MDD

Genetic predisposition

A
  • 1st-degree relatives are 2-3x more likely to have MDD
  • Concordance rate for monozygotic twins is about 50%, 10-25% for dizygotic twins
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26
Q

What is the typical course and prognosis of Major Depressive Disorder?

How many patients eventually commit suicide?

A
  • If left untreated, depressive episodes are self-limiting but usually last from 6-13 months
  • Episodes occur more frequently as the disorder progresses
  • Risk of subsequent episode is 50% within the first 2 yrs after the first episode
  • About 15% of patients eventually commit suicide.
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27
Q

How can medications be used to treat Major Depressive Disorder?

A
  • Antidepressant medications signficantly reduce the length and severity of symptoms
  • May be used prophylactically btwn major depressive episodes to reduce the risk of subsequent episodes
  • 75% of patients are treated successfully with medical therapy
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28
Q

What are the 4 main treatment options for Major Depressive Disorder?

A
  • Hospitalization
  • Pharmacotherapy
  • Psychotherapy
  • Electroconvulsive therapy
29
Q

When is hospitalization indicated for major depressive disorder?

A

Indicated if patient is at risk for suicide, homicide or is unable to care for self

30
Q

What are the 3 categories of antidepressant medications?

A
  • Selective serotonin reuptake inhibitors (SSRIs)
  • Tricyclic antidepressants (TCAs)
  • Monoamine oxidase inhibitors (MAOIs)
31
Q

What are the side effects of SSRIs?

A
  • Safer and better tolerated than other classes of antidepressants
  • Side effects mild but include:
    • Headache
    • GI disturbance
    • Sexual dysfunction
    • Rebound anxiety
32
Q

What are the side effects of TCAs?

A
  • Most lethal in overdose
  • Side effects
    • Sedation
    • Weight gain
    • Orthostatic hypotension
    • Anticholinergic effects
    • Can aggravate prolonged QTC syndrome
33
Q

What are the side effects of MAOIs?

A
  • Useful for treatment of refractory depression
  • Risk of hypertensive crisis when used with sympathomimetics or ingestion of tyramine-rich foods (wine, beer, aged cheeses, liver, smoked meats)
  • Risk of serotonin syndrome when used in combination with SSRIs
  • Most common side effect: orthostatic hypotension
  • Tyramine is an intermediate in the conversion of tyrosine to NE
34
Q

What are 3 common adjuvant medications used for major depressive disorder?

Why are they used?

A
  • Stimulants (methylphenidate)
    • Terminally ill, patients w/ refractory symptoms
    • Action rapid, but potential for dependence limits use
  • Antipsychotics
    • Patients w/ psychotic features
  • Liothyronine (T3), Levothyroxine (T4), lithium, L-tryptophan (serotonin precursor)
    • Convert nonresponders to responders
35
Q

What type of psychotherapy is useful for major depressive disorder?

A
  • Behavioral therapy
  • Cognitive therapy
  • Supportive psychotherapy
  • Dynamic psychotherapy
  • Family therapy
  • May be used in conjunction with pharmacotherapy
36
Q

When is electroconvulsive therapy indicated for MDD?

Is it safe?

A
  • Indicated if:
    • Patient is unreponsive to pharmacotherapy
    • Patient cannot tolerate pharmacotherapy
    • Rapid reduction of symptoms is desired (suicide risk, etc)
  • ECT is safe and may be used alone or in combination with pharmacotherapy
37
Q

How is ECT performed?

What is a common side effect?

A
  • Premedication with atropine
  • General anesthesia, admin of muscle relaxant
  • Generalized seizure induced
    • Passing current of electricity across the brain (unilateral or bilateral)
    • Seizure lasts <1 min
  • 8 treatments administered over 2-3 week period, significant improvement often noted after 1st treatment
  • Common SE: retrograde amnesia (disappears w/i 6 months)
38
Q

What is Melancholic Depression?

A
  • 40-60% of hospitalized patients with major depression
  • Characterized by:
    • Anhedonia
    • Early morning awakenings
    • Psychomotor disturbance
    • Excessive guilt
    • Anorexia
  • Example: MDD with melancholic features
39
Q

What is Atypical Depression?

A
  • Characterized by:
    • Hypersomnia
    • Hyperphagia
    • Reactive mood
    • Leaden paralysis
    • Hypersensitivity to interpersonal rejection
40
Q

What is Catatonic Depression?

A
  • Characterized by:
    • Catalepsy (immobility)
    • Purposeless motor activity
    • Extreme negativism or mutism
    • Bizarre postures
    • Echolalia
  • May also be applied to bipolar disorder
41
Q

What is Psychotic Depression?

A
  • 10-25% of hospitalized depressions
  • Characterized by:
    • Delusions
    • Hallucinations
42
Q

Bipolar I disorder is traditionally known as….

A

Manic Depression

43
Q

What is the DSM-IV Criteria for Bipolar I Disorder?

A
  • Only requirement is the occurence of one manic or mixed episode
    • 10-20% of patients experience only manic
  • May be interspersed euthymia, major depressive episodes, dysthymia or hypomanic episodes (but none required for diagnosis)
44
Q

Bipolar Disorder I

  • Lifetime prevalence: ___%
  • Women vs. men
  • Ethnic differences?
  • Onset usually before age ___
A
  • Lifetime prevalence: 1%
  • Women and men equally affected
  • No ethnic differences seen
  • Onset usually before age 30
45
Q

What factors contribute to the etiology of Bipolar I?

What is the difference in family members?

A
  • Biological, environmental, psychosocial and genetic factors are all important
  • 1st degree relatives of patients with bipolar disorder are 8-18x more likely to develop the illness
  • Concordance rates
    • Monozygotic twins: 75%
    • Dizygotic twins: 5-25%
46
Q

How long do untreated manic episodes last?

What is the typical course?

A
  • Untreated manic episodes generally last about 3 months
  • Course usually chronic w/ relapses
  • As disease progresses, episodes may occur more frequently
  • Only 7% of patients do not have a recurrence of symptoms after their 1st manic episode
47
Q

What is the prognosis of Bipolar I?

What is used for prophylaxis?

A
  • Worse prognosis than MDD
  • Only 50-60% of patients treated w/ lithium experience significant improvement in symptoms
  • Lithium prophylaxis btwn episodes helps to decrease the risk of relapse
48
Q

What are the 3 treatment options for Bipolar I disorder?

A
  • Pharmacotherapy
  • Psychotherapy
  • ECT
49
Q

What type of pharmacotherapy is used to treat Bipolar I disorder?

A
  • Lithium
    • Mood stabilizer
  • Anticonvulsants (carbamazepine, valproic acid) & mood stabilizers
    • Useful for rapid cycling bipolar disorder & mixed episodes
  • Olanzapine
    • A typical antipsychotic
50
Q

What type of psychotherapy is used for Bipolar I?

A
  • Supportive psychotherapy
  • Family therapy
  • Group therapy (once the acute manic episode has been controlled)
51
Q

What is the usefulness of ECT in Bipolar I?

A
  • Works well in treatment of manic episodes
  • Usually requires more treatments than for depression
52
Q

What is “rapid cycling”?

A

Occurrence of 4 or more mood episodes in 1 year

53
Q

What are the side effects of lithium?

A
  • Weight gain
  • Tremor
  • GI disturbances
  • Fatigue
  • Arrhythmias
  • Seizures
  • Goiter/hypothyroidism
  • Leukocytosis (benign)
  • Coma
  • Polyuria
  • Polydipsia
  • Alopecia
  • Metallic taste
54
Q

Bipolar II disorder is alternatively called…

A

recurrent major depressive episodes w/ hypomania

55
Q

What is the DSM-IV criteria for Bipolar II disorder?

A
  • Hx of one or more major depressive episodes and at least one hypomanic episode
  • If there has been a full manic episode even in the past, then the diagnosis is not bipolar II disorder, but bipolar I
56
Q

Bipolar II Disorder

  • Lifetime prevalence: ___%
  • Women vs. men
  • Onset usually before age ___
  • Ethnic differences?
A
  • Lifetime prevalence: 0.5%
  • Slightly more common in women
  • Onset usually before age 30
  • No ethnic differences seen
57
Q

Bipolar II disorder

  • Etiology
  • Course and prognosis
  • Treatment
A
  • Etiology same as bipolar I disorder
  • Tends to be chronic, requiring long-term treatment
  • Treatment same as bipolar I disorder
58
Q

What is the DSM-IV criteria for Dysthymic Disorder?

A
  • Depressed mood for the majority of time of most days for at least 2 years (children for at least 1 yr)
  • At least 2 of the following:
    • Poor concentration or difficulty making decisions
    • Feelings of hopelessness
    • Poor appetite or overeating
    • Insomnia or hypersomnia
    • Low energy or fatigue
    • Low self-esteem
  • During the 2-year period
    • The person has not been without the above symptoms for >2 months at a time
    • No major depressive episode
59
Q

For Dysthymic Disorder, the patient must never have had…..

A

a manic of hypomanic episode

would make diagnosis bipolar or cyclothymic disorder

60
Q

What is Double Depression?

A

Patients w/ major depressive disorder with dysthymic disorder during residual periods

61
Q

What is the acronym for Dysthymic Disorder?

A

CHASES

  • poor Concentration or difficulty making decisions
  • feelings of Hopelessness
  • poor Appetite or overeating
  • inSomnia or hypersomnia
  • low Energy or fatigue
  • low Self-esteem
62
Q

Dysthymic Disorder

  • Lifetime prevalence: ___%
  • Women vs. men
  • Onset before age ___ in 50% of patients
A
  • Lifetime prevalence: 6%
  • 2-3x more common in women
  • Onset before age 25 in 50% of patients
63
Q

What is the course and prognosis of Dysthymic Disorder?

A
  • 20% of patients will develop major depression
  • 20% will develop bipolar disorder
  • >25% will have lifelong symptoms
64
Q

How is Dysthymic Disorder treated?

A
  • Cognitive therapy and insight-oriented psychotherapy are the most effective
  • Antidepressant medications are useful when used concurrently (SSRIs, TCAs, MAOIs)
65
Q

What is cyclothymic disorder?

A

Alternating periods of hypomania and periods with mild to moderate depressive symptoms

66
Q

What is the DSM-IV criteria for cyclothymic disorder?

A
  • Numerous periods with hypomanic symptoms and periods with depressive symptoms for at least 2 years
  • The person must never have been symptom free for >2 months during those 2 years
  • No hx of major depressive episode or manic episode
67
Q

Cyclothymic Disorder

  • Lifetime prevalence: ___%
  • May coexist with _________.
  • Onset usually age _____.
  • Males vs. Females
A
  • Lifetime prevalence: <1%
  • May coexist with borderline personality disorder
  • Onset usually age 15-25
  • Males = Females
68
Q

Cyclothymic Disorder

  • Course & prognosis
  • Treatment
A
  • Chronic course
  • 1/3 of patients eventually diagnosed with bipolar disorder
  • Antimanic agents used to treat bipolar disorder
69
Q

What are 6 other disorders of mood in DSM-IV?

A
  • Minor depressive disorder
    • Episodes of depressive symptoms that do not meet criteria for MDD
    • Euthymic periods are also seen, unlike dysthymic disorder
  • Recurrent brief depressive disorder
  • Premenstrual dysphoric disorder
  • Mood disorder due to a general medical condition
  • Substance-induced mood disorder
  • Mood disorder not otherwise specified (NOS)

Psychiatry (18 decks)

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