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Mood Disorders

Behavioral Medicine

Disproportionate emotional rxn to stressor; within 3 months of event onset; sx remission usually within 6 months = Adjustment disorder
Major depression defn: Depressed mood + anhedonia; >4 clinical features; x >2 weeks; no mania or medical cause
Major depression clinical features: sleep problems, guilt, low self esteem, fatigue, poor concentration, no appetite, psychomotor, suicidality, somatic complaints
Major depression physiology Serotonin, epi-norepi, dopamine, acetylcholine, histamine; adrenal, thyroid, growth hormone; genetic; psychosocial / family
Psychopharmalogic tx for MDD must be continued for how long: At least 6 months after sx improvement (lest relapse)
Defn dysthymic disorder Chronically depressed mood for >2 years; not meet MDD criteria; intervals w/o depressed mood are <2 months
Dysthymic disorder mgmt SSRI +/- SNRI; CBT
Defn Bipolar disorder I 1 or more manic episodes (elevated or irritable x1 wk), poss depressive episodes; sxs not 2/2 other psych dz, med dz, substance abuse; possible psychosis
Bipolar disorder I clinical features Grandiosity, little sleep, pressured speech, flight of ideas, increased goal-directed activity, risk taking
Bipolar disorder I mgmt Lithium; ?antipsychotics (or Valp or CMZ); short term BZOs for hyperactivity or agitation
Bipolar responds to neuroleptics but these patients are at increased risk for: neuroleptic malignant syndrome or tardive dyskinesia
Defn Bipolar disorder II One or more episodes of major depression and hypomania (vs just mania); hypomania lasts 4 days
Bipolar disorder II mgmt similar to Bipolar I; Lamictal if predominately depression; antidepressants may precipitate mania
Defn Cyclothymic disorder Mild Bipolar II sxs; numerous episodes (depression & hypomania) over 2 years; no sx-free interval of >2 months
Phobia (including social phobia) tx Beta blockers (atenolol 25-50mg or propranolol 20-40mg); SSRIs +/- Buspar; benzos
PTSD mgmt SSRIs (1stline) >1 year, alt: SNRI, TCAs, trazodone, anticonvulsants, clonidine, propranolol. Eye movement desensitization reprocessing, CPT, CBT
Difference btw PTSD and acute stress disorder ASD: lasts at least 2 days, resolves within 4 weeks
Clinical features of acute stress disorder Sense of numbness, detachment, derealization, depersonalization, dissociative amnesia
Acute stress disorder mgmt Supportive psychotherapy; short-term BZOs
Created by: Adam Barnard Adam Barnard