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UWM Patho II Exam 4
Mood Disorder
| Question | Answer |
|---|---|
| Define Mood and Affect | 1.Mood is defined as an internal emotional condition 2.Affect refers to how the emotional condition is expressed: euphoria, joy surprise, fear, sadness, etc. |
| What are mood disorders? | Mood disorders are abnormalities of mood and affect |
| What makes a mood disordered? | 1.Depression and elation are normal human emotions. 2.Disorder is when it gets too long-term or too extreme |
| Mania | Mania, or elevation of mood, is associated with: 1.rapid, excited speech 2.decreased need for sleep 3.feeling of self-importance (grandiosity) |
| Depression | Depression is associated with: 1.decreased energy 2.difficulty in concentrating 3.difficulty in sleeping 4.Feeling guilty 5. reduction in appetite 6.suicidal thoughts |
| What is the difference between major depression (aka, unipolar disorder) and bipolar disorder (aka, manic-depressive disorder)? | 1.In major depression patients have only depression. 2.In bipolar disorder patients have both mania and depression. 3.About 15% patient exhibit only mania |
| Hypomanic episode (hypomania) | 1.an episode of manic symptoms that does not meet all of the criteria for a manic episode. 2.It is distinguished from mania by the absence of psychotic symptoms and by its lower degree of impact on functioning. |
| Dysthymic disorder (dysthymia) | mild form of major depression (non-psychotic depression) Depressed mood, loss of interest or pleasure Chronic (> 2 years) Not severe enough for hospitalization Lifetime prevalence: 5% 30~50% of alcoholics have secondary depression. |
| Cyclothymic disorder (cyclothymia) | 1.mild form of bipolar (non-psychotic bipolar) 2.Chronic (> 2 years) 3.alternating states 4.Often not recognized by the person (ego-syntonic) |
| Etiology of mood disorders: Heredity | 1.may be inherited - some evidence that it may run in families 2.Studies show “major depression is thought to be 40~70% heritable, but involves an interaction of several genes with environmental events.” |
| Etiology of mood disorders: Life experiences | 1.Job loss 2.poverty 3.financial difficulties 4.gambling addiction 5.unemployment 6.loss of a spouse or other family member 7.divorce or the end of a committed relationship 8.involuntary celibacy 9.other traumatic events |
| Etiology of mood disorders: Medical conditions | Certain illnesses including: 1.cardiovascular disease 2.hepatitis 3.mononucleosis 4.hypothyroidism 5.organic brain damage caused by degenerative conditions such as Parkinson disease, multiple sclerosis, etc |
| Etiology of mood disorders: Biological factors | 1.antidepressant drugs increase levels of certain neurotransmitters, such as serotonin and NE 2.(MAO)inhibitors are a major class of drugs to tx depression 3.Dopamine is decreased during depressive episodes and increased during manic episodes |
| How is the endocrine system associated with mood disorders? | Abnormalities of the limbic–hypothalamic-pituitary axis are seen in patients with mood disorders: 1.Seasonal affective disorder (SAD) abnormal melatonin metabolism (tx with phototherapy) |
| What are other biologic factors associated with mood disorders other than NT and Endocrine disorders? | 1.Immune system function and sleep patterns may be abnormal 2.PET scans show abnormally high glucose metabolism in amygdala of depressed 3.Smaller hippocampus -atrophy greater if depressed longer 4.Linked to abnormally high levels of glucocorticoids |
| What are psychological factors of mood disorders? | 1.The loss of a parent in the first decade of life and loss of a spouse correlate with major depression 2.Low self-esteem and self-defeating or distorted thinking are connected with depression. |
| What is the definition of major depression (unipolar disorder) | Severely depressed mood characterized by: 1.loss of interest in typical activities 2.self-deprecation 3.inability to concentrate 4.Symptoms for at least 2 weeks |
| What is the prevalence and the predictors of major depression? | Lifetime Prevalence: 20~25% of women; 9~12% of men Gender: Females to Males: 2 : 1 Age onset: mean age 20 years Genetics: 1.5 to 3 times more common with first degree relatives |
| What neurochemical changes take place in major depression? | Decreased norepinephrine Decreased serotonin Decreased dopamine Decreases in most hormones (but increase in corticosteroids) Metabolites of these also decreased |
| What correlates biologically with major depression? | PET scans show abnormally high glucose metabolism in amygdala of depressed people Smaller hippocampus, atrophy greater if depressed longer Linked to abnormally high levels of glucocorticoids |
| What is the prevalence of suicide in major depression? | 1.60% of depressed patients have suicidal ideation 2. 10~15% of depressed patients die by suicide |
| How does sleep correlate to major depression? | 1.Increased REM in first half of sleep 2.Decreased REM latency 3.Decreased Stage 4 sleep 4.Increased REM time overall 5.Early morning waking |
| What is the Diagnostic criteria for major depression? | 1.Depressed mood 2.↓ interest in pleasure 3.Change in appetite 4.Change in sleep 5.Psychomotor agitation or retardation 6.↓ energy 7.Feelings of guilt or worthlessness 8.Difficulty concentrating 9.suicide ideation 10.Symptoms for at least 2 we |
| What are treatments for major depression? | Medication, psychotherapy, and electroconvulsive therapy (ECT), may be used when chemical treatment fails. |
| What is the prognosis for major depression? | outcome good with treatment, Relapse - most depressive episodes can be treated with either medication, psychotherapy, or both, depression is a recurring problem for many people. When repeated episodes of depression, maintenance tx may be needed. |
| What medications are used in the treatment of major depression? | SSRIs are 1st line therapy. MAOIs decrease degradation of NE and serotonin. TCA (tricyclic antidepressants) oldest, block re-uptake of NE and serotonin. |
| What causes postpartum blues? | 1) changes in hormone levels (↓ levels of estrogen and progesterone) 2) the stress of childbirth 3) awareness of increased responsibility 4) disappointment over the child’s appearance 5) fatigue |
| What are postpartum blues? | mild and transitory form of 'moodiness',80% of postpartum women have. Normal. Symptoms last from a few hours to several days, and include tearfulness, irritability, hypochondriasis, sleeplessness, impairment of concentration, and headache. |
| What is postpartum depression? | A depressive episode with onset occurring one month postpartum. Prevalence rates from 5% to 10% It is widely considered to be treatable |
| What is postpartum psychosis? | About 0.1 to 0.2% of severely depressed women after childbirth Characterized by hallucinations or delusions and severe anxiety |
| What is bipolar disorder (manic-depressive illness)? | unusual shifts in a person’s mood, energy, and ability to function. are symptoms of major depression plus symptoms of mania: a period of abnormal and persistent elevated, expansive, or irritable mood alternates between depression and mania |
| What is Bipolar I disorder (subtype of bipolar disorder)? | one or more manic episodes with or without major depressive episodes. |
| What is Bipolar II disorder (subtype of bipolar disorder)? | hypomanic episodes as well as at least one major depressive episode. |
| What is Cyclothymic disorder (subtype of bipolar disorder)? | a presence or history of hypomanic episodes with periods of depression that do not meet criteria for major depressive episodes. If alternates within 48~72 hours, called "rapid cycling bipolar disorder” |
| What are the manic symptoms of bipolar disorder? | Increased self-esteem or grandiosity Low frustration tolerance Decreased need for sleep Flight of ideas Excessive involvement in activities Weight loss and anorexia Erratic and uninhibited behavior Increased libido |
| What are the neurochemical changes that take place during the manic phase of bipolar disorder? | Increased norepinephrine (NE) Increased serotonin Slight increase in dopamine |
| What changes in sleep patterns occur during the manic phase of bipolar disorder? | Multiple awakenings Markedly decreased sleep time |
| When is a manic episode diagnosed? | A manic episode is diagnosed if elevated mood occurs with 3 or more of the other symptoms most of the day, nearly every day, for 1 week or longer. |
| How is bipolar disorder diagnosed? | Combo of manic and depressed disorders Bipolar I requires one or more manic or mixed episodes Bipolar II disorder requires only one hypomanic episode Cyclothymic disorder requires the presence of numerous hypomanic episodes (lasting at least 2 years) |
| How is bipolar treated with medication? | Lithium is drug of choice; reduces formation of NE and serotonin (side effect: nephrogenic diabetes insipidus) The first known and "gold standard" mood stabilizer is lithium, while almost as widely used is sodium valproate |
| Is there a cure for bipolar disorder? | No, but many individuals with bipolar disorder can live full and satisfying lives with appropriate treatment Persons with bipolar disorder are likely to have periods of normal or near normal functioning between episodes |
Created by:
czenecke
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