| Mood Disorders |
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| Major Depressive Disorder |
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| Bipolar Disorder |
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| Differential Diagnosis |
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| What is this? |
A mood d/o is characterized by one or more major depressive episodes (MDE) |
I) one manic or mixed (meet criteria for mania and MDE) episode (usually requiring hospitalization) II) At least one MDE and on hypomanic episode |
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| DSM IV criteria for diagnosis? |
1) Depressed mood or anhedonia (lost interest) 2) 5 symptoms from SIG E CAPS list 3) for a 2 WEEK PERIOD |
Manic episode is 1 week or more of persistently elevated, expansive or irritable mood plus 3 DIG FAST symptoms. Psychotic symptoms common in mania |
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| Symptoms of episode |
SIG E CAPS: Sleep, Interest, Guilt, Energy, Concentration, Appetite, Psychomotor, Suicide |
DIG FAST: Distractability, Insomnia, Grandiosity, Flight of ideas, Activities/psychomotor Agitation, Sexual indiscretions, Talkativeness/pressured speech |
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| Who gets this? |
Females in mid-20s; in elderly incidence increases with age; chronic illness and stress increases risk. 15% will die due to suicide |
M:F is 1:1, fam hx increases risk, onset 20s, frequency of mood episodes increases with age, 10-15% die suicide |
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| What do they tell you? |
Depressed mood/anhedonia + SIG E CAPS |
DIG FAST. Excessive engagement in pleasurable activities, reckless behavior, and/or psychotic features ***antidepressant meds may trigger mania |
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| What are the different types within the disorder? |
1) Psychotic features: delusions/hallucinations 2) Postpartum: 1 mon; 10% risk, high recurrence; psychosis 3) Atypical: wt gain, hypersomnia 4) Seasonal: Depr commonly in winter; responds light therapy 5) Double depression: MDE in dysthmia |
1) Bipolar I (mania or mixed episode) 2) Bipolar II (MDE + hypomania) 3) Rapid cycling: greater than 4 episodes/year (MDE, manic, mixed or hypomanic) 4) Cyclothymic: less severe alternating hypomania and moderate depression >2yrs |
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| What is used for treatment? |
1) Meds: effective 50-70%; 2-6w to work; treat >6mon 2) ECT 6-12Xs for refractory or psychotic depression (SE- anterograde amnesia, HA, confusion) 3) Psychotherapy + meds 4) Phototherapy for seasonal |
1) Mania: antipsychotics and mood stabilizers 2) Depression: mood stabilizers +/- antidepressant (don't want to trigger mania); ECT can be used in refractory cases |
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| Mood d/o due to medical condition |
Hypothyroid, Parkinson, CNS, neoplasms, stroke (esp ACA), dementias, parathyroid d/o |
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| Substance-induced mood d/o |
illicit drugs, alcohol, antiHTNs, steroids, OCPs |
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| Adjustment d/o with depressed mood |
symptoms resembling MDE within 3 months of identifiable stressor |
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| Normal bereavement |
After loved one lost |
No severe impariment/suicidality; resolves in year but varies |
may lead to major depressive d/o requiring Rx |
| Dysthmia |
milder, chronic depressed mood present most of time for >2yrs |
often treatment resistant |
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