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Mood Disorders
MDD. BiPolar. Dysthymic. Clyclothymic
| Question | Answer |
|---|---|
| Another name for mood disorders | Affective disorders |
| Define Mood disorder | Abn range of moods & lose some control over them. Can have distress & impairment of social/job fxning. |
| Difference btw Mood Disorder & Mood Episode | Mood disorders are made of a pattern of moood episodes. Episode - discrete time of abn mood. |
| List types of mood episodes | 4x. Major depressive, Manic, Hypomanic, mixed. |
| List main mood disorders | MDD, biplor I and II, Dysthymic, Cyclothymic. |
| T/F some mood ds have PSYCHOTIC FEATURES? | T (delusions/hallucinations) |
| DSM Criteria for Major Depressive EPISODE | @ least 5 of following & mst include Depressed mood & Anedonia @ least 2 weeks. SIG E CAPS + depressed mood (9x). |
| To qualify for MDepisode you can have sx due to substances or medical condtions? | F |
| to have MD episode you MUST have social or occupational impairment? | T |
| 15% risk of commtting suicide later in life for what condition? | Previously hospitalized for MD episode. |
| DSM IV criteria for Manic episode | abn & persistn elveated, expansive or irritable mood @ least 1 wk. @least 3 of following (4 if only irritable). DIG FAST. Distracted, Insomina, Grandiosity, Flight ideas, Activyt/agitiation, Speech (pressured), Thoughtlessness. **Can have psychotic sx. |
| To have either depressed or manic episode it must not be due to what? | Substances or a medical condition. |
| Mixed Episode criteria | DSM criteria for both Major Depressive & Manic Episodes. Present nearly everyday @least 1week. |
| What type of mood do mixed episode patients have? | Irritability. |
| What mood episode has poor response to Lithium? | Mixed episode. Anticonvulsants may help. |
| WHich 2 mood episodes are Psychiatric Emerencies? | Manic and Mixed Episodes bc can be a danger to others and them selves due to impaired judgement. ***other psychiatric emergencies. Neuromalignat syndrome from antipsychotics. |
| Define hypomanic Episode | distinct time of elevated,expansive or irritable mood w/ @least 3 sx from manic (4 if irritable). |
| WHat are the main diff btw hypomanic and manic episodes? | Manic - lasts@least 7d/ severe social/job impairment/ need hospitalization/psychotic features. Hypomanic - @least 4d/no marked social impairment/no hospitalization/no psychotic features. |
| General definition of mood disorders | chronic courses of relative nl fxning btw episodes. Can be triggered by medical condtions or drugs. |
| ddx of mood disorders 2nd to medical illness | Depressive episode - CVA, endocirnopaties, parkinsons, viral illness, carcnoid syomdre, cancer (lymphoma/pancreatic CA, SLE. Manic - hyperthyroidism temporal lobe sizures, MS neoplasm, hiv. |
| mood disorder 2ndary to drugs | depressive - etoh, antihtn, barbiturates, corticosteroids, lveodopa, anticovulsants, antipsycthoics, diruteics, sulfonamids, w/darwl cocain, amphteamies manic - corticosteroids, sympathomimietics, dopamine goanists, antideresants, bronchodilator,levodopa |
| MDD dsm criteira | @ least one MD episode + no hx manic or hypomanic episode. maybe unaware of depressed mood or have vague, somatic ocmplaints. |
| What seasonal subype of MDD occurs in winter months? | Seasonal affective disorder. Respond to light therapy |
| epidimiology of MDD? | life prevalnce 15% onset - any age, avg 40yo no race preerence prevalance in elderly 25-50% |
| triad for seasona affective ds? | 1 irritabiity carboydrate drawing hypersominia |
| What are the sleep prbs in mdd? | Multiple awakenings. Initial & terminal insomnia (hard to fall asleep and early awake), hypersomnia, REM earlier in the night & stage 3 & 4 decreased. |
| do the following contribue to MDD? biology, genetics, environment, psychosocial | T |
| Describe abn of serotonin/catecholamines | dec brain/csf serotonin & its metabolite 5-HIAA. Abn reg of beta-adrenergic rectorps. Drugs that inc sertonin/NE/dpmines alleviate sx. |
| How re cortisol & thyroid axis affected? | High cortisol - hyperactity of hypothalimic-pit-adrenal axis - can't dexamethasone suppress. abn thryiod axis - assoc thyroid ds or have nl thyroid hormone levels but blunted resonse to of TSH to giving them TRH. ***abn not specific to MDD |
| Can MDD have psychtoic sx? | yes |
| 2/3 of MDD contemplate suciide & 15% actually do it? T? | Yes |
| only half of pts w/ MDD get tx. t/f | T |
| What are good prognostic factors for MDD? | stable family & social fxning. |
| What is assoc w/ later dev of MDD? | LOSS OF parent before 11yo |
| what is MDD genetic predispation of first degree relatives? | 2-3x more likely to get MDD. |
| Are depressive espidoes self-limted? & just 6-18months | T |
| How often to depressive episodes in mdd occur as dz progresses? | more freq |
| What is the risk for the next depressive episode after the first in mdd? & how many eventually commit suicide? | 50% w/in first 2 years & 15% commit suicide |
| What doe antidepressants do? & how efficacious are they? | shorten the length and severity of sx. Can use prophylactially betw epsidoes. 75% success |
| General outline of MDD tx? | Hopsitalization - suicide, homicid, can't self care meds - SSRI, TCA, MAOI Adjuvant meds - stimulatns, antipsychtoics, to make responsders (T3, T4, Li, L-tryptophan Psychotheraphy & ECT |
| How long does it take antidepresants to work? | 4-8weeks |
| are all antidepreastn created equal in efficancy? | yes, but se differ |
| What are the sx of serotonin syndrome? | autonoimc instalbity, hyperthermia, seizures. coma/death |
| Who can't tolerate se of antiderpesants? | pregnant and elderly. |
| MAOIS good for what type of MDD? | atypicald epression |
| When is ECT indicated? | not responed to medss or can't tolerate meds or raid reduction of sx is needed (suicide). |
| Is ECT safe & when can it be used? | for MDD. its safe. used aloen or in combo w/ meds |
| How do you perform ect? | pre med w/ atrpine > genral nthesias > mm relaxant > genarlized sizure indcued vai electricit for <1min. 8tx over 2-3weeks. see imporve after 1wk. |
| common se of ect? | retrograd amnesia. resolves w/in 6mos. |
| List types of Depressive disorders | Melancholic atypical Catatonic Psychotic |
| Features of melancholic depressive ds | Mcc TYPE. 60% of hospitalized. anehdonia, earlying mornig awake, pshchomotor, excessive guilt, anorexia. dx "MDD w/ melancholic features" |
| features of atypicaL depressive ds | hypersomnia, yperphagia, reactive mood, leaqden pralysis hypersensitvy to interpersonal rejection. |
| features of catatonic depressive ds | catalepsy (immobility), purposeless motor acitivty, exterme negativis or mutism, bizarre postures, echolalia. may also be applied to bipolar ds. |
| features of psychotic depressive ds | 25% of hostilated. delusions or halucations |
| how tx catatonic type of mdd | antidepressants and antipsychotic concurrently. |
| How is BPI different from BPII via dsm? | BP2 people NEVER had a FULL manic episode as seen in BP1s. |
| DSM criteria for Bipolar 1 disorder (BP1) | ONLY req - 1manic or mixed episode. Btw manics can have (but not req) - euthymia, MD episodes, dysthymia or hyomanic epsiodes. |
| Can BP1 also have psychotic features? | yes. During depressive or manic epsiodes. |
| What is age of onset & other epi? | B4 30yo M=F in freq no ethic diff lifetime prev 1% |
| ETIOLOGY of bp1? | bio+environ + psychosocial + genetics |
| Lifely hood of first degress relative for BPE1? | 8-18x more likley. |
| How long do untreated bp1 episodes last? | 3mos. chronic course w/ relpase only 7% don't relpase after frist manic epsidoe. |
| who has worse prognosis MDD or bp1? | bp1 |
| outline of tx | Meds, psychotherapy, ECT |
| meds for bp1 | Li - mood stabilizer. Prophylaxis btw episodes can help dec risk of relapse. ANticonvulsants - moost stailizers esp for rpaid cycing and mixed epidoes Olanzapine - typical antipsychotic |
| ECT for bp1 WORKS WELL for? | manic eipsides usu more tx than for depression. |
| Recurrent major depressive eipsidoes w/ hypomania aka? | BPII |
| Define rapid cycling | 4 or more mood episodes in 1 eyar (MD, manic, mixed etc). |
| BP 2 DSM criteria | hx of 1 or more MD episodes & @least 1 hypomanic episode. Never have a FULL manic episode!! |
| epi for bp2 | livetie preve 0.5% slightly more common in F onset b4 30yo just liek bp1 no ethinic diff seen |
| etio | same as bp1 |
| course & prognosis | chronic thus need long term care. |
| tx for bp 2 same as bp1? | yes |
Created by:
HugAmango
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