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Mood Disorders

MDD. BiPolar. Dysthymic. Clyclothymic

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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