Mood Disorders

Question 1

Mood Disorders

Answer 1

• Major Depressive Disorder
• Persistent Depressive Disorder
• Premenstrual Dysphoric Disorder
• Bipolar I Disorder
• Bipolar II Disorder
• Cyclothymic Disorder

Question 2

Major Depressive Disorder gender difference

Answer 2

F>M

18- to 29-year-old individuals»_space;> age 60 years or older

Question 3

Biopsychosocial model of depression

Answer 3

how biology (genetics, disability, physical health), social conditions (family, school, friends) and psychological factors (self-esteem, social skills, coping skills) all play into depression

Question 4

Monoamine Hypothesis of depression

Answer 4

Depression is due to deficiency of monoamines like serotonin, dopamine, or NE

Question 5

Diathesis-Stress/Dual-Risk Model

3 components are

Answer 5

1. Diathesis- persons genetic or biological vulnerability to a mental illness
2. Stress- physical or emotional
3. Protective factors- help keep a person from developing a mental illness

Question 6

Criteria for Major Depressive Disorder

Answer 6

-5 (or more) sx have been present during the same 2-week period and represent a change from previous functioning:
at least one of the symptoms is either (1) depressed mood or (2) loss of interest or pleasure
SIG E CAPS
-Sleep Disturbance
-Interests decreased
-Guilt or feelings of worthlessness
-Energy loss/fatigue
-Concentration problems
-Appetite/weight changes
-Psychomotor retardation/agitation
-Suicidal ideation

Question 7

Depression can present in children as

Answer 7

irritability or aggressiveness

Question 8

Weight gain and hypersomnia are

Answer 8

atypical presentations (This matters for when prescribing certain meds, may may s/s worse or better)

Question 9

Subtypes of MDD

Answer 9

1. With mood-congruent psychotic features; hard to tell from schizoaffective disorder; prominent depression symptoms; chronic depression/consistent; no delusions or hallucinations
2. With mood-incongruent psychotic features
3. With catatonia
4. With peripartum onset- formerly known as post partum
5. With seasonal pattern- old name for seasonal depression

Question 10

MDD with peripartum onset: This specifier can be applied to the current or, if full criteria are not currently met for a major depressive episode, most recent episode of major depression if onset of mood symptoms occurs _______

Answer 10

during pregnancy or in the 4 weeks following delivery

Question 11

MDD with seasonal pattern

Answer 11

• Worse with colder months, end of August-February depression starts
• Light therapy works well (light box)
• Onset and remission of major depressive episodes certain time of year
• Most episodes begin in fall or water and remit in spring

Question 12

Scales for measuring depression

Answer 12

• Hamilton Rating Scale for Depression

- Beck Depression Inventory

Question 13

Diagnostic Criteria for Persistent Depressive Disorder

Answer 13

• Depressed mood for most of the day, for more days than not, as indicated by either subjective account or observation by others, for at least 2 years.
• Note: In children and adolescents >1 year.

• 2 (or more) of the following:
  1. Poor appetite or overeating
  2. Insomnia or hypersomnia
  3. Low energy or fatigue
  4. Low self-esteem
  5. Poor concentration
  6. Feelings of hopelessness

Question 14

Other disorder that you have to have for 2 years for clinical diagnosis?

Answer 14

Cyclothymia

AND persistent depressive disorder

Question 15

For Persistent Depressive Disorder, during the 2-year period (1 year for children or adolescents) of the disturbance, the individual has never ____________

Answer 15

been without the 2 required symptoms for more than 2 months at a time.

• Criteria for a major depressive disorder may be continuously present for 2 years.
• There has never been a manic episode or a hypomanic episode, and criteria have never been met for cyclothymic disorder

My notes:

• Chronic sadness that doesn’t resolve, can function and go to work, etc.
• Higher functioning than with MDD

Question 16

Meds for MDD and PDD

Answer 16

• Psychotropic meds
• SSRI: selective serotonin reuptake inhibitor (fluoxetine, sertraline)
• SNRI: serotonin norepinephrine reuptake inhibitor (venlafaxine, duloxetine)
• NDRI: norepinephrine and dopamine reuptake inhibitor (bupropion)

My notes:
-If 2 SSRIs don’t work, next they will try SNRI

• Bupropion: Smoking sensation, attention deficit issues, depression (NOT anxiety) stay away from this if they have anxiety (Side effect=increased anxiety!!)
• Biggest SSRI complaint= decreased libido

Question 17

Therapy for MDD and PDD

Answer 17

• CBT: Cognitive Behavioral Therapy, good to start with
• Psychodynamic Therapy: can be stressful; don’t use unless pt is high functioning
• Interpersonal Therapy- talk about family/relationships

Question 18

Premenstrual dysphoric disorder

Answer 18

• The most common primary symptom of premenstrual dysphoric disorder (PMDD) is irritability.
• Increased dose about 2 weeks before period to help with irritability

Question 19

Diagnostic criteria for premenstrual dysphoric disorder

Answer 19

*For most menstrual cycles during the past year, at least 5 of the following 11 symptoms (including at least 1 of the first 4 listed) were present:

1. Markedly depressed mood, feelings of hopelessness, or self-deprecating thoughts
2. Marked anxiety, tension, feelings of being “keyed up” or “on edge”
3. Marked affective lability (eg, feeling suddenly sad or tearful or experiencing increased sensitivity to rejection)
4. Persistent and marked anger or irritability or increased interpersonal conflicts
5. Decreased interest in usual activities
6. Subjective sense of difficulty in concentrating
7. Lethargy, easy fatigability, or marked lack of energy
8. Marked change in appetite, overeating, or specific food cravings
9. Hypersomnia or insomnia
10. A subjective sense of being overwhelmed or out of control
11. Other physical symptoms, such as breast tenderness or swelling, headaches, joint or muscle pain, a sensation of bloating, or weight gain

*The symptoms must have been present for most of the time during the last week of the luteal phase, must have begun to remit within a few days of the onset of menstrual flow, and must be absent in the week after menses

Question 20

Treatment for Premenstrual Dysphoric Disorder

Answer 20

• Hormone therapy: Oral contraceptives, Estrogen, GnRH agonists
• Anti-depressant: can be just for the course of the symptoms

Question 21

Causes of Bipolar Disorder

Answer 21

• Genetics
• Structural MRI: Increase in volume of the lateral ventricles, globus pallidus
• Functional MRI: abnormal modulation between ventral prefrontal and limbic regions – amygdala
• Kindling Hypothesis (Life factors make it worse; deaths in family, job loss, etc)
• Early life stress and dysfunction of hypothalamic-pituitary adrenal axis, leads to over activation, which may play a role in the pathogenesis of bipolar disorder.

Question 22

For a diagnosis of bipolar I disorder, it is necessary to

Answer 22

meet the criteria for a manic episode

-The manic episode may have been preceded by and may be followed by hypomanic or major depressive episodes

Question 23

Definition of Manic Episode

Answer 23

persistently elevated, expansive, or irritable mood and abnormally and persistently increased goal-directed activity or energy, lasting at least 1 week

Question 24

Diagnostic Criteria for Bipolar Disorder I

Answer 24

-3 (or more) of the following symptoms (four if the mood is only irritable) are present

DIG FAST

• Distractibility
• Irresponsibility (buying sprees, sexual indiscretions, or foolish business investments, seeks pleasure without consequences)
• Grandiosity (inflated self esteem)
• Flight of ideas (racing thoughts)
• Activity or Agitation increase (increased goal directed behavior)
• Sleep need decreases
• Talkativeness or pressured speech

Question 25

Bipolar II Disorder requires

Answer 25

a current or past hypomanic episode AND the criteria for a current or past major depressive episode

Question 26

Definition of Hypomanic Episode

Answer 26

A distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased activity or energy, lasting at least 4 consecutive days and present most of the day, nearly every day.

Question 27

Diagnostic Criteria for Bipolar II Disorder

Answer 27

*requires hypomanic episode and major depressive episode *3 (or more) of the following symptoms have persisted (four if the mood is only irritable): DIG FAST (mania mnemonic)

Question 28

Cyclothymic Disorder- For at least 2 years (at least 1 year in children and adolescents) there have been numerous periods with

Answer 28

hypomanic symptoms that do not meet criteria for a hypomanic episode and numerous periods with depressive symptoms that do not meet criteria for a major depressive episode. -During the above 2-year period (1 year in children and adolescents), the hypomanic and depressive periods have been present for at least half the time and the individual has not been without the symptoms for more than 2 months at a time.

Question 29

Cyclothymic Disorder- criteria for a __________ have never been met.

Answer 29

major depressive, manic, or hypomanic episode -The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

Question 30

Treatment for Bipolar Treatment

Answer 30

- Mood stabilizers: lithium, valproic acid, divalproex sodium, carbamazepine and lamotrigine (Lamictal) - Atypical Antipsychotics: olanzapine, risperidone, quetiapine, aripiprazole, ziprasidone, lurasidone, asenapine - Antidepressants: help manage depression. Usually along with a mood stabilizer or antipsychotic. Antidepressant along can sometimes trigger a manic episode. * Lithium toxicity is very bad and dangerous * Don’t give patients lithium who are threatening to overdose or commit suicide