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43 Cards in this Set

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Major Depressive Disorder (MDE)
criteria
Depressed mood and/or loss of interest or pleasure (> 2 weeks)
4 of following symptoms:
Physical - sleep problems, apetite change, fatigue, psychomotor, retardation/agitation
Psychological - low self-esteem/guilt, poor concentration/indecisive, thoughts of death/suicide
SIGECAPS
Sleep disorder
Interest and pleasure
Guilt, poor self esteem
Energy, fatigue
Concentration probs, indecisive
Apetite change
Psychomotor agitation/retard
Suicidal ideation, thoughts of death
Dysthymia
criteria
1) Depressed mood for most of day, more days than not, > 2 yrs
2) >2 of following: poor apetite/overeating, insomnia/hypersomnia, low energy/fatigue, low self esteem, poor concentration/indecisiveness, feeling hopeless
3) Never had a manic, mixed hypomanic episode
4) < 2 months without 1 and 2
Double Depression
combo of dysthymia with a major depressive episode
Mania
criteria
1) Distinct period of of abnormally, persistently elevated, expansive, irritable mood x> 1 wk (any duration if hospitalization required)
2) >3 of following (4 if irritable): inflated self esteem/grandiosity, less need for sleep, more talkative, flight of ideas/thoughts racing, distractibility, increase goal-directed activity/psychomotor agitation, excessive involvement in pleasurable activities with high potential for pain
3) Sx no meet criteria for Mixed Episode
4) Sx cause impairment, need hospitalization, or psychotic features present
Hypomania
1) Distinct period of abnormally and persistently elevated, expansive, or irritable mood, lasting at least 4 days
2) At least 3 of the following (4 if irritable): inflated self esteem/grandiosity, less need for sleep, more talkative, flight of ideas, distractibility, increase in goal-directed activity/psychomotor agitation, excessive involvement in pleasurable activities
3) Episode causes unequivocal change in function observed by others
4) NO marked impairment, NO psychotic features
DIGFAST
Distractibility
Impulsivity/involvement in pleasurable activities
Grandiosity
Flight of ideas
Activity - inc. goal directed
Sleep - less need
Talkativeness - increased
Mixed Episode
1) Criteria met for manic and depressive episodes almost every day x > 1 wk
2) Causes marked impairment, needs hospitalization, psychotic features present
3) Sx not due to direct effects of a substance/general med condition
Cyclothymia
1) > 2 yr with hypomanic + depressive periods that do NOT meet criteria for MDE or Mania
2) Not without sx for > 2 mo
3) No manic, mixed, or MDE during first 2 yrs of sx
4) Sx cause significant distress/impairment
Depression: Comorbidities
--Heart disease
--Diabetes
--Stroke
--Pancreatic cancer
--Hypothyroidism
Rapid Cycling
More common in BPII and women
Episodic
Influenced by antidepressants/hypothyroidism
Medical Causes of Mood Sx
MS, Stroke, lupus, Tumors, SZ, head injuries
Meds associated with mood changes
Steroids, Interferon, Stimulants, Thyroid meds, Beta blockers
Anatomical changes
MDD: smaller prefrontal lobe, smaller hippocampal volume

BP: smaller prefrontal lobe, larger BG and thalamus, increased ventricular size
Brain derived neurotrophic factor (BDNF)
Growth hormone for brain
Chronic administration of antidepressants increases BDNF expression/trkB receptor within hippocampus
Direct infusion of BDNF into midbrain has antidepressant effects
Peptides under consideration for mood disorders
5HT, NE, DA, Cortisol/HPA axis, TRH/Thyroid axis, Substance P, others
Mood
prolonged emotional tone
Affect
moment to moment emotional state
Negative cognitive triad
Unrealistically negative and demeaning view of oneself, the world, and the future
Learned Helplessness
Follows experience with uncontrollable events. Outcome independent of effort -> hopelessness and loss of self esteem (culture of poverty)
Frequency of Mood Disorders in Population
1% BP
6% MDD
6% Dysthymia
Exclusion Criteria for Depression
Schizophrenia, Delusional disorder, Uncomplicated bereavement, Hallucination/delusion minus mood symptoms, Depressogenic substance/med condition
Treatment for Depression: Psychotherapy
Psychoanalytic (reduce conflicts, restore attachments, improve self esteem, overcome trauma)
Cognitive
Interpersonal
Treatment for Depression: ECT
safe and rapid, for nonresponsive, melancholic depression, suicidality, psychotic sx
Intracranial mass = main contraindication
Complications for Dysthymia
Substance abuse, underachievement, marital conflict, increased risk MDD, suicide
Bereavement
Depressive sx minus worthlessness and self reproach
Severe impairment < 3mo
Increased risk CVD, suicide, altered immune function
Anniversary phenomena
Exclusion Criteria for Mania
Schizophrenia, schizophreniform disorder, delusional disorder
Delusions, hallucinations minus mood disorder
Med condition/substance = cause
Causes of Manic-like states
Substance (Antidepressants, stimulants, steroids)
Neuro (tumor, trauma, stroke, AIDS, lupus)
Endocrine (hyperthyroidism, hypercortisolism)
Rapid Cycling Bipolar Disorder
4+ episodes per year
More common with chronicity, women, thyroid abnormalities, antidepressants
Bipolar Disorder Epidemiology
1.3% pop
Males = females
More frequent in higher socioeconomic classes
onset slightly earlier than MDD: 15-19 (impairment), 20-24 (treatment), 25 (hospitalized)
suicide: 25% attempt, 15% succeed
Different Manifestations in Cultural Subgroups
Blacks -> paranoia
Hispanics -> somatic complaints
Blacks treated for depression less than Hispanics
Med Conditions and Depression
Stroke, Parkinson's, Cancer, MI, Rheumatoid Arthritis, DM, AIDS
Depressed HIV patients: paroxetine vs imipramine
Imipramine has greater effect on reducing depression than paroxetine
Melancholia
loss of pleasure or lack of reactivity to pleasurable stimuli and (3 of 6):
dif from other sad moods, worse in morning, wake up early, psychomotor retard/agitate, significant anorexia/weight loss, excessive inappropriate guilt
Atypical Features for Depressive Disorder
Mood reactivity, and (2 of 4):
weight gain/inc apetite, hypersomnia, leaden paralysis, interpersonal rejection sensitivity
Seasonal Pattern
regular temporal relationship between mood onset and time of year.
Over 2 yr, 2 episodes in pattern, no non-seasonal episodes
Phototherapy
6-8 hrs bright light prior to onset of episodes. Response 3-5 days. Most 4/5 female, bipolar, atypical features.
Bipolar I disorder
Manic episode alone, marked impairment in function
Bipolar II disorder
1+ MDD + hypomanic episode, NO marked impairment
Recurrent major depressive episodes with hypomania. No Hx manic episode
BP with Catatonic features
manic episode + (2 of 5):
motoric immobility, frenetic motor activity, extreme negativism/mutism, peculiar voluntary mvmts(posturing, stereotypy, grimacing), echolalia/echo-proxia
Treatment for Bipolar Disorder
Lithium Carbonate or Valproate
Neuroleptic vs Benziodiazepine -> behavioral safety
Bilateral ECT
Genetics of Bipolar Disorder
50% have parent with BP
25% chance of giving to child
abnormal gene on chromo V, X
biological mediation of temperamental instability
Secondary Meds for Bipolar Disorder
Lithium +
Anticonvulsants, kindling
Clonidine (alpha2 agonist, inhibit locus cereuleus)
Propanolol
Ca channel blocker (verapamil/nifedipine)