Behavioral Science - Mood Disorders

Front 1

Major Depressive Disorder (MDE)
criteria

Back 1

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

Front 2

SIGECAPS

Back 2

Sleep disorder
Interest and pleasure
Guilt, poor self esteem
Energy, fatigue
Concentration probs, indecisive
Apetite change
Psychomotor agitation/retard
Suicidal ideation, thoughts of death

Front 3

Dysthymia
criteria

Back 3

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

Front 4

Double Depression

Back 4

combo of dysthymia with a major depressive episode

Front 5

Mania
criteria

Back 5

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

Front 6

Hypomania

Back 6

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

Front 7

DIGFAST

Back 7

Distractibility
Impulsivity/involvement in pleasurable activities
Grandiosity
Flight of ideas
Activity - inc. goal directed
Sleep - less need
Talkativeness - increased

Front 8

Mixed Episode

Back 8

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

Front 9

Cyclothymia

Back 9

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

Front 10

Depression: Comorbidities

Back 10

--Heart disease
--Diabetes
--Stroke
--Pancreatic cancer
--Hypothyroidism

Front 11

Rapid Cycling

Back 11

More common in BPII and women
Episodic
Influenced by antidepressants/hypothyroidism

Front 12

Medical Causes of Mood Sx

Back 12

MS, Stroke, lupus, Tumors, SZ, head injuries

Front 13

Meds associated with mood changes

Back 13

Steroids, Interferon, Stimulants, Thyroid meds, Beta blockers

Front 14

Anatomical changes

Back 14

MDD: smaller prefrontal lobe, smaller hippocampal volume

BP: smaller prefrontal lobe, larger BG and thalamus, increased ventricular size

Front 15

Brain derived neurotrophic factor (BDNF)

Back 15

Growth hormone for brain
Chronic administration of antidepressants increases BDNF expression/trkB receptor within hippocampus
Direct infusion of BDNF into midbrain has antidepressant effects

Front 16

Peptides under consideration for mood disorders

Back 16

5HT, NE, DA, Cortisol/HPA axis, TRH/Thyroid axis, Substance P, others

Front 17

Mood

Back 17

prolonged emotional tone

Front 18

Affect

Back 18

moment to moment emotional state

Front 19

Negative cognitive triad

Back 19

Unrealistically negative and demeaning view of oneself, the world, and the future

Front 20

Learned Helplessness

Back 20

Follows experience with uncontrollable events. Outcome independent of effort -> hopelessness and loss of self esteem (culture of poverty)

Front 21

Frequency of Mood Disorders in Population

Back 21

1% BP
6% MDD
6% Dysthymia

Front 22

Exclusion Criteria for Depression

Back 22

Schizophrenia, Delusional disorder, Uncomplicated bereavement, Hallucination/delusion minus mood symptoms, Depressogenic substance/med condition

Front 23

Treatment for Depression: Psychotherapy

Back 23

Psychoanalytic (reduce conflicts, restore attachments, improve self esteem, overcome trauma)
Cognitive
Interpersonal

Front 24

Treatment for Depression: ECT

Back 24

safe and rapid, for nonresponsive, melancholic depression, suicidality, psychotic sx
Intracranial mass = main contraindication

Front 25

Complications for Dysthymia

Back 25

Substance abuse, underachievement, marital conflict, increased risk MDD, suicide

Front 26

Bereavement

Back 26

Depressive sx minus worthlessness and self reproach
Severe impairment < 3mo
Increased risk CVD, suicide, altered immune function
Anniversary phenomena

Front 27

Exclusion Criteria for Mania

Back 27

Schizophrenia, schizophreniform disorder, delusional disorder
Delusions, hallucinations minus mood disorder
Med condition/substance = cause

Front 28

Causes of Manic-like states

Back 28

Substance (Antidepressants, stimulants, steroids)
Neuro (tumor, trauma, stroke, AIDS, lupus)
Endocrine (hyperthyroidism, hypercortisolism)

Front 29

Rapid Cycling Bipolar Disorder

Back 29

4+ episodes per year
More common with chronicity, women, thyroid abnormalities, antidepressants

Front 30

Bipolar Disorder Epidemiology

Back 30

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

Front 31

Different Manifestations in Cultural Subgroups

Back 31

Blacks -> paranoia
Hispanics -> somatic complaints
Blacks treated for depression less than Hispanics

Front 32

Med Conditions and Depression

Back 32

Stroke, Parkinson's, Cancer, MI, Rheumatoid Arthritis, DM, AIDS

Front 33

Depressed HIV patients: paroxetine vs imipramine

Back 33

Imipramine has greater effect on reducing depression than paroxetine

Front 34

Melancholia

Back 34

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

Front 35

Atypical Features for Depressive Disorder

Back 35

Mood reactivity, and (2 of 4):
weight gain/inc apetite, hypersomnia, leaden paralysis, interpersonal rejection sensitivity

Front 36

Seasonal Pattern

Back 36

regular temporal relationship between mood onset and time of year.
Over 2 yr, 2 episodes in pattern, no non-seasonal episodes

Front 37

Phototherapy

Back 37

6-8 hrs bright light prior to onset of episodes. Response 3-5 days. Most 4/5 female, bipolar, atypical features.

Front 38

Bipolar I disorder

Back 38

Manic episode alone, marked impairment in function

Front 39

Bipolar II disorder

Back 39

1+ MDD + hypomanic episode, NO marked impairment
Recurrent major depressive episodes with hypomania. No Hx manic episode

Front 40

BP with Catatonic features

Back 40

manic episode + (2 of 5):
motoric immobility, frenetic motor activity, extreme negativism/mutism, peculiar voluntary mvmts(posturing, stereotypy, grimacing), echolalia/echo-proxia

Front 41

Treatment for Bipolar Disorder

Back 41

Lithium Carbonate or Valproate
Neuroleptic vs Benziodiazepine -> behavioral safety
Bilateral ECT

Front 42

Genetics of Bipolar Disorder

Back 42

50% have parent with BP
25% chance of giving to child
abnormal gene on chromo V, X
biological mediation of temperamental instability

Front 43

Secondary Meds for Bipolar Disorder

Back 43

Lithium +
Anticonvulsants, kindling
Clonidine (alpha2 agonist, inhibit locus cereuleus)
Propanolol
Ca channel blocker (verapamil/nifedipine)