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44 Cards in this Set

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Attenuated depression
Dysthymia
Attenuated Mania
Hypomania
Mood disorder sx
Impaired judgement
problems with physical func.
disruption of life
Severe = psychotic sx
4 Primary Mood Disorders
Major Depressive Disorder
Bipolar Disorder (I and II)
Dysthymic Disorder
Cyclothymic Disorder
9 symptoms for Major Depressive Disorder
1. Subjective report of depression
2. Dec interest or pleasure in activities
3. Change in appetite (weight change, up or down)
4. Insomnia/Hypersomnia
5. Psychomotor agitation or retardation
6. Fatigue or energy loss
7. Feel worthless of guilty
8. Problems concentrating or thinking.
9. Thoughts of death or suicide
5 Criteria to Diagnose MDD (not the 9 sx, but the criteria)
A. 5 of 9 sx present during same 2 week period
B. No Mania sx
C. Significant distress or impairment in social func.
D. Sx not caused by substance or medical condition
E. Sx not caused by bereavement (depression cannot be diagnosed <2mos after loss of loved one)
What % weight loss often seen with depression
>5% of body weight lost
Type of depression more likely to show weight gain and excess somnolence
Atypical Depression
Is there diurnal variation in depression? Explain.
Yes.
More depressed in the morning
What % of depressed pt's deny depression? What is this called?
50%.
Masked Depression
Tx for Seasonal Affective Disorder (SAD)
Full Spectrum Light Exposure
MDD is usually cause by:
A combination of biological and social factors
Which of the following is a significant risk factor for MDD?
a. ethnicity
b. education
c. marital status
d. income
e. being female
E. being female
Which sex is more depressed?

What are the stats?
Female

M = 5-12%
F = ~2x M (10-24%)
What % of depressed people seek treatment?
25%
What happens to most episodes of depression without tx?
Self-limiting. Resolves in 6-12 months
Successfully tx'd episodes of depression last?
Less than 3 months
3 classes of antidepressants
HCA's
SSRIs
MAOIs
Example SSRI used for depression
fluoxetine (Prozac)
Antidepressants take at least ____ weeks to work.
3 weeks
Psychostimulants are sometimes used to tx depression quickly. What is a drawback of these drugs?
Tolerance and Dependence
Treatment in which a grand mal seizure is introduced by passing an electric current through the brain.
ECT
3 examples of when ECT is indicated for depression?
When pt with severe depression doesn't respond to antidepressent meds.

When drugs are too dangerous or have intolerable side effects

When rapid resolution is needed (suicidal pt, etc)
5 criteria for Bipolar Disorder
A. A distinct period of abnormally and persistently elevated, expansive, or irritable mood lasting at least 1 week or less if hospitalization is necessary

B. At least 3 sx (4 if mood is only irritable)

C. No sx of depression
D. Significant distress or social/occupational impairment
E. Sx not caused by substance or medical condition
7 sx of mania
1. Inflated self esteem
2. dec need for sleep
3. talkativeness
4. flight of ideas
5. distractibility
6. inc activity or agitation
7. engagement in activity likely to have negative consequences
Difference between Bipolar I and II
I = depression + mania
II = depression + hypomania
Describe psychotic sx of mania
Occur during manic episodes
Mainly delusions of power
pt returns to nl between episodes
Particularly strong biological influence on development of mania
Genetics
Describe Bipolar tx in full (side effects, preferred drugs, bad drugs)
Lithium (SE = renal and thyroid dysfunction, tremor, weight gain).

If pt shows "rapid cycling" (>4 episodes/year) then rx = Anticonvulsants (divalproex, carbamazepine).

Sedatives (lorazepam)

Acute mania = Antipsychotics (haloperidol, olanzapine, risperidone)
Less severe form of MDD
Dysthymic disorder
Less severe form of Bipolar disorder
Cyclothymic disorder
Sx of dysthymic disorder
low self esteem
dec productivity
No anhedonia or suicidality
Sx of cyclothymic disorder
alternating states of dysthymia and hypomania
How long must sx persist to dx dysthymic/cyclothymic disorders
At least 2 years
Dysthymic and Cyclothymic population statistics
Dysthymic = 6% of pop.
Female 2x > Males

Cyclothymic = 1% of pop.
No sex difference
Dysthymic disorder tx
antidepressants
psychotherapy
Cyclothymic tx
mood stabilizers (similar to tx for bipolar)
Medical conditions that could cause mania
Hyperthyroid
Stroke
Brain Neoplasm
Infection (particularly in the R orbitofrontal cortex)
Medical causes of depression
CA (pancreatic, GI)
viral (PNA, flu, aids)
endocrine (hypothyroid, cushings)
Neuro (parkinson's, MS, huntington's, stroke, dementia)
Nutritional
Renal, Cardiopulmonary
Rx drugs that can cause depressive sx
Reserpine
other antihypertensives
antineoplastic agents
steroids
Opiate withdrawal
Rx drugs that can elevate mood
Steroids
Amphetamines
Cocaine
Adjustment disorder with depressed mood is dx'd when:
sx do not meet criteria for major depressive episode, follow within 2 mos of a significant stressor, persist for up to 6 mos after stressor has terminated
Normal Bereavement time frame
2 mos ( > 2 mos = MDD)
2 common misdiagnoses of depressed patients
Anxiety disorder
somatoform disorder