First Aid Psych 3-1 Mood Disorders

Front 1

1. Mood?

Back 1

a. A mood is a description of one’s internal emotional state.
b. Both external and internal stimuli can trigger moods, which may be labeled as sad, happy, angry, irritable, and so on.
c. It is normal to have a wide range of moods and to have a sense of control over one’s moods.

Front 2

2. Mood disorders?

Back 2

a. Pts w/mood disorders (aka affective disorders) experience an abnormal range of moods and lose some level of control over them.
b. Distress may be caused by the severity of their moods and the resulting impairment in social and occupational functioning.

Front 3

3. Mood episodes?

Back 3

a. Are distinct periods of time in which some abnormal mood is present.
b. They include depression, mania, mixed-state, and hypomania.

Front 4

4. Mood disorders?

Back 4

a. Defined by their patterns of mood episodes.
b. They include Major Depressive Disorder (MDD), bipolar I, bipolar II< dysthymic, and cyclothymic.
c. Some may have psychotic features as well (delusions or hallucinations).

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5. Note: When pts have delusions and hallucinations caused by mood disorders, they are usually mood congruent.

Back 5

a. i.e. depression causes psychotic themes of paranoia and worthlessness, and mania causes psychotic themes of grandiosity and invincibility.

Front 6

6. SIG E. CAPS (sx of major depression)?

Back 6

a. Sleep
b. Interest
c. Guilt
d. Energy
e. Concentration
f. Appetite
g. Psychomotor activity
h. Suicidal ideation.

Front 7

7. Criteria for MDD?

Back 7

a. Must have at least 5 of the following sx (must include either number 1 or 2) for at least a 2-week period:
1. Depressed mood
2. Anhedonia (loss of interest in pleasurable activities
3. Change in appetite or body weight (↑ or ↓)
4. Feelings of worthlessness or excessive guilt.
5. Insomnia or hypersomnia
6. Diminished concentration
7. Psychomotor agitation or retardation (ie, restlessness or slowness)
8. Fatigue or loss of energy
9. Recurrent thoughts of death or suicide.
b. Sx cannot be due to substance use or medical conditions, and they must cause social or occupational impairment.

Front 8

8. Criteria for Manic episode?

Back 8

a. A period of abnormally and persistently elevated, expansive, or irritable mood, lasting at least 1 week (or any duration if hospitalization is necessary) and including at least 3 of the follow (4 if mood is irritable).
1. Distractibility
2. Inflated self-esteem or grandiosity
3. ↑ in goal-directed activity (socially, at work, or sexually)
4. ↓ need for sleep
5. Flight of ideas or racing thoughts
6. More talkative or pressured speech (rapid and uninterruptible)
7. Excessive involvement in pleasurable activities that have a high risk of negative consequences (eg, shopping sprees, sexual indiscretions).
b. These sx cannot be due to substance use or medical conditions, and they must cause social or occupational impairment.

Front 9

9. What % of manic pts have psychotic sx?

Back 9

a. 75%.

Front 10

10. Mixed episode?

Back 10

a. Criteria are met for both manic and MDD episodes.
b. These criteria must be present nearly every day for at least 1 wk.
c. As w/a manic episode, this is a psychiatric emergency.

Front 11

11. Hypomanic episode?

Back 11

a. A distinct period of elevated, expansive, or irritable mood that includes at least 3 of the sx listed for the manic episode criteria (4 if mood is irritable).
b. There are significant differences between mania and hypomania?

Front 12

12. Mania vs. Hypomania?

Back 12

a. Mania- lasts at least 7 days. Hypomania at least 4.
b. Mania-Causes severe impairment in social or occupational functioning. Hypomania has no marked impairment in social of occupational functioning.
c. Mania may necessitate hospitalization to prevent harm to self or others. Hypomania does not require hospitalization
d. Mania may have psychotic features. Hypomania does not.

Front 13

13. DIG FAST (sx of manic episode)?

Back 13

a. Distractibility
b. Insomnia/compulsive behaviour
c. Grandiosity
d. Flight of ideas/Racing thoughts
e. Activity/agitation
f. Speech (pressured)
g. Thoughtlessness

Front 14

14. Predominant mood state in mixed episodes?

Back 14

a. Irritability.
b. Pts w/mixed episodes have a poorer response to lithium.
c. Anticonvulsants may help.

Front 15

15. Medical causes of manic episode?

Back 15

a. Metabolic (hyperthyroidism)
b. Neurological disorders (temporal lobe seizures, MS)
c. Neoplasms
d. HIV infection

Front 16

16. What mood disorders are stroke pts at very high risk for developing?

Back 16

a. Depression.

Front 17

17. Diagnosis of Major Depressive Disorder MDD?

Back 17

a. At least one major depressive episode.
b. No hx of manic or hypomanic episode.

Front 18

18. Prevalence of MDD?

Back 18

a. 16.2% in US (48 million Americans).
b. Average age of onset is 40 (but any age)
c. 2x as prevalent in women than men during reproductive yrs.
d. No ethnic or socioeconomic differences.

Front 19

19. Sleep problems associated w/MDD?

Back 19

a. Multiple awakenings
b. Initial and terminal insomnia (hard to fall asleep and early morning awakenings)
c. Hypersomnia (excessive sleepiness).
d. REM sleep shifted to earlier in night and stages 3 and 4 ↓.

Front 20

20. Leading theory of cause of MDD?

Back 20

a. Neurotransmitter deficiencies in the brain.
b. ↓ brain and CSF levels of 5-HT and its main metabolite 5-HIAA.
c. Abnormal regulation of beta-adrenergic receptors has also been shown.
d. Drugs that ↑ availability of 5-HT, NE, and dopamine often alleviate sx of depression.

Front 21

21. Contributing factors to MDD?

Back 21

a. High cortisol- Hyperactivity of hypothalamic-pituitary-adrenal axis as shown by failure to suppress cortisol levels in dexamethasone suppression test.
b. Abnormal thyroid axis: Thyroid disorders are associated w/depressive sx.
c. GABA and endogenous opiates may have a role.
d. Psychosocial/life events: Stable family and social functioning have been shown to be good prognostic indicators in the course of MDD.
e. Genetics: First degree relatives are 2-3x more likely to have MDD.
f. High concordance rates among twins.

Front 22

22. Course and prognosis of depressive episodes?

Back 22

a. If left untx’d, depressive episodes are self-limited but usually last from 6-13 months.
b. Generally, episodes occur more frequently as the disorder progresses.

Front 23

23. What cancer has a high association w/depression?

Back 23

a. Pancreatic

Front 24

24. Anhedonia?

Back 24

a. Inability to experience pleasure, which is a common finding in depression.

Front 25

25. 2 most common kinds of sleep disturbances association w/depression?

Back 25

a. Difficulty falling asleep and early morning awakening.

Front 26

26. Note: Loss of a parent before age 11 is associated w/the later development of MDD.

Back 26

26. Note: Loss of a parent before age 11 is associated w/the later development of MDD.

Front 27

27. SSRI SE?

Back 27

a. Safer and better tolerated than other classes of antidepressants.
b. SE are mild and include:
1. HA
2. GI disturbance
3. Sexual dysfunction
4. Rebound anxiety.

Front 28

28. SSRI-like meds that also have activation of other neurotransmitters include?

Back 28

1. Venlafaxine (Effexor)
2. Duloxetine (Cymbalta)
3. Bupropion (Wellbutrin)

Front 29

29. TCA SE?

Back 29

a. Most lethal in overdose.
b. SE include:
1. Sedation
2. Wt. gain
3. Orthostatic hypotension
4. Anticholinergic effects
5. Can aggravate prolonged QTC syndrome!

Front 30

30. MAOI SE?

Back 30

a. Risk of hypertensive crisis when used w/sympathomimetics or ingestion of tyramine-rich foods (such as wine, beer, aged cheeses, liver, and smoked meats.
b. Risk of serotonin syndrome when used in combination w/SSRIs.
c. Most common SE is Orthostatic Hypotension!