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41 Cards in this Set

  • Front
  • Back
In contrast to normal sadness that occurs in healthy people, how do patients with primary mood disorders differ?
They show a discordance between life events and how they feel emotionally
Define Major Depressive Disorder
One episode or recurrent episodes of major depression in an individual’s lifetime
What are the symptoms used to classify MDD according to DSM-IV-TR?
Observation by others of depressed mood
Decreased interest or pleasure in most activities (anhedonia)
Change in appetite
Persistent insomnia or hypersomnia
Psychomotor agitation or retardation
Daily fatigue or loss of energy
Feelings of worthlessness or guilt
Problems concentrating or thinking
Recurrent thoughts of death or suicide
Sleep disturbances
How many of the previous symptoms are considered diagnostic of MDD?
Must be present during the same 2 week period
At least one must be #1 or 2
Requires 2 or more episodes with a symptom free interval of 2 months
What is different about atypical depression?
Weight gain instead of loss and more excessive somnolence
What feature of depression is the greatest risk for suicide?
Feelings of hopelessness, those that have been hospitalized for depression, those with psychotic symptoms (delusions)
Describe delusions of depression
Congruent with negative mood, involving themes of destruction, catastrophe, and fatal illness
Describe masked depression
Headaches and body aches, vague physical symptoms instead of presenting with depression
Diagnosed by elimination and when patient has other symptoms of depression (weight loss and insomnia)
Describe Seasonal Affective Disorder and treatment
Associated with winter season and short days
Treated with full spectrum light
What causes MDD?
Biological – heredity, altered neurotransmitter activity, abnormal limbic-hypothalamic-pituitary-adrenal axis
Social – loss of primary attachment figure in childhood, catastrophic loss of loved one in adulthood, low self-esteem, negative interpretation of ordinary life events
Who is at greatest risk for MDD?
Females (25%)
Older persons who are chronically ill or widowed
What is the lifetime prevalence of MDD in males and females?
Male – 5-12%
Female – 10-25%
What are the treatments for MDD?
Heterocyclic antidepressants
Psychostimulants - 1) Used because other antidepressants take 3 weeks to work. 2)Can cause tolerance and dependence
Electroconvulsive therapy - For patients that do not respond to meds, or can’t take them
Psychotherapy - more effective in conjunction with meds
What are reasons why patients don’t seek treatment for MDD?
May have masked depression
May not be able to afford treatment
Culturally not valued or considered a personal or moral weakness
Emotional illness is less ‘real’
How quickly do depressive episodes last?
With treatment – 3 mos
Without treatment – 6-12 mos
Define Bipolar disorder
Episodes of both depression and mania (or depression and hypomania)
One episode of depression plus one episode of mania or hypomania
Describe symptoms of mania
Inflated self image or grandiosity
increased energy and activity, agitation
rapid thoughts and pressured speech, talkativeness
Decreased need for sleep
Flight of ideas
Engagement in activities that are likely to have negative consequences
May also have: Psychotic delusions, decreased need for food, lack of modesty in dress and behavior
What is the DSM-IV-TR criteria for a manic episode?
3-4 manic symptoms present for at least a 1 week period
Define a hypomanic episode
Mild mania symptoms (ex. inflated self esteem, talkativeness, hypersexuality) for at least a 4 day period
Describe psychotic symptoms that occur with bipolar disorder I
During manic episodes, themes of power and influence
What is a distinguishing feature of mania caused by Bipolar disorder I from schizophrenia?
BPDI – mania has delusions of grandiosity
Schizophrenia – paranoid delusions
What are the causes of BPD?
Biological - 1) Changes in neurotransmitter activity 2)Endocrine abnormalities 3)Genetics (not as big a factor in MDD)

No gender, cultural, or ethnic difference in occurrence
What are the treatments for BPD?
Lithium - 1) Adverse effects: renal/thyroid dysfunction, tremor, weight gain; C/I in rapid cycling BPD
Anticonvulsants (divalproex, carbamazepine)
Sedative agents (lorazepam, conazepam)
Antipsychotics (haloperidol, olanzapine, risperidone)
Psychotherapy (helpful for chronic BPD)
What is rapid cycling BPD?
More than 4 episodes in a year
Why do you not give antidepressants to BPD patients?
They can provoke a hypomanic or full-blown manic episode
Ask questions to determine correct diagnosis before prescribing
What is dysthymic disorder and what is the treatment?
Less severe MDD lasts at least 2 years
Symptoms: low self esteem, decreased productivity
Treatment: antidepressant meds and psychotherapy
What is anhedonia?
Loss of interest or pleasure
What is cyclothymic disorder and what is the treatment for it?
Alternating states of dysthymia and hypomania
Less severe version of BPD
Treatment: mood stabilizing agents
What is the difference between cyclothymic disorder and BPD?
No delusions with cyclothymic disorder and less severe
What is the difference between MDD and dysthymic disorder?
no suicidal ideation and hopelessness in dysthymic disorder
No change in body weight
Ability to function at work
What other conditions can cause depression?
Medical - 1) Cancer (pancreatic/GI)
2) Viral illness (influenza, pneumonia)
3) Endocrine abnormalities (hypothyroid, cushing’s)
4) Neurologic illness (parkinson’s, MS, dementia)
5) Nutritional deficiency
6) Renal or cardiopulmonary disease

Psychiatric - 1) Schizophrenia
2) Somatoform disorders
3) Eating disorders
4) Anxiety disorders
5) Adjustment disorders
6) Substance abuse withdrawal (from opiates, sedatives, stimulants)
What other conditions can cause manic symptoms?
Endocrine problems (hyperthyroid)
Neurological lesions (stroke, neoplasm, infection)
Medications (steroids)
What other disorders can present with major depressive episodes?
Adjustment disorder with depressed mood - 1)Mood symptoms do not meet criteria for MDD.
2) Follow within 2 mos of major psychosocial stressor, persist up to 6 mos after stressor ends

Normal bereavement - 1) Within 2 mos of death of a loved one
2) If it persists for more than 2 mos after loss - MDD
What misdiagnosis are poor BPD patients most likely to get?
Which symptom is more associated with depression that normal reaction to serious illness?
Excessive guilt
In the US, compared to men, what chances do women have of developing MDD and BPD?
Higher, equal
In a patient taking Prozac, What do these symptoms describe? (increased activity level, flight of ideas, pressured speech)
Precipitated manic episode
These symptoms describe what disorder? (weight loss, problems concentrating, no sense of sadness or hopelessness)
In a depressed patient, neurotransmitter availability before treatment is?
Decreased serotonin
What percentage of risk does a monozygotic twin have for developing BPD v. other siblings?
75% v. 12%
A man has flashbacks about his girlfriend’s death 2 months ago following a hit and run. He often cries and wishes for the death of the culprit. What is the diagnosis?
Normal bereavement