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41 Cards in this Set
- Front
- Back
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3 Main Mood Disorders
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Depression, Mania and Hypo Mania
Hypo Mania=Mania light (less severity) |
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Mood Episode
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-A persistent mood syndrome,
not due to organic causes not related to a psychotic episode -Either extremely happy or sad and inappropriate/(non congruent with your life) for your circumstances Needs to be consistency, pattern or duration |
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Depression
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Depression: Adults: have to have symptoms everyday for 2 weeks or 1 week for 18yrs and under
Depressive episodes make up depression People will present with depression but you need to screen for mania |
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Diagnosing Mood Disorders
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In diagnosis of mood disorders: 5 numbers in diagnosis (no X's)
-Episodes are necessary to make diagnosis -Some Dx require episode of symptoms and duration -Some require patterns of episodes |
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Specifications
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Mild
Moderate Severe With or without psychotic features Partial or full remission |
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Depressive Episodes Overview
p.349/Criteria p. 346 |
-Last 2 weeks or more (2 +days in brief)
-Builds towards sufficient symptoms to meet depressive disorder -Prominent mood is sad -Within 6mo-1yr and still functioning it is bereavement only |
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Depressive Episodes Symptoms
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-Sleep Disturbances
-Appetite Disturbances -Loss of Libido -Irritability -Sad -Hopelessness, Worthlessness, Helplessness |
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Depression Criteria
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-1 or more depressive episode
-Duration of the episode is critical -Without history of manic, mixed or hypomanic symptoms -Not grieving - Even 1 manic episode classifies bipolar, if ever been manic can not go back to regular depression |
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Psycomoter Agitation
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wiggling foot (Tigger)
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Psychomotor Retardation:
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(Eeyore)
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Depression and Anxiety
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Anxiety: often goes hand and hand with depression and can be the cause of the depression of vice versa
Treatment and meds are pretty much the same |
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(SLAP Model)
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Suicide Ideation
S=suicide thinking L=lethality of method A=availability of agent P=plan |
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Coding Depression
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MUST USE 5 DIGITS
-first three numbers are 296 -Forth Digit is: -2 for single depressive episode -3 if recurrent |
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Depression Coding 5th digit
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Fifth Digit is severity
1=mild 2=moderate 3=severe w/o psychotic features 4=severe with psychotic features 5=partial remission 6=full remission 0=no clue No diagnosis=V7109, unless this don’t use V |
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Depression
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-Person never without symptoms for more than 2 months at a time
-In first 2 years: if they meet criteria for major depressive disorder they move into major depressive disorder. -Make sure there has never been a manic episode than they move to Bipolar. -Look for substances can cause depressions: weed, zanax, liquior -Symptoms have to cause impairment and different from their norm -Specify if: early: onset before 21/ Late after 21 |
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Dysthymia
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-Depression Lite (at least 2 yrs)
-Code 300.4 -Dysthmia: no thought issues, hard time concentrating. Just down in the dumps. -2yrs/1yr kids -Depressed mood + 2 symptoms (sad) -No cognitive symptoms |
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Depression Stats
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-2 weeks/1-kids
-Depressed mood + 4 symptoms -+ vegetative symptoms |
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Unipolar Depression
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-Late onset
-More females -+ insomnia - less psychosis -+antidepressants -Does not have mania all by itself |
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Bipolar Depression
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-Earlier onset
-Males=Females -Hypersominia - +psychosis - -antidepressants |
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Mania
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-Typically expansive elated, sometimes angry p. 362
-Duration 1 week, during this period need to have 3 or more of the following: see below -Medication my lessen severity -Must be in the moderate or sever range. Person thinks they can fix US. If president will talk to them. -Sleep: less than 3 hours -Feeling and probably look great -Diarrhea of the mouth you can't get a word in |
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Manic Episodes
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-Goal directed activity: unfinished
-Pleasurable activity: high risk, unsafe sex, many partners -Different from their normal selves. -Flight of ideas: all over the place -May go buy house, shoes, don't think about it -Not in kids -Not caused by AOD -AOD: Alcohol and other drugs AOD: Alcohol and other drugs |
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Manic Course
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-Mean age of onset=20. Some start in 50's.
-The younger they are the poorer the prognosis -Typically episode will begin suddenly, start in the afternoon by next day full blown mania. -Person is having a really good time, they will not seek treatment during manic phase. -Mania: can be irritable and mean |
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Hypomanic Episode
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-The same as mania except for: duration is 4 days not a week and only need 3 symptoms.
-It is less severe -Pressured speech but it will be easier to talk to them |
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Mixed Episodes
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-P. 365 mixed episodes: they meet crietia for mania, depression (cycling) in the same day for at least a week.
-Take major toll on the boy -Rapid cycling: 4 or more episodes in a 12mo period p.427? Added to diagnosis |
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Types of Bipolar
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-Bipolar I-cycles of manic and depressive episodes
-Bipolar II-cycles of hypomanic and depressive episodes --Cyclothymia-cycles of subclinical depression (less than 5 sym) and hypomania |
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Bipolar 1:
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cycles of mania (1wk, 3 or more criteria )/ depressive 2 wks 5 criteria)
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Bipolar 2:
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cycles of hypo mania (4 d cycle, less severe)
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Cyclothymia:
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sub clinical depression 2yrs, kids 1yr, sub clinical depression and hypo mania (mainia lite) p. 400 not symptom free for more than 2 mos. Like dysthimia
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Bipolar 1 & 2
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-No matter disorder must be impairment
-Bipo 1; must be severe impairment If severe on either pole (depressive or manic) they are in BiPo 1 -Mild =BiPo 2 -If not sure put in BiPo 2 (high moderate Bipo1/ low moderate BiPo 2 Bipo1 every manic episode has depressive episode -BiPo2 may have more depression, hypo mania is so light it appears as a good mood. -When diagnosing Bipolar need to know where they are now or most recent episode. |
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Bipolar Specifiers
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-Manic or depressive episode
-Single or recurrent |
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Bipolar I Cycle Patterns
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-Mixed: cycle between manic and depressive
-Rapid cycles: 4 or more cycles in 12 mo -is not continuous, remits |
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Depressive Criteria Bipolar I
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-Establish a pattern of depressive/manic episodes without deterioration over time
-Must have normal periods between moods -Self medication is common |
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Characteristics of Bipolar II
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-At least 1 hypomanic episode
-At least 1 depressive episode -Must specify the current episode -Must cause mild impairment |
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Hypomanic Criteria Bipolar II
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Must be a change in functioning
-tend to over commit or over spend -Pleasure seeking behavior present -Impairment but not severe -no legal problems or bankruptcy |
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Levels of Severity Bipolar
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Levels and severity determine Bipo1 & Bipo 2
Cyclohtimia: made up of disythimia & hypo mania |
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Coding Bipolar I Fourth Digit
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296.x
-Fourth digit is for current episode -0=single manic episode -4=currently in mania -5=depression -6=mixed -7=no clue |
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Coding Bipolar I Fifth Digit
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296.xx
Fifth digit is severity -1= mild -2= moderate -3= severe w/o psychotic features -4=severe with psychotic features -5=partial remission -6=full remission -0=no clue |
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Coding Bipolar Fifth Digit
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If they have a Dx of Bipolar but their current state is hypomania than the fifth digit is zero
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Coding Bipolar II
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296.89
-specify current hypomanic or depressed -specify features: mild, moderate, severe (with or without psychosis), catatonic, melancholic, atypical, postpartum |
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Clythothymia
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+2 years of multiple periods of hypomania
= 2 years of depressive symptoms w/o major depression (subclinical or dysthymia) -often develop depression in response to cycles -Code: 301.13 |
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NOS
GMC |
NOS: post postpartum depression, premenstrual disphoric disorder
GMC: general medical condition; depression from thyroid disorder |
