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32 Cards in this Set
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- Back
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Nervous System- Mood Disorders by Eitel
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Nervous System- Mood Disorders by Eitel
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DSM-IV-TR Criteria for Major Depressive Episode
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2 week period of either depressed mood or anhedonia plus 5 of the following:
-Significant weight loss -Insomnia or hypersomnia -Psychomotor retardation or agitation -Fatigue -Worthlessness or guilt -Decreased concentration or indecisiveness -Suicide ideation Clinically significant impairment Not due to bipolar mixed episode, substance abuse, GMC, or bereavement |
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Mnemonic - Major Depressive Episode
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Depressed mood
Sleep disturbance Interest decreased Guilt Energy diminished Concentration decrease Appetite change Psychomotor inc. or dec. Suicidal ideation |
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DSM-IV-TR Criteria for Manic Episode
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Elevated, expansive or irritable mood for at least 1 week
3 or more of the following (4 if only irritable mood): -Inflated self-esteem or grandiosity -Decreased need for sleep -More talkative or pressured speech -Flight of ideas or racing thoughts -Distractibility -Increased goal-directed activity or psychomotor agitation -Excessive involvement in pleasurable activities with a high potential for negative consequences Symptoms caused marked impairment or psychotic features present Not due to substance, GMC, or mixed episode |
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Mnemonic for Mania – “DIGFAST”
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Distractibility – poorly focused, multitasking
Insomnia – decreased need for sleep Grandiosity – inflated self esteem Flight of ideas – racing thoughts Activities - Increased goal-directed actions Speech – pressured or more talkative Thoughtlessness – “risk-taking” behaviors (e.g., sexual, financial, travel, driving) |
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DSM-IV-TR Criteria for Hypomanic Episode
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Elevated, expansive or irritable mood for at least 4 days
3 or more of the following (4 if only irritable mood): -Inflated self-esteem or grandiosity -Decreased need for sleep -More talkative or pressured speech -Flight of ideas or racing thoughts -Distractibility -Increased goal-directed activity or psychomotor agitation -Excessive involvement in pleasurable activities with a high potential for negative consequences Episode associated with an unequivocal change in function uncharacteristic of the person and is observable by others Does NOT cause marked impairment in social or occupational functioning, require hospitalization, and not associated with psychotic symptoms Not due to effects of a medication, substance abuse or GMC |
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DSM-IV-TR Criteria for Mixed Episode
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Criteria for both a Manic Episode and a Major Depressive Episode are met nearly every day during at least a 1 week period
The mood disturbance causes significant social or occupational impairment, requires hospitalization or has psychotic symptoms Not due to medication, substance abuse or GMC |
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Major Depressive Disorder
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1 or more Major Depressive Episodes
No manic, hypomanic or mixed episodes No other psychiatric disorder to account for the symptoms -Single or recurrent episodes -Severity indicators: mild, moderate, severe, severe with psychotic features, partial or full remission -Course specifiers: chronic, catatonic, atypical, melancholic, or post-partum onset |
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Dysthymic Disorder
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Depressed mood > 2 years
Has not met criteria for MDD At least 2 of the following: -Change in appetite -Change in sleep -Fatigue, loss energy -Low self esteem -Poor concentration -Hopelessness Not without sx for more than 2 weeks at a time Double depression = Dysthymia + MDE |
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Depressive Disorder, NOS
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Includes disorders that do not meet full criteria for Major Depressive Disorder
-Premenstrual dysphoric disorder -Minor depressive disorder -Recurrent brief depressive disorder -Postpsychotic depressive disorder of schizophrenia -MDE superimposed on a psychotic disorder |
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Bipolar I Disorder vs Bipolar II Disorder
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1 Manic or mixed episode OR
Manic + depressive episodes May also have hypomanic episodes Pt has at least one 1 hypomanic + at least 1 MDE but no manic or mixed episodes |
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Cyclothymic Disorder
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-Dysthymia + intermittent hypomanic episodes over a period of 2 or more years
-Never meet criteria for MDE or manic episode during first 2 years -After 2 years, there may be superimposed manic, mixed or MDE |
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Substance-Induced Mood Disorder
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One or both of the following:
-Prominent depressed mood or markedly diminished interest /pleasure -Elevated, expansive or irritable mood Mood symptoms developed during or within 1 month of substance use or withdrawal OR Medication use is etiologically related to the disturbance The disturbance is not better accounted for by an underlying mood disorder or delirium |
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Adjustment Disorder with Depressed Mood
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Depressive symptoms develop in response to an identifiable stressor(s) within 3 months
Symptoms cause marked distress or significant impairment in social or occupational functioning Not due another Axis 1 disorder or bereavement Symptoms do not persist beyond 6 months once the stressor or its consequences has been terminated |
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Differential Diagnosis for Major Depressive Episode
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Major Depressive Episode:
Major depressive disorder Bipolar I or II disorder “Double depression” Mood disorder due to a GMC Substance-induced mood disorder Adjustment disorder Simple or complicated bereavement Dementia with prominent apathy Other mental disorders w/ depression as a feature (e.g., schizoaffective disorder) |
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Differential Diagnosis: Manic or hypomanic episode
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Manic or hypomanic episode:
Bipolar I or II disorder Cyclothymic disorder Mood disorder due to a GMC Substance-induced mood disorder MDE with prominent irritability Attention deficit/hyperactivity disorder Other mental disorders with mania as a feature (e.g., schizoaffective disorder) |
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Epidemiology of Major Depressive Disorder
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Major Depressive Disorder:
Lifetime prevalence: 5-12% men, 10-25% women Sex ratio: 2:1 women/men Rates highest among 25-44 year olds and lowest for those > 65 Mean age of onset mid 20’s Number of previous episodes increases likelihood of future episodes 5-10% of persons with a single MDE will have a manic episode 1.5 – 3 times more common in 1st degree relatives with the disorder |
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Epidemiology for Bipolar Disorder
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Bipolar Disorder:
Point prevalence 1% in men and women Lifetime prevalence: 0.4 - 1.6% Sex ratio: men = women Age onset between childhood – 50 yrs New onset mania occurring after age 65 more likely due to GMC Episodes are recurrent in > 90% Recurrent episodes may lead to progressive deterioration in functioning High prevalence rate of mood disorders in 1st degree relatives |
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Epidemiology for Dysthymic disorder and cyclothymic disorder
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Dysthymic disorder:
Lifetime prevalence 6% More common in females Onset usually earlier than MDD, chronic course, may have “double depression” Cyclothymic disorder: Lifetime prevalence 0.4 – 1% Equally common in men and women Usually begins in adolescence or early adult life Chronic course; 15 -50% develop BP I or BP II |
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Pathophysiology of Mood Disorders
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No single physiologic mechanism
Evidence suggests dysregulation of several neurotransmitter systems (esp. 5HT, NE, DA) Neuroendocrine dysregulation -Hyperactivity of the HPA axis ( cortisol) -Release TSH, GH, FSH, LH, testosterone, melatonin Kindling Abnormalities in cerebral metabolism Genetic factors Psychosocial factors |
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Treatment – Depressive Disorders, Biologic
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Biologic:
Antidepressant medication Stimulants Lithium Augmentation strategies Electroconvulsive therapy (ECT) Vagal nerve stimulation Experimental -Transcranial magnetic stimulation (rTMS) |
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Treatment – Depressive Disorders, Psychological
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Psychological:
Psychotherapy + antidepressants Cognitive behavioral therapy (CBT) Interpersonal therapy Psychoanalytic / psychodynamic therapy Supportive therapy Group therapy Family therapy |
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Antidepressant Medications,
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SSRIs
Prozac, Sarafem (fluoxetine); Zoloft (sertraline); Paxil, Paxil CR (paroxetine); Celexa (citalopram); Lexapro (escitalopram) SNRIs Effexor XR (venlafaxine); Cymbalta (duloxetine); Pristiq (esvenlafaxine) Others Wellbutrin (bupropion); Remeron (mirtazapine); Serzone (nefazadone) TCAs e.g., nortriptyline, imipramine MAOIs e.g., phenelzine, selegiline |
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Treatment – Bipolar Disorders, Biologic
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Biologic:
Lithium Anticonvulsant mood stabilizers Antipsychotic medications Sedatives Combination treatment ECT in refractory cases |
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Treatment – Bipolar Disorders, Psychological
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Psychological:
Psychotherapy + antimanic drugs Cognitive therapy Behavioral therapy Psychoanalytic therapy Supportive therapy Group therapy Family therapy |
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Antimanic Medications
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Lithium*
Anticonvulant mood stabilizers Depakote (divalproex)*; Tegretol (carbamazepine); Lamictal (lamotrigene)*; Neurontin (gabapentin); Trileptal (oxcarbazepine) Antipsychotics Zyprexa (olanzapine)*; Risperdal (risperidone)*; Seroquel (quetiapine)*; Abilify (aripiprazole)*; Geodon (ziprasidone)* Other Agents Verapamil; Nimodipine; Clonidine; Clonazepam; Clozapine *FDA approved for mania |
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Severe depressive episode(s)
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Major Depressive Disorder
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Minor depressive episodes with symptoms for > 2yrs
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Dysthymic Disorder
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Minor depression > 2 yrs with 1 major depressive episode
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“Double Depression”
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At least 1 manic episode
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Bipolar I Disorder
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At least 1 major depression and 1 hypomanic episode
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Bipolar II Disorder
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Minor depression and hypomania for > 2 yrs
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Cyclothymic Disorder
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