Psychiatry: Mood Disorders

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BrookeNH10
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Psychiatry: Mood Disorders
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2013-01-30 14:49:21
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Psychiatry Mood Disorders
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Psychiatry Mood Disorders
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  1. Depressive Disorders
    • Major Depressive Disorder (MDD)
    • Dysthymic Disorder
  2. Bipolar Disorders
    • Bipolar I and II
    • Cyclothymic Disorders
  3. Diagnostic Criteria for MDD
    5/9 symptoms, 2+ weeks
  4. Symptoms of MDD
    • *Depressed mood (or irritable mood: <18)
    • *Anhedonia
    • Appetite
    • Sleep disturbance, too much/too little
    • Agitation or retardation
    • Fatigue
    • Feelings of worthlessness or guilt
    • Difficulty concentrating or deciding
    • Recurrent thoughts of death

    • SPACE DRAGS
    • Sleep Disturbance
    • Pleasure/interest (lack of); anhedonia
    • Agitation+\???
    • Concentration
    • Energy (lack of)/fatigue
    • Depressed mood
    • Retardation movement+\???
    • Appetite Disturbance
    • Guilt, worthless, useless
    • Suicidal thought
  5. Single vs. Recurrent MDD
    • Single= 1 episode
    • Recurrent= 2+ episodes separated by > 2 month period
  6. Percentage of recurrent MDD that will have another episode at some point in their life
    60%
  7. Diagnostic Criteria for Dysthymia
    • 2 years (or 1 year for someone under 18)
    • Can't be w/o symptoms > 2 months
    • 3/7 symptoms
  8. Symptoms of Dysthymia
    • *Depressed (or irritable mood: <18)
    • Concentrating or deciding
    • Appetite
    • Sleep disturbance, too much/too little
    • Energy (lack of)/fatigue
    • Low self esteem (MDE:  worthlessness)
    • Hopelessness (MDE:  suicidal thought)
  9. Bipolar Dx
    Alternating btw Depression and Mani/hypomania

    (The two ends of the emotional spectrum.  This is not a personality disorder!)
  10. Diagnostic Criteria for Manic Episode
    • 1 week
    • 4/8 symptoms (5/8 if mood is irritable)
  11. Symptoms of Manic Episode
    I DIG FAST

    • *Intense elated mood or irritable mood
    • Distracted- can't dismiss ireelevant stimuli
    • Indiscretion/disinhibition (pleasure acts)
    • Grandiosity or inflated self-esteem
    • Flight of ideas/racing thoughts
    • Activity increase (goals; very productive)
    • Sleep deficit/ decrease need for sleep
    • Talkative; pressure to keep talking
  12. Percentage of people who have a manic episode that have another episode
    90%
  13. What percentage of Manic Episodes occur before or after an MDE
    65%
  14. Duration of hypomanic episodes
    4 days
  15. Diagnostic criteria for Hypomanic Episode
    • 4 days in duration
    • Functioning= different
    • Not impaired (socially, or occupationally)
    • 3/8 symptoms (4/7 if mood= irritable)
  16. Diagnostic Criteria for Mixed Episode
    • 7 days, nearly every day
    • Meet criteria for Manic Episode
    • meet criteria for MDE (except for duration)
  17. Diagnostic Criteria for Bipolar I
    • 1+ manic/ mixed episode
    • Do not have an MDE
  18. Diagnostic criteria for Bipolar II
    • 0 manic/mixed episode
    • 1+ hypomanic episode
    • 1+ MDE
  19. Cyclothymic Dx
    • 0 manic/mixed episode; 0 MDE
    • Many periods: hypomanic and depressed symptoms
    • Chronic (2 years) w/o any remission for 2 months
  20. What disorders affect men and women equally?  What gender is affected more heavily by all the others?
    • Bipolar affects men and women equally.
    • Women are more heavily affected by all the others.
  21. Avg Length of
    • MDE: 4-9 mo
    • DYST: 5 yrs
    • BP1: Wks-mo
    • BP2: Wks-mo
    • CYC: Chronic
  22. Why are women more affected than men?
    Hormone theories have been disproved!!!

    • General Response to depressed mood:
    • Women:  Ruminating/brooding (not reflection; causes, meaning, and consequences)
    • Men: Distraction
  23. There is a strong genetic component in the diagnosis of mood disorders
    Multiple genes likely at play

    Relatives:  8-9% of BP relative have BP (compared to 1% of population)

    Twins:  MZ (60%), DZ (19%)
  24. Nerochemical factors of MDD
    • Serotonin= decreased (instability, impulsivity, aggression, suicide)
    • Dopamine= decreased (Low exploratory, outgoing, pleasure-seeking)
    • Norepinephrine= decreased (low alertness)
  25. Neurochemical Factors:  Bipolar Disorder
    • Serotonin:  decreased (instability, impulsivity, aggression, suicide)
    • Dopamine:  increased (exploratory, outgoing, pleasure seeking; not cocaine stimulates dopamine production - produces manic-like behavior)
    • Norepinephrine:  increased (regulates tendencies, alertness)
  26. Diathesis-Stress Model
    • Diathesis= biology (serotonin transporter [s/l]; controls ability of an axon to reabsorb serotonin after its release)
    • Stress= environment (# of stressful life events)
  27. Number of stressul life events likely to show an increase in depression
    4
  28. Serotonin receptor genotype that most likely predisposes to depression
    s/s
  29. Psychological Causes of Depression:  Arbitrary Inference
    Drawing a negative conclusion that lacks supports (ie. Company goes out of business and you lose your job.  You're convined its due to your inabilities)
  30. 2 Psychological Causes of Depression
    • Arbitrary Inference
    • Overgeneralization
  31. Psychological Causes of Depression:  Overgeneralization
    Sweeping generlizations from 1 neg incident (ie. if lecturer gives numerous lectures on mood disorders and loses her train of though.  Then she's convinced she can never give a lecture again.)
  32. Bouts of insomnia trigger
    manic episodes
  33. Consistence of routine is important for
    Bipolar disorder
  34. Percentage of MDD missed by primary MD
    40%
  35. Often misdiagnosed as MDD
    BP

    (Pts. seek help when depressed)
  36. Percentage of known MDD asked about suicide
    35%
  37. Docs likely contacted 1 month prior to suicide
    Primary care doctor (45% of the time)
  38. Empirically Based Screening for Depression
    • PHQ-9 (Patient Health Questionnaire)
    •        9 Q's, +=10
    • MDQ (Mood Disorder Questionnaire)
    •        13 Q's, +=7

    Remember:  screening does NOT equal diagnosis
  39. Continual Assessment of Depressive Disorders involves
    • Screening
    • Monitoring
    • Treating
  40. Tx for MDD
    • SSRIs (Serotonin Reuptake Inhibitors)
    • Antidepressants
  41. MoA of SSRIs
    • Prevents the presynaptic neuron from reabsorbing serotonin
    • Neurotransmitter remains longer in the synaptic cleft
    • Can be recognized again and again by the receptors of the recipient cell
  42. MoA of Antidepressants
    • Change brain levels of neurotransmitters
    • Effective for 60% of pts.
    • Take 3-4 wks to produce effects
    • Placebo effect:  Improvement because expects effect
  43. Name 5 SSRIs
    Zoloft, Luvox, Celexa, Paxil, or Seroxat
  44. Tx for BP
    • Mood Stabilizers: Lithium
    • Anticonvulsants:  Depakote, Tegretol

    Giving a bipolar person antidepressant will throw them into a manic episode
  45. Lithium (tx in BP)
    • Decreases duration/frequency, severity of both manic and depressed episodes
    • 70% have an initial response
    • Many ultimately relapse
  46. Side effects of Lithium
    Tremors, thirst, weight gain, cognitive impairment

    *Must be monitored closely because it can be toxic
  47. Electroconvulsive Therapy (ECT)
    • Pt. is anesthetized and given muscle-relaxing drugs to prevent bone breakage
    • Electric shock (less than 1 second) administered to the brain to produce seizures (last several minutes)
    • usually done every other day for 6-12 sessions
    • Can significantly reduce depression in pts. who don't respond to medication

    Controversial b/c:  We don't know why it works.  Produces memory loss/confusion (disappears after a week or two)
  48. BP:  Psychological treatments
    Goal:  Stabilize rhythms (sleep-wake cycle)
  49. MDD: Psychological Treatments
    • Cognitive-Behavioral Therapy (CBT)- Cognitive erors and distorted thoughts
    • Interpersonal Therapy-resolve problems in relationships; skills to form new relationships
  50. CBT vs. Medication
    • CBT is as effective as medication (60%)
    • Actually changes neurotransmitter levels

    CBT is more effective at:  1) maintaining gains; 2) preventing further relapse

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