Psychiatry: Mood Disorders

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Psychiatry: Mood Disorders
2013-01-30 14:49:21
Psychiatry Mood Disorders

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

    • 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
  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

    • *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
  13. What percentage of Manic Episodes occur before or after an MDE
  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
  28. Serotonin receptor genotype that most likely predisposes to depression
  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
  35. Often misdiagnosed as MDD

    (Pts. seek help when depressed)
  36. Percentage of known MDD asked about suicide
  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