Term
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Definition
| "Mood" (or "affect") is a pervasive emotional state that influences one's view of self, others and environment |
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Term
| dimensions of describing of mood |
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Definition
Thymic dimension (spectrum)
Anxiety (scale of 0-high)
Anger (scale of 0-high) |
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Term
| spectrum of thymic dimension of mood |
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Definition
feeling up/down
euphoric (highest)
euthymic (neutral)
dysthymic
depression |
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Term
| significance/burden of mood disorders |
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Definition
| depression is #1 and bipolar disorder is #6 on the WHO Global Burden of Disease |
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Term
| general def of mood disorders |
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Definition
| sustained, disabling extremems of mood |
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Term
| biogenic amines that play a role in the neurobiology of mood disorders |
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Definition
NE
serotonin
**levels are directly related to mood**
most antidepressants increase synaptic transmission of norepinephrine, serotonin, or both |
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Term
| *NT levels associated with depression* |
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Definition
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Term
| *NT levels associated with mania* |
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Definition
*elevated NE
*elevated serotonin |
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Term
| neuroendocrine dysfunction of HPA axis in depression |
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Definition
-hyperactivation of hypothalamic-pituitary-adrenal axis leads to excess cortisol secretion
-50% of cases show nonsuppression of cortisol (tested with synthetic cortisol; DST)
-immune functions may be suppressed with depressed mood (increased likelihood of becoming physically ill) |
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Term
| neuroendocrine dysfunction of hypothalamic-pituitary-thyroid axis in depression |
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Definition
-10% of severely depressed patients have hypothyroidism
-thyroid augmentation is beneficial even in some euthyroid patients |
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Term
| neurophysiological dysfunction in depression |
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Definition
sleep architecture is disrupted:
-decreases TST
-decreased REM latency (get to REM quicker - characteristic of sleep deprivation)
-increased total REM sleep |
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Term
| neuroimaging in depression |
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Definition
-decreased volume of frontal lobes and hippocampus (memory attachment)
-decreased metabolic activity in the frontal lobes
-increased metabolic activity of the hippocampus (bring up memories) and amygdala (anxiety/mood mediation) |
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Term
| psychosocial factors leading to mood disorders |
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Definition
stress
cognitive factors
psychoanalytic theory |
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Term
| psychosocial factors: STRESS |
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Definition
-early life losses (e.g. death of a parent) are associated with greater risk of depression in adulthood
-acute life stress is highly associated with onset of depression |
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Term
| psychosocial factors: COGNITIVE FACTORS |
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Definition
-negative self image, interpretation of events, and expectation for the future are associated with depression
-"learned helplessness": passivity and despair associated with lack of control over life events (e.g. in children who have been chronically abused) |
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Term
| psychosocial factors: PSYCHOANALYTIC THEORY |
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Definition
| depression arises from ambivalence toward a lost love object; usually in which there were strong + and - feelings in the relationship |
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Term
| episodic mood symptoms: different DSM-listed diagnoses |
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Definition
Major Depressive Episode
Manic Episode
Hypomanic Episode |
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Term
| major depressive episode (DSM-IV criteria) |
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Definition
-2 weeks of depressed mood or adhedonia
-accompanied by 3-4 "Vegetative" symptoms
*symptoms cause significant distress or impairment in function over a substantial period of time
-not attributable to substance abuse or medical illness
-not in the context of normal behavior |
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Term
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Definition
-diminished interest or pleasure
-loss of pleasure in NOT necessary experienced as sadness |
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Term
| vegetative symptoms that can accompany depression |
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Definition
(need 3-4 for major depressive episode)
-decreased appetite or weight loss or increased appetite
-insomnia (usually early waking) or increased sleep
-psychomotor retardation o agitation
-fatigue or loss of energy
-feelings of worthlessness or inappropriate guilt
-impaired concentration or indecisiveness
-recurrent thoughts of death or suicide |
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Term
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Definition
Atypical
Melancholia
Postpartum
Catatonic
Psychotic features
Seasonal patter |
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Term
| atypical subtype of depression |
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Definition
REVERSED vegetative sypmtoms:
-hypersomnia
-increased appetite, weight gain
-rejection sensitivity |
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Term
| melancholia subtype of depression |
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Definition
"classical depression"
-prominent anhedonia
-intensely vegetative symptoms |
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Term
| postpartum subtype of depression |
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Definition
-occurs within +/- 4 weeks of delivery of a child
-(delivery often does not follow a benign course)
-hormonal evidence, doesn't occur with adoption |
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Term
| catatonic subtype of depression |
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Definition
-characteristic motor signs
-not responding to environment at all |
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Term
| psychotic features subtype of depression |
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Definition
| psychosis is present only during depressive episodes |
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Term
| seasonal pattern subtype of depression |
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Definition
depression occurs at specific times of the year
-depression is most common in fall and winter
-appears to be related to exposure to amount of light |
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Term
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Definition
-a distinct/sustained period of AT LEAST ONE WEEK during which there is abnormally and persistently elevated, expansive, or irritable mood
-symptoms must cause substantial impairment in ability to function, or be accompanied by active psychotic symptoms
-accompanied by 3-4 diagnostic symptoms |
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Term
| diagnostic symptoms of a manic episode |
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Definition
(need 3-4)
-inflated self esteem or grandiosity
-decreased need for sleep (vs. inability to sleep seen in depression)
-loud, rapid, and intrusive speech
-flight of ideas or racing thoughts, distractibility
-increased involvement in goal directed activities
-high risk behavior (fast driving, indiscriminate sex, sending sprees, ill-considered financial investments, etc) |
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Term
| subtypes of manic episodes |
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Definition
Mixed
Psychotic features
Rapid cycling |
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Term
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Definition
-meets criteria for both depressive and manic episode
-symptoms may rapidly alternate or be simultaneously present
-mood state shifts all over the place |
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Term
| psychotic features in manic episode |
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Definition
RULE, not the expection
-psychosis occurs in ~80% of manic people
-often mood congruent (e.g. grandiose delusions), but may be indistinguishable from psychotic symptoms of schizophrenia or other disorders
-insight seems to be good between episodes, but very poor during the episode |
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Term
| rapid cycling manic episode |
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Definition
- 4+ episodes per year
-NOT cycling up and down during the day |
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Term
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Definition
same diagnostic features as manic episode, but*:
-shorter duration (at least 4 days)
*NO significant impairment in function
*NO psychosis
*NO hospital admission
-still making sense and functioning
-very productive people, but can escalate to manic state if untreated |
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Term
| DSM-IV classifications for mood disorders |
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Definition
Major Depressive Disorder
Major Depressive Disorder with Psychotic Features
Dysthymic Disorder
Bipolar I Disorder
Bipolar I Disorder
Cyclothymic Disorder
Substance Induced Mood Disorder |
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Term
| major depressive disorder (MDD) |
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Definition
| one or more major depressive episodes without a manic or hypomanic episode |
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Term
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Definition
-peak age of onset is late 20's
-range of onset childhood-late life
-sudden (w/in 6m of stressor) or gradual (weeks-months of subclinical symptoms)
-50% of pts have subsequent episode
-50% of pts recover within 6 months (w/ treatment) |
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Term
| specific stressors and MDD |
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Definition
identification of specific stressors does not change the diagnoses
same: outcome, prognosis, treatment |
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Term
| recurrence of depressive episode in MDD |
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Definition
-risk recurrence increases with age
-risk recurrence increases with number of previous episodes
-average number of episodes = 4
-50% of patients will experience a subsequent episode |
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Term
| complications and co-morbidities of MDD |
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Definition
-15% lifetime suicide risk; highest of any disorder
-depressive pseudodementia: cognitive deficits related to poor concentration and energy; resolves with improvement in mood; usually in older patients
-substance abuse
-anxiety disorders are common |
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Term
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Definition
-lifetime risk: F 10-25%, M 5-12%
-point prevalence: F 5-10%, M 2-3%
-2xF>M
-strongly biological disorder: 50-70% concurrence in MZ twins
-25% risk to 1st degree relatives |
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Term
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Definition
(works very well!)
-antidepressant medication
-psychotherapy
-electroconvulsice therapy (ECT) |
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Term
| antidepressant medications |
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Definition
-SSRI's and atypical antidepressants are 1st linea gents
-TCAs less common, older
-MAOIs least common, older
-all medications work in 65-70% of cases (30% placebo response - highest)
-at least 6 months of treatment is optimal
-prophylactic treatment is effective for patients with a high risk for relapse |
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Term
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Definition
-can be as effective as meds in mild-moderate depression
-CBT and IPT techniques
-65-70% effectiveness in mild-moderate depression
**combo of psychotherapy and medication more effective than either treatment alone** |
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Term
| electroconvulsive therapy (ECT) |
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Definition
-indicated for severe depression, lack of response to other treatments, psychotic features, high suicide risk, starvation or dehydration, prior good response, or patient preference
-relative CIs are intracranial mass, dementia, severe personality disorder, high, anesthesia risk
-primary side effect is memory loss and confusion (both are self-limited)
-effective in 70-805 of patients
-maintenance ECT used when risk of relapse is high
-maintenance antidepressants used in all other cases |
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Term
| major depressive disorder with psychotic features |
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Definition
-10% of depressed patient develop psychotic features
-psychotic symptoms are ofthen (not always) congruent with mood
-ECT much more effective (80-90%) than any medication or med combo |
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Term
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Definition
"mini-depression"
-at least 2 years of depressed mood
- 2+ vegetative symptoms
-does not meet criteria for major depressive episode for at least the first 2 years
-lifetime risk 6%; point prevalence 3%
-often co-morbid with episodes of major depression ("double-depression")
-treatment is the same as for MDD |
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Term
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Definition
| at least one manic episode with or without a depressive episode |
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Term
| onset and course of bipolar I |
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Definition
-peak onset in 20's
-range of onset from teens to 60's
-symptoms progress rapidly (days) from pleasantly elevated mood at onset -->euphoria-->irritability-->psychosis
-some cases progress to catatonia
-episodes are often triggered by physical or psychosocial stressors
-episodes are often preceded or followed immediately by a depressive episode (~60%)
**recurrence likely** |
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Term
| repeat manic episodes in bipolar I |
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Definition
**>90% of patients have recurrent episodes**
-70-80% of patietns return to full function between episodes
-20-30% have persistent mood instability or functional impairment between episodes
-episodes occur every 2-3 years for patients in their 20's, increase to 1-2/year for patients in their 50's (carried implications for prophylaxis) |
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Term
| complications with bipolar I |
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Definition
-10-15% lifetime suicide risk
-substance abuse is common (and also acts as a trigger for episodes) |
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Term
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Definition
-lifetime prevalence 1% of adult population
-F=M
-strongly biological disorder: ~80% concurrence in MZ twins
-25% risk to 1st degree relatives |
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Term
| acute treatment of bipolar I |
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Definition
-antipsychotic meds are 1st line tx
-mood stabilizers: lithium, valproic acid, anticonvulsants
-AVOID antidepressants during manic phase because it will drive things higher |
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Term
| maintenance treatment of biopolar I |
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Definition
-mood stabilizers (lithium, valproic acid, anticonvulsants)
-antidepressant meds may be indicated (esp. if patient spends more time depressed than manic) |
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Term
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Definition
-at least one HYPOmanic episode (no manic episode) with at least one depressive episode
-similar onset, course, complications to bipolar I
- 2-3% lifetime prevalence
-treatment same as with MDD and bipolar I |
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Term
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Definition
-chronic fluctuating mood not meeting criteria for manic or major depressive episodes
-insidious onset in adolescence or young adulthood followed by chronic course
-50% risk of eventual development of bipolar I or bipolar II
-lifetime prevalence 0.4-1% |
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Term
| substance induced mood disorder |
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Definition
-prominent and persistent mood disturbance (depressed or elevated) related to intoxication or withdrawal from a substance
-may improve spontaneously with detoxification
-some cases require additional treatment with antidepressant meds
-antidepressants are rarely effective if intoxication or withdrawal continues or recurs |
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Term
| substances of substance induced mood disorder |
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Definition
-drugs of abuse, medications, toxins
-alcohol is most common substance causing depressed mood
-amphetamine, cocaine, and steroid are commonly associated with mood elevation |
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