Mood Disorders-Psychopathology & Diagnostic Reasoning

Module 2, Week 3

What is the mnemonic used to recall the diagnostic criteria for Major Depressive Disorder (MDD)?

SIGECAPS (Sleep, Interest, Guilt, Energy, Concentration, Appetite, Psychomotor, Suicidal ideation)

What is the minimum symptom count and duration required to diagnose Major Depressive Disorder?

5 or more SIGECAPS symptoms present for a minimum duration of 2 consecutive weeks

Which two core symptoms require at least one to be present for a valid Major Depressive Disorder diagnosis?

Depressed mood or Anhedonia (loss of interest or pleasure)

What is the clinical definition of anhedonia?

A profound loss of interest or pleasure in nearly all activities

What is the mnemonic used to recall the diagnostic criteria for a Manic Episode?

DIGFAST (Distractibility, Irresponsibility, Grandiosity, Flight of ideas, Activity increase, Sleep decrease, Talkativeness)

What is the minimum duration required to classify a manic episode under DSM-5-TR guidelines?

Symptoms must persist for at least 1 week and cause significant functional impairment

What is the primary difference in functional impairment between a Manic and a Hypomanic episode?

Mania causes severe functional impairment, whereas hypomania does not cause significant impairment in daily functioning

What is the strict minimum duration required to diagnose a Hypomanic Episode?

Symptoms must persist for at least 4 consecutive days

What is the absolute baseline diagnostic requirement to establish Bipolar I Disorder?

At least one documented full manic episode (depressive episodes are common but not strictly required for diagnosis)

What specific combination of episodes is mandatory to diagnose Bipolar II Disorder?

At least one hypomanic episode AND at least one major depressive episode

What is the diagnostic threshold for Cyclothymic Disorder in adults?

Fluctuating hypomanic and depressive symptoms that do not meet full episode criteria, persisting for at least 2 years

What is the clinical hallmark and duration threshold for Persistent Depressive Disorder (Dysthymia) in adults?

A chronic depressed mood described as "baseline sadness" lasting for at least 2 years

What key clinical feature differentiates Persistent Depressive Disorder from Major Depressive Disorder?

Patients with PDD can still temporarily enjoy some things and experience moments of baseline interest

What is the timeline constraint for the onset and resolution of Adjustment Disorder?

Symptoms must emerge within 3 months of an identifiable stressor and typically resolve within 6 months of its termination

What organic endocrine condition must be ruled out before diagnosing a primary Depressive Disorder?

Hypothyroidism

What heavy metal metabolic condition is an organic medical differential for depressive episodes?

Wilson's disease (copper overload)

What are the four primary classes of standard antidepressant medications used to manage Depressive Disorders?

SSRIs, SNRIs, Tricyclic Antidepressants (TCAs), and Monoamine Oxidase Inhibitors (MAOIs)

What non-pharmacological somatic treatment is indicated for treatment-resistant or refractory Major Depressive Disorder?

Electroconvulsive Therapy (ECT)

What are the gold-standard first-line mood stabilizers used for the maintenance treatment of Bipolar Disorders?

Lithium and Valproate (Valproic Acid)

Which two medications are highly utilized secondary mood stabilizers to manage bipolar depressive phases?

Lamotrigine and Quetiapine

What drug class must be added immediately to a patient's regimen during an acute manic crisis in an emergency setting?

An atypical antipsychotic

What is the primary treatment modality for mild-to-moderate Persistent Depressive Disorder and Cyclothymic Disorder?

Cognitive Behavioral Therapy (CBT)

What is the core treatment framework indicated for Adjustment Disorder?

Supportive psychotherapy

When are medications indicated in the treatment of an Adjustment Disorder?

Short-term targeted use to treat specific secondary symptoms like insomnia or severe somatic anxiety

What is the core diagnostic feature of Disruptive Mood Dysregulation Disorder (DMDD)?

Chronic, severe persistent irritability manifested by frequent, severe temper outbursts out of proportion to the situation

What is the strict age requirement restriction for a valid new diagnosis of Disruptive Mood Dysregulation Disorder?

The initial diagnosis must not be made before age 6 or after age 18

At what age must the symptom onset of Disruptive Mood Dysregulation Disorder be clearly evident?

Symptoms must have an uncharacteristically early onset before age 10

What is the minimum frequency of temper outbursts required to satisfy the criteria for Disruptive Mood Dysregulation Disorder?

Outbursts must occur on average 3 or more times per week

What duration criteria must be met to confirm a diagnosis of Disruptive Mood Dysregulation Disorder?

Symptoms must be consistently present for 12 or more months without a symptom-free period exceeding 3 consecutive months

In how many settings must a child exhibit symptoms to fulfill a severe Disruptive Mood Dysregulation Disorder diagnosis?

Symptoms must be present in at least two separate settings (e.g., home and school) and severe in at least one setting

Why was Disruptive Mood Dysregulation Disorder added to the DSM-5-TR depressive disorders chapter?

To address the historical overdiagnosis of pediatric Bipolar Disorder in children presenting with chronic non-episodic irritability

What clinical feature distinguishes early-onset Bipolar Disorder from Disruptive Mood Dysregulation Disorder in pediatric assessments?

Bipolar disorder requires distinct, episodic shifts from baseline mood (mania/hypomania), whereas DMDD features chronic, non-episodic irritability

How does the required symptom duration for Persistent Depressive Disorder alter when diagnosing children and adolescents?

The chronic depressed or irritable mood duration requirement drops from 2 years down to 1 year for pediatric patients

What atypical mood presentation often replaces a depressed mood as the primary subjective indicator in pediatric depression?

Persistent, pervasive irritability

What specific psychiatric emergency must be rigorously screened for when a pediatric patient presents with severe early-onset depressive features?

Active or passive suicidal ideation and self-harming behaviors

What is the primary objective of using structured rating scales (e.g., PHQ-9, MDQ) during a diagnostic patient interview?

To establish a baseline symptom severity, track objective clinical progression, and complement clinical diagnostic reasoning

What screening tool is widely utilized during interviews to identify potential cases of Bipolar Disorder?

Mood Disorder Questionnaire (MDQ)

What critical interview question must a PMHNP ask a depressed patient before safely prescribing an antidepressant monotherapy?

Have you ever experienced a historical period of elevated, expansive, or hyper-irritable mood lasting several days (screening for undiagnosed mania/hypomania)

What severe clinical risk is associated with initiating an SSRI or SNRI monotherapy in a patient with a hidden or unrecorded Bipolar history?

Induction of a treatment-emergent manic episode or rapid cycling

When formulating a differential diagnosis for a mood disorder, what priority rule must a PMHNP always apply?

Rule out all underlying substance-induced or direct general medical etiologies first

What critical objective documentation rule must be maintained when recording patient information regarding a suicide risk assessment?

Explicitly document the presence or absence of a plan, intent, access to lethal means, and specific protective factors

What specific clinical notation must be recorded in the patient file when a manic patient displays rapid transitions between disconnected thoughts?

Flight of ideas

How should a PMHNP document a patient's physical movements when they appear slowed, heavy, and structurally delayed due to severe depression?

Psychomotor retardation

What is the primary clinical rationale for formulating a comprehensive differential diagnosis list for a patient presenting with an altered mood?

To systematically contrast overlapping clinical criteria to ensure accurate diagnostic selection and safe, tailored pharmacotherapy

What is the primary neurobiological mechanism of action for Selective Serotonin Reuptake Inhibitors (SSRIs)?

Inhibition of the presynaptic serotonin transporter (SERT), leading to increased synaptic serotonin concentrations

What is the core therapeutic mechanism of action for Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs)?

Dual inhibition of presynaptic serotonin (SERT) and norepinephrine (NET) transporters to boost both neurotransmitters in the cleft

What dangerous, life-threatening pharmacodynamic syndrome can occur if an SSRI or SNRI is combined with another serotonergic agent like an MAOI?

Serotonin Syndrome (characterized by hyperthermia, autonomic instability, hyperreflexia, and clonus)

What is the mandatory washout period required when switching a patient from a standard SSRI to a Monoamine Oxidase Inhibitor (MAOI)?

A minimum 2-week (14 days) washout period to prevent Serotonin Syndrome

What unique antidepressant requires an extended 5-week washout period before starting an MAOI due to its exceptionally long half-life?

Fluoxetine (Prozac)

What FDA black box warning is applied to all antidepressant medications across the lifespan for children, adolescents, and young adults?

Increased risk of suicidal ideation and behavior in patients aged 24 and under during initial treatment phases

What specific severe dermatological black box warning is associated with Lamotrigine (Lamictal) titration?

Stevens-Johnson Syndrome (SJS) / Toxic Epidermal Necrolysis (TEN)

What critical clinical counseling directive must be given to a patient starting Lamotrigine to mitigate the risk of a severe rash?

Strictly adhere to the slow titration schedule and seek emergency medical care immediately if any new skin rash or mucosal lesion develops

What severe metabolic black box warnings are associated with the utilization of atypical (second-generation) antipsychotics for acute mania?

Increased risk of hyperglycemia, severe weight gain, dyslipidemia, and new-onset Type 2 Diabetes Mellitus

What black box warning applies to atypical antipsychotics when used off-label to manage behavioral symptoms in elderly patients?

Increased risk of all-cause mortality, primarily due to cardiovascular or infectious (pneumonia) events in elderly patients with dementia

What is the narrow therapeutic serum reference range for Lithium Carbonate during the acute stabilization phase of mania?

0.8 to 1.2 mEq/L

What is the target maintenance serum therapeutic range for Lithium Carbonate during long-term stable treatment?

0.6 to 1.0 mEq/L

At what serum concentration level do early clinical signs of acute Lithium Toxicity typically manifest?

Levels exceeding 1.5 mEq/L

What are the baseline and ongoing laboratory monitoring requirements for a patient prescribed Lithium?

Thyroid Function Tests (TSH), Renal Function Tests (BUN/Creatinine), and Serum Electrolytes

What common over-the-counter medication class is strictly contraindicated in patients taking Lithium due to the risk of precipitously raising lithium levels?

NSAIDs (Non-Steroidal Anti-Inflammatory Drugs, which reduce renal clearance of lithium)

What is the therapeutic serum reference range for Valproic Acid (Depakote) when managing Bipolar Disorder?

50 to 125 mcg/mL

What two critical black box warnings require routine laboratory tracking for patients taking Valproic Acid?

Hepatotoxicity (requires baseline and routine LFTs) and Pancreatitis (requires monitoring for severe abdominal pain and amylase/lipase)

What baseline and ongoing objective measurements must a PMHNP track for a patient taking an atypical antipsychotic?

Body Mass Index (BMI), Waist Circumference, Fasting Plasma Glucose or HbA1c, and Fasting Lipid Panel

What dangerous, idiosyncratic neurological reaction to antipsychotic medications presents with lead-pipe rigidity, hyperthermia, and elevated creatine kinase (CK)?

Neuroleptic Malignant Syndrome (NMS)

What is the clinical term for a reversible cognitive impairment caused by severe depression in geriatric patients?

Pseudodementia

How do patients with pseudodementia typically respond to cognitive testing compared to patients with true dementia?

They often show poor effort and say "I don't know" rather than confabulating or trying to guess answers

What is a key diagnostic difference in onset between true dementia and depressive pseudodementia?

Pseudodementia has a rapid, identifiable onset with strong subjective distress over memory losses

What organic nutritional deficiency frequently mimics severe depression and cognitive decline in geriatric patients?

Vitamin B12 deficiency

What specific physiological screening must be checked in geriatric patients to rule out vascular causes of late-onset depression?

Cardiovascular or cerebrovascular changes (Vascular Depression): BP monitoring, MRI, blood panels, & cognitive tests (Mini-Mental State Examination)

What psychotherapeutic modality focuses heavily on identifying and shifting negative cognitive distortions and automatic thoughts?

Cognitive Behavioral Therapy (CBT)

What evidence-based short-term therapy is specifically designed to treat depression by resolving role transitions and grief?

Interpersonal Psychotherapy (IPT)

What therapy modality utilizes free association and explores unconscious conflicts rooted in early childhood experiences?

Psychodynamic Psychotherapy

What humanistic therapeutic approach emphasizes unconditional positive regard and a non-directive client-centered relationship?

Rogerian (Person-Centered) Therapy

What is the strongest single predictor of a future suicide attempt in a child or adolescent presenting with depression?

A history of a previous suicide attempt

What atypical behavioral presentation in children and adolescents often serves as a red flag masking underlying suicidal intent?

A sudden, uncharacteristic onset of severe behavioral acting out, aggression, or a drop in academic performance

What unique Black Box Warning risk must a PMHNP monitor for when initiating an SSRI in a pediatric patient with Major Depressive Disorder?

A paradoxical transient increase in suicidal ideation and activation energy (worsening distress, such as severe anxiety, agitation, panic attacks, hostility, impulsivity, and restlessness) during the first 2 to 4 weeks of treatment

What specific age group carries the highest statistical risk for antidepressant-induced suicidal behavior according to FDA warnings?

Children, adolescents, and young adults under the age of 25

What core diagnostic feature characterizes Early-Onset Bipolar Disorder in children compared to the classic adult presentation?

Extreme mood lability, highly explosive temper outbursts, and chronic irritability rather than distinct, discrete episodes of classic euphoria

How does "grandiosity" uniquely manifest in a pediatric patient experiencing an early-onset manic or hypomanic episode?

Believing they possess magical powers, can break adult rules without consequences, or possess superior knowledge over authority figures and teachers

What sleep disturbance pattern is a cardinal, highly specific marker of an active early-onset manic episode in children?

A markedly decreased need for sleep where the child wakes up fully energized after only a few hours without daytime fatigue

What psychiatric condition is the most common and difficult-to-differentiate comorbidity overlapping with early-onset Bipolar Disorder in children?

Attention-Deficit/Hyperactivity Disorder (ADHD)

Why must a PMHNP stabilize mood with a mood stabilizer before treating comorbid ADHD with a stimulant in early-onset Bipolar Disorder?

Stimulant monotherapy can destabilize the child and trigger severe mania, rapid cycling, or extreme behavioral aggression

What specific modifier is diagnosed if a patient has MDD but experiences at least three manic/hypomanic symptoms that do not meet full bipolar criteria?

Major Depressive Disorder, with mixed features

If a pediatric patient meets the diagnostic criteria for both DMDD and ODD (Oppositional Defiant Disorder), which diagnosis takes clinical precedence?

Disruptive Mood Dysregulation Disorder (DMDD) takes diagnostic precedence and is the only one diagnosed

Why can a diagnosis of Disruptive Mood Dysregulation Disorder (DMDD) never coexist with a diagnosis of Bipolar Disorder?

DMDD requires chronic, non-episodic irritability, whereas Bipolar Disorder requires distinct, episodic shifts in mood

What specific specimen or screening must always be evaluated prior to prescribing Valproic Acid to a female patient of childbearing age?

A serum pregnancy test (due to severe teratogenic risks and neural tube defects)

What clinical specifier is applied if a patient with Bipolar Disorder experiences 4 or more distinct mood episodes within a single 12-month period?

With rapid cycling

What specific neurodevelopmental condition must be completely ruled out before diagnosing DMDD, since both feature severe temper outbursts?

Autism Spectrum Disorder (ASD)

What unique somatic symptom pattern characterizes "Atypical Depression" compared to classic Major Depressive Disorder?

Leaden paralysis (heavy limbs), hypersomnia, hyperphagia (increased appetite/weight gain), and rejection sensitivity

What is the specific timeframe restriction for diagnosing "Postpartum Onset" depression or mania according to the DSM-5-TR?

Symptoms must onset during pregnancy or within the first 4 weeks postpartum

Duration of mania:

At least 7 days (or any duration if it requires hospitalization)

Duration of hypomania:

At least 4 consecutive days

Severity of mania:

Severe disruption in work, social activities, or relationships

Severity of hypomania:

Noticeable change in mood, but no major disruption

Mania vs. hypomania: hospitalization

Often required in mania, but not required for the diagnosis of hypomania

Psychotic Features: mania vs. hypomania

Can include hallucinations or delusions in mania. Does not include psychosis in hypomania