kaplan mood

What is the definition of mood?

A pervasive and sustained emotion or feeling tone that influences a person's behavior and colors his or her perception of being in the world.

What are the two main categories of mood disorders?

Depressive disorders and bipolar disorders.

What is the lifetime prevalence of major depressive disorder?

Almost 17 percent (highest lifetime prevalence of any psychiatric disorder).

What is the lifetime prevalence of major depressive episode?

Range 5-17 percent, average 12 percent.

What is the lifetime prevalence of dysthymic disorder?

Range 3-6 percent, average 5 percent.

What is the lifetime prevalence of bipolar I disorder?

0 to 2.4 percent.

What is the lifetime prevalence of bipolar II disorder?

0.3 to 4.8 percent.

What is the lifetime prevalence of cyclothymic disorder?

0.5 to 6.3 percent.

What is the sex difference in major depressive disorder?

Twofold greater prevalence in women than in men (independent of country or culture).

What is the sex difference in bipolar I disorder?

Equal prevalence among men and women.

What is the sex difference in rapid cycling bipolar disorder?

Women have a higher rate of being rapid cyclers (four or more manic episodes in a 1-year period).

What is the mean age of onset for bipolar I disorder?

About 30 years.

What is the mean age of onset for major depressive disorder?

About 40 years.

What percentage of all patients with major depressive disorder have onset between ages 20 and 50 years?

50 percent.

What is the relationship between marital status and major depressive disorder?

Occurs most often in persons without close interpersonal relationships and in those who are divorced or separated.

What is the socioeconomic correlation with bipolar I disorder?

Higher than average incidence among upper socioeconomic groups.

What is the lifetime prevalence for major depressive disorder in persons with OCD?

About 67 percent.

What is the lifetime prevalence for social phobia in persons with OCD?

About 25 percent.

What is the lifetime history of substance use disorders in patients with bipolar I disorder according to the ECA study?

61 percent.

What is the lifetime history of panic disorder in patients with bipolar I disorder according to the ECA study?

21 percent.

What is the lifetime history of OCD in patients with bipolar I disorder according to the ECA study?

21 percent.

What are the two neurotransmitters most implicated in the pathophysiology of mood disorders?

Norepinephrine and serotonin.

What is the correlation suggested by basic science studies between downregulation of beta-adrenergic receptors and clinical antidepressant responses?

Probably the single most compelling piece of data indicating a direct role for the noradrenergic system in depression.

What is the role of dopamine in mood disorders theorized to be?

Dopamine activity may be reduced in depression and increased in mania.

What percentage of depressed outpatients show evidence of increased HPA activity?

20 to 40 percent.

What percentage of depressed inpatients show evidence of increased HPA activity?

40 to 60 percent.

What percentage of people evaluated for depression have previously undetected thyroid dysfunction?

Approximately 5 to 10 percent.

What sleep disturbance is associated with depression?

Reduced REM latency (combination of increased REM drive and decreased slow-wave sleep).

What combination of sleep abnormalities identifies approximately 40 percent of depressed outpatients and 80 percent of depressed inpatients?

Reduced REM latency, increased REM density, and decreased sleep maintenance.

What is the concordance rate for mood disorder in monozygotic twins?

70 to 90 percent.

What is the concordance rate for mood disorder in same-sex dizygotic twins?

16 to 35 percent.

What chromosomal region has the strongest evidence for linkage to bipolar disorder?

Chromosome 18q and chromosome 22q.

What is the heritability estimate for mood disorders from twin studies?

Genes explain only 50 to 70 percent of the etiology of mood disorders.

What life event is most often associated with development of depression?

Losing a parent before age 11 years.

What environmental stressor is most often associated with the onset of an episode of depression?

Loss of a spouse.

What is the risk of depression in unemployed persons compared with employed persons?

Three times more likely to report symptoms of a major depressive episode.

What is the duration required for a major depressive episode in DSM-5?

At least 2 weeks.

What is the duration required for a manic episode in DSM-5?

At least 1 week (or any duration if hospitalization is necessary).

What is the duration required for a hypomanic episode in DSM-5?

At least 4 consecutive days.

How many symptoms are required for a major depressive episode in DSM-5?

Five (or more) symptoms during the same 2-week period, with at least one being depressed mood or loss of interest/pleasure.

How many symptoms are required for a manic episode in DSM-5?

Three (or more) symptoms (four if mood is only irritable).

How many symptoms are required for a hypomanic episode?

Three (or more) symptoms (four if mood is only irritable), lasting at least 4 days.

What is bipolar I disorder defined as?

A clinical course of one or more manic episodes and, sometimes, major depressive episodes.

What is bipolar II disorder defined as?

Episodes of major depression and hypomania rather than mania.

What is a mixed episode?

A period of at least 1 week in which both a manic episode and a major depressive episode occur almost daily.

What is the specifier "with melancholic features" characterized by?

Severe anhedonia, early morning awakening, weight loss, and profound feelings of guilt.

What are the features of atypical depression?

Overeating and oversleeping (reversed vegetative symptoms), leaden paralysis, and interpersonal rejection sensitivity.

What is the prevalence of rapid cycling in bipolar disorder?

5 to 15 percent of patients have four or more episodes per year.

What is seasonal affective disorder (SAD)?

Patients with a seasonal pattern to their mood disorders tend to experience depressive episodes during a particular season, most commonly winter.

What percentage of all depressed patients contemplate suicide?

About two-thirds.

What percentage of depressed patients commit suicide?

10 to 15 percent.

What percentage of depressed patients complain of trouble sleeping?

About 80 percent.

What percentage of depressed patients complain of reduced energy?

97 percent.

What percentage of depressed patients have anxiety symptoms?

As many as 90 percent.

What is the most common symptom of depression on mental status examination?

Generalized psychomotor retardation.

What percentage of manic patients have delusions?

75 percent.

What percentage of manic patients are assaultive or threatening?

About 75 percent.

What is depressive pseudodementia?

A cognitive impairment in depression where about 50 to 75 percent of patients complain of impaired concentration and forgetfulness.

What is the Zung Self-Rating Depression Scale?

A 20-item self-report scale where a normal score is 34 or less and a depressed score is 50 or more.

What is the Hamilton Rating Scale for Depression (HAM-D)?

A widely used depression scale with up to 24 items, each rated 0 to 4 or 0 to 2, with a total score of 0 to 76.

How long does an untreated depressive episode last?

6 to 13 months.

How long does a treated depressive episode last?

About 3 months.

What percentage of patients with major depressive disorder have a manic episode 6 to 10 years after the first depressive episode?

About 5 to 10 percent.

What is the probability of recovery in the first year after hospitalization for a first episode of major depressive disorder?

About 50 percent.

What percentage of patients experience a recurrence of major depressive disorder in the 2 years after hospital discharge?

30 to 50 percent.

What percentage of patients experience a recurrence of major depressive disorder in the 5 years after hospital discharge?

50 to 75 percent.

What percentage of patients with bipolar I disorder have a second manic episode within 2 years of the first?

40 to 50 percent.

What is the approximate percentage of patients with bipolar I disorder who achieve significant control of symptoms with lithium?

50 to 60 percent.

What is the therapeutic lithium level for acute mania?

Between 0.6 and 1.2 mEq/L.

What is the typical dose of valproic acid for acute mania?

750 to 2,500 mg per day, achieving blood levels between 50 and 120 micrograms/mL.

What is the average dose of lamotrigine for maintenance treatment?

200 mg per day.

What is the incidence of severe rash (Stevens-Johnson syndrome) with lamotrigine?

Approximately two in 10,000 adults and four in 10,000 children.

What is the duration required for dysthymic disorder in adults?

Depressed mood most of the time for at least 2 years.

What is the duration required for dysthymic disorder in children and adolescents?

Depressed mood most of the time for at least 1 year.

What is the prevalence of dysthymia in patients with major depressive disorder (double depression)?

Approximately 40 percent.

What percentage of patients with dysthymia have an insidious onset before age 25 years?

About 50 percent.

What percentage of patients with dysthymia progress to major depressive disorder?

About 20 percent.

What percentage of patients with dysthymia progress to bipolar II disorder?

About 15 percent.

What is the lifetime prevalence of cyclothymic disorder estimated to be in the general population?

About 1 percent.

What percentage of patients with cyclothymic disorder have positive family histories for bipolar I disorder?

About 30 percent.

What is the female-to-male ratio in cyclothymic disorder?

About 3 to 2.

What is the age of onset range for cyclothymic disorder?

50 to 75 percent of all patients have an onset between ages 15 and 25 years.

What percentage of patients with cyclothymic disorder develop a major mood disorder?

About one-third.

What psychodynamic theory did Freud propose for depression?

The classic view involving disturbances in infant-mother relationship during oral phase, object loss, introjection, and anger directed inward.

What is the cognitive triad of depression according to Aaron Beck?

(1) Negative views about the self, (2) negative views about the environment, and (3) negative views about the future.

What is learned helplessness theory?

Depression results from the experience of uncontrollable events leading to cognitive motivational deficit and emotional deficit.

What is the goal of cognitive therapy for depression?

To alleviate depressive episodes by helping patients identify and test negative cognitions and develop alternative ways of thinking.

What is interpersonal therapy based on?

Current interpersonal problems likely have roots in early dysfunctional relationships and are involved in precipitating current depressive symptoms.

What is the NIMH Treatment of Depression Collaborative Research Program finding?

High depression severity suggested a good response to interpersonal therapy and pharmacotherapy.

What is vagal nerve stimulation (VNS)?

An experimental treatment using an electronic device implanted in the skin to stimulate the left vagus nerve, showing some efficacy in chronic recurrent major depressive disorder.

What is transcranial magnetic stimulation (TMS)?

A treatment using very short pulses of magnetic energy to stimulate nerve cells; indicated for depression in patients who failed one prior antidepressant.

What is the success rate of total sleep deprivation in temporarily relieving depression?

Approximately 60 percent of patients with depressive disorders exhibit significant but transient benefits.

What is phototherapy (light therapy) used for?

Treatment of seasonal affective disorder (mood disorder with seasonal pattern), typically involving exposure to 1,500 to 10,000 lux or more.

What percentage of patients with seasonal depression are women?

At least 75 percent.

What is the mean age of presentation for seasonal affective disorder?

40 years.

What is the most common clinical mistake leading to unsuccessful antidepressant trial?

The use of too low a dosage for too short a time.

How long should antidepressant treatment be maintained?

At least 6 months or the length of a previous episode, whichever is greater.

What percentage of outpatients with uncomplicated major depressive disorder achieve remission with medication?

Only 35 to 50 percent achieve remission (virtual absence of depressive symptoms).

What is the best-documented augmentation strategy for antidepressant nonresponse?

Lithium or thyroid hormone augmentation.

What is the mechanism of action of ketamine for treatment-resistant depression?

Inhibits the postsynaptic glutamate binding protein N-methyl-D-aspartate (NMDA) receptor.