PSYCH: MOOD, ANXIETY, & TRAUMA DISORDERS

Mood Disorder

change in mood that is persistent for longer than 2 weeks; is often accompanied by physical, emotional, and functional deficits; can be related to other factors like stressors, illness, or substance abuse

Anhendonia

lack of pleasure in previously pleasurable activities

To be diagnosed with major depressive episode:

***must have 5 or more of the below to meet criteria + depressed mood/anhendonia

-appetite disturbance/weight change

-sleep disturbance (most common symptom)

-psychomotor agitation

-loss of energy/fatigue

-feelings of worthlessness

-decreased concentration/cognition

-recurrent thoughts of death/suicide

-self-rejection

To be diagnosed with depression PT 2:

-symptoms must last for at least two weeks

-symptoms causes significant social, occupational, or interpersonal functioning

Persistent Depressive Disorder

-also known as Dysthymia; chronic depression w/o complete remission for two years or more

***episodes of major depression with incomplete remission b/t episodes

Adjustment Disorder

-mood change in reaction to identifiable stressor

-symptoms are brief in duration

-generally do not require pharmacology to treat

Manic Episode

-elated, euphoric, "giddy" mood

-inflated sense of self-esteem

-thought processes are racing yet goal-oriented

-can be focused on topics such as religion, sexuality, business, etc.

-speech pressured, difficult to interpret

-lacks need for sleep

-excessive foal-directed activity with high risk behaviors

-impulsive, easily-angered

how long does a manic episode typically last for diagnosis? what can trigger an episode?

-mood lasts for at least 7 days

-can be triggered by medication, stress, drug use, or spontaneous

Hypomanic Episode

less intense and shorter version of mania

Bipolar Disorder I

-at least one documented manic episode

-major depressive episodes common but not necessary for diagnosis

-diagnosis can be difficult or delayed

Bipolar Disorder II

-at least one major depressive episode & at least one episode of hypomania

Mood Disorder Treatment:

1) Diagnosis (w/ severity)

2) Discuss treatment modes w/ patient

3) Choose specific treatments

4) Follow-up/Monitoring (Most Important!)

SSRI's

-standard of care for depression treatment

-ease of dosing, minimal toxicity in overdose

-generally well-tolerated

-pt preferences, past responses, or family responses can be considered in selection

SNRI's

-trmt option that some clinicians consider first line with SSRIs

-NE receptor binding can help treat anxious distress or concentration issues associated with depression

-duloxetine also indicated for anxiety and neuropathic pain disorders, increasing utility in patients with comorbid issues

Course of Treatment Criteria:

-treatment course of 6 to 8 weeks is considered adequate to assess response

-after response is determined, may proceed with dose increase, augmentation, or change to new agent

-continuation of treatment for 9 months following adjustments as needed

Lithium Carbonate

***classic treatment for bipolar mania

-long term risk of renal impairment, thyroid impairment, tremor, etc.

-toxicity very possible and can cause disorientation, psychosis, and may be fatal; tight therapeutic window (requires blood monitoring for serum levels)

-can be used for antidepressant supplementation

Anxiety

-state of increased worry, fear, & concern, especially over future events

-S/S: increased HR/respiratory rate, agitation, tension

-may include avoidance behaviors and fears of "losing it" or "going crazy"

Panic Attack

-sudden, rapidly escalating onset of fear & anxiety, sometimes without provacation

-rapid HR, palpitations, sweating, dizziness, chest pain, hot or cold flashes, fear of death, depersonalization, etc.

Panic Disorder

-sudden & recurrent onset of panic attacks

-up to 25% experience nocturnal panic attacks

-fear of recurrence and increased anxiety over further attacks for at least a month after

-pt engages in avoidance behaviors to prevent future attacks

Generalized Anxiety Disorder (GAD)

-excessive, intrusive worries about everyday situations that causes significant stress and functional impairment

S/S: muscle tension, restlessness, insomnia, GI disturbance, headaches, fatigue, etc.

-may have episodes of increased anxiety that resemble panic attacks

Selective Mutism

refusal to speak due to increased anxiety, more common in children

post-traumatic stress disorder (PTSD)

Constellation of anxiety & depressive symptoms that originate as a response to an emotionally traumatic event; many cases resolve after 6 months; may be chronic in 1 out of 3 patients

Symptoms of PTSD:

flashbacks, nightmares, avoidance behavious, excessive worry, hyperviligence, insomnia, social isolation, sense of foreshortened future

Acute Stress Disorder

-onset of symptoms similar to PTSD in response to specific stressor

S/S: brief dissociation, doesn't exceed one month

Mixed Specifier:

during either a depressive or manic episode, exhibits at least 3 diagnostic criteria for the opposite mood are also present

Mood Spectrum:

mania> euthymia > depression

Agoraphobia specifier:

fear of marketplace

bipolar disorder diagnosis tips:

-rule out substance induced origin

-rule out origin due to medical conditions

-rule out other mental disorders

-note psychotic features specifier

-note anxious distress specifier

social anxiety disorder

debilitating anxiety in social situations and avoidance of socialization

specific phobia

avoidance of a specific situation or object that causes debilitating anxiety