Bipolar and depressive disorders

What 5 medical problems can mimic depressive disorder?

hypothyroidism, substance abuse, low vitamin D, anemia, and low vitamin B 12

What are some other things that should be on the differential for depressive symptoms besides depression?

hypothyroidism, vitamin deficiencies, adjustment disorder, prodrome for psychotic disorder, depressive episode of bipolar disorder, and substance use

What are some labs to consider running for depressive symptoms?

thyroid functioning test, vitamin B 12 and folate levels, vitamin D levels, substance use, CBC, metabolic profile

What is the MDQ used for?

it is best for screening bipolar I disorder, and it is less sensitive for bipolar II and unspecified bipolar disorder

The MDQ is a screening tool or diagnostic tool?

screening (not diagnostic)

Why is it important to rule out bipolar disorder before treating for depression?

most antidepressants (especially when prescribed first) can worsen manic/hypomanic episodes

What are the diagnostic symptoms of depression?

SIGECAPS

sleep (insomnia or oversleeping), decreased interest, guilt/hopelessness, decreased energy, decreased concentration, decreased appetite (food and sex), psychomotor agitation or retardation, and suicide

What is the DSM-V criteria for major depressive disorder

symptoms present most days over the past 2 weeks

must impair functioning

can’t be explained by other illness or substance use

What is another name for major depressive disorder?

unipolar disorder

depression is associated with a decrease is ____ and if left untreated it can lead to _____

decrease in norepi and serotonin

untreated can lead to decrease in frontal lobe and hippocampal volume

What is the PHQ-9 used for? Is it a diagnostic or assessment tool?

used as a screening tool for depression, also can be a diagnostic tool, assessment of severity, and can show progression over course of treatment

What is persistent depressive disorder?

depressed mood for at least 2 years

depressed or irritable mood accompanied by 2+: appetite change, sleep disturbance, fatigue, low self-esteem, poor concentration, feeling hopelessness

basically its major depressive disorder but long term (2 weeks vs 2 years)

Substances like alcohol, opiates, cocaine, amphetamines, and corticosteroids can cause _____

substance/medication induced depressive disorder

What is premenstrual dysphoric disorder? (the card is long…don’t be overwhelmed, just get the basics)

symptoms begin 1 week before menses and end typically within the the first few days of meses

need 1: hopelessness, depressed mood, self-critical thoughts, tension, anxiety, on-edge feeling, increased sensitivity to rejection, anger, and irritability

need 1: anhedonia (loss of enjoyment from previously joyful things), poor concentration, fatigue, appetite change, sleep disturbance, overwhelmed feeling, breast tenderness, bloating, weight gain, or aches

need a total of 5 but one from each

What is disruptive mood dysregulation disorder?

this is a childhood diagnosis (not diagnosed 1st time after 18)

irritable mood with angry outbursts, physical or verbal aggression, symptoms for 1 year, symptoms occur in 2+ settings

What is the mortality rate with major depression?

21% attempt suicide

What is the criteria for mania?

DIGFAST

distractibility, irresponsibility, grandiosity (inflated self esteem), flight of ideas, activity increase, sleep deficit, and talkativeness

Explain mania vs hypomania

mania: 1+ week, can be admitted to psych unit or get arrested

hypomanic: 4 days at least but less than 7, often still functional and will not be admitted to psych unit or arrested

What is the prevalence of bipolar I disorder?

1%

How do we generally treat bipolar?

SGA (second gen antipsychotics) or mood stabilizers and therapy

treat for the phase they are in (mania or depression)