#3 Mood Disorders

pathophysiology for Depressive disorders

• altered HPA, leading to dysregulation of the stress response

• altered serotonin activity in the CNS

what neurotransmitter is affected/altered in major depressive disorders

serotonin

what is the DSM-5 criteria for depression?

5 of the 9 symptoms must last for at least 2 weeks with daily occurrence, including:

1. loss of interest/pleasure in doing things (anhedonia)

2. depressed mood

what are the other DSM-5 symptoms for depressive disorders?

1. weight

2. sleep

3. energy

4. concentration

5. recurrent thoughts of death or suicide

First line treatment for depressive disorders

1. cognitive behavioral therapy

   1. CBT, interpersonal, supportive

AND

2. SSRI/SNRI

pathophysiology for anxiety disorders

• overactive amygdala

  • low activation threshold

  • overgeneralizes threat as a result

• HIGH norepinephrine + LOW GABA

  • sudden SNS stimulation → intensifies feelings of anxiety. basis for tachycardia, tremors, and diaphoresis

“worry as avoidance model” in GAD

• theory where verbalizing worries may worsen fear response or reinforce the worry cycle

• cognitive feedback loop as a result

DSM-5 criteria for Generalized Anxiety Disorder

excessive, uncontrollable worry most days for at least 6 months, & 3/6 of the following symptoms

what are the other DSM-5 symptoms for generalized anxiety disorders?

1. irritability

2. restlessness

3. fatigue

4. poor concentration

5. muscle tension

6. sleep disturbances

what is the first line of treatment for GAD

SSRIs/SNRIs + cognitive behavioral therapy

pathophys for panic disorders

• INCREASE in norepi + DECREASE in GABA

  • excess release of norepi causes the abrupt surge of panic attack symptoms

• sudden stimulation of SNS increases feelings of anxiety and panic

DSM-5 criteria for panic disorders

recurrent, unexpected panic attacks that peak within minutes, plus 4 or more of the following panic symptoms

what are the other DSM-5 symptoms for panic disorders?

1. chest pain (angina)

2. palpitations

3. sweating

4. trembling

5. dizziness

6. dyspnea

7. fear of losing control/dying

what is the one month criterion for panic disorders?

requires either:

persistent concern about panic attacks

OR

significant maladaptive behavior change following at least one attack

what is the first line treatment for panic disorders?

trigger identification with CBT + SSRI/SNRI/TCA/MAOI

benzodiazepines and panic disorders

benzos can only address acute symptoms

benzodiazepines and generalized anxiety disorder

benzos are used for short-term use only with GAD

pathophys for borderline personality disorder

frontal lobe dysfunction shows changes leading to:

1. impulsivity

2. cognitive inflexibility

3. poor self-monitoring

4. perseveration (uncontrollable repetition)

What are the DSM-5 criteria for borderline personality disorder?

requires 5/9 features including:

1. efforts to avoid abandonment / fear of abandonment

2. unstable relationships + self-image

3. impulsivity

4. recurrent self-harm or suicidal behavior

5. chronic emptiness

what is the first line treatment for borderline personality disorder?

1. dialectal behavior therapy

2. NO meds are used/approved for this disorder