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Toronto Notes 2019 Mood Disorders Treatment
• antipsychotics,psychotherapy,andantidepressants
Prognosis
• mayrespondwelltoantipsychoticsbutmostpatientsrefusethemandhavechronic,unremittingcourse; some maintain a high level of functioning; some progress to schizophrenia
Mood Disorders
Definitions
• accuratediagnosisofamooddisorderrequiresacarefulpastmedicalandpsychiatrichistorytodetect past mood episodes and to rule out whether these episodes were secondary to substance use, a medical condition, etc
• moodepisodesrepresentacombinationofsymptomscomprisingapredominantmoodstatethatis abnormal in quality or duration (e.g. major depressive, manic, mixed, hypomanic). DSM-5 Criteria for mood episodes are listed below
• typesofmooddisordersinclude:
■ depressive (major depressive disorder, persistent depressive disorder)
■ bipolar (bipolar I/II disorder, cyclothymia)
■ induced by or due to (“secondary to”) a general medical condition, substance, medication, other
psychiatric condition
Medical Workup of Mood Disorder
• routinescreening:physicalexam,CBC,extendedelectrolytes,renal,liverandthyroidfunctiontests, drug screen, medications list
• additionalscreening:B12(inolderpeople),neurologicalconsultation,chestX-ray,ECG,headimaging
Mood Episodes
DSM-5 Diagnostic Criteria for Major Depressive Episode
Reprinted with permission from the Diagnostic and Statistical Manual of Mental Disorders, 5th ed. 2013. American Psychiatric Association
A. ≥5 of the following symptoms have been present during the same 2 wk period and represent a change from previous functioning; at least one of the symptoms is either 1) depressed mood or 2) loss of interest or pleasure (anhedonia)
Note: do not include symptoms that are clearly attributable to another medical condition
■ depressed mood most of the day, nearly every day, as indicated by either subjective report or
observation made by others
■ markedlydiminishedinterestorpleasureinall,oralmostall,activitiesmostoftheday,nearlyeveryday
■ significant and unintentional weight loss/weight gain, or decrease/increase in appetite nearly every day
■ insomnia or hypersomnia nearly every day
■ psychomotor agitation or retardation nearly every day
■ fatigue or loss of energy nearly every day
■ feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every
day (not merely self-reproach or guilt about being sick)
■ diminished ability to think or concentrate, or indecisiveness, nearly every day
■ recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific
plan, or a suicide attempt or a specific plan for committing suicide
B. the symptoms cause clinically significant distress or impairment in social, occupational, or other
important areas of functioning
C. the episode is not attributable to the direct physiological effects of a substance or a GMC
DSM-5 Criteria for Manic Episode
Reprinted with permission from the Diagnostic and Statistical Manual of Mental Disorders, 5th ed. 2013. American Psychiatric Association
A. a distinct period of abnormally and persistently elevated, expansive, or irritable mood, and abnormally and persistently increased goal-directed activity or energy, lasting ≥1 wk and present most of the day, nearly every day (or any duration if hospitalization is necessary)
B. during the period of mood disturbance and increased energy or activity, ≥3 of the following symptoms have persisted (4 if the mood is only irritable) have been present to a significant degree and represent a noticeable change from usual behaviour
■ inflatedself-esteemorgrandiosity
■ decreased need for sleep (e.g. feels rested after only 3 h of sleep)
■ more talkative than usual or pressure to keep talking
■ flight of ideas or subjective experience that thoughts are racing
■ distractibility (i.e. attention too easily drawn to unimportant or irrelevant external stimuli)
■ increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor
agitation
■ excessive involvement in pleasurable activities that have a high potential for painful consequences
(e.g. engaging in unrestrained shopping sprees, sexual indiscretions, or foolish business
investments)
C. the mood disturbance is sufficiently severe to cause marked impairment in social/occupational
functioning or to necessitate hospitalization to prevent harm to self or others, or there are psychotic
features
D. the episode is not attributable to the physiological effects of a substance or another medical condition
Psychiatry PS9
Criteria for Depression (≥5)
MSIGECAPS
Mood: depressed
Sleep: increased/decreased Interest: decreased
Guilt
Energy: decreased
Concentration: decreased Appetite: increased/decreased Psychomotor: agitation/retardation Suicidal ideation
Criteria for Mania (≥3)
GST PAID
Grandiosity
Sleep (decreased need)
Talkative
Pleasurable activities, Painful consequences Activity
Ideas (flight of)
Distractible