Mood Disorders

Bipolar Disorder I

PresentationPresence of at least 1 manic episode for at least 1 week (↑ Mood → cheerful, enthusiastic, Expansive or Irritable + ≥ 3 or 4 (if irritable) of 7 of DIGFAST)

• Manic = DIG FAST → ≥3 symptoms
1. Distractibility
2. Impaired judgment/ Indiscretion
3. Grandiosity
4. Flight of ideas
5. Activity ↑
6. Sleep deficit
7. Talkativeness
Management-lithium 1st line
-valproic acid, carbamazepine
-second-generation antipsychotics (olanzapine), first-generation antipsychotics (haloperidol) or benzos may be added if psychosis or agitation develops
-other treatment: electroconvulsive therapy, MAOI, SSRIs, TCAs (however antidepressants medications may precipitate mania)

-therapy: CBT, interpersonal, good sleep hygiene recommended

Bipolar Disorder II

Presentation• Hypomania = TAD HIGH
1. Talkative
2. Attention-deficit
3. Decreased need for sleep
4. High self-esteem/ grandiosity
5. Ideas that race
6. Goal-directed activity increased
7. High-risk activity
Hypomania Characteristics-≥ 1 hypomanic episode + ≥ 1 major depressive episode
-mania or mixed episodes are absent

-symptoms similar to manic symptoms -> period of elevated, expansive, or irritably mood at least 4 days that is clearly different from the usual non-depressed mood but does not cause marked impairment, no psychotic features and does not require hospitalization usually
-does not include racing thoughts or excessive psychomotor agitation
Management-similar to bipolar I (antipsychotics, mood stabilizers, benzos)

1. acute mania: mood stabilizers (lithium), valproate, second-generation antipsychotics
2. depression: lithium, valproate, carbamazepine, second-generation antipsychotics
3. mixed: atypical antipsychotics, valproate

Cyclothymic Disorder

Presentation2 years (1-year in Children and Adolescents) of hypomania + mild depressive symptoms (not MDE)
– Mildly depressed mood and Mild mania (cycles)
– No symptom-free period > 2 months
– Dysthymia and Hypomania → milder form of bipolar disorder lasting at least 2 years
– At least 2 years of hypomanic symptoms that DO NOT meet criteria for Manic Episode and numerous periods of depressive symptoms that DO NOT meet the criteria for MDE
Management-similar to bipolar I: mood stabilizers and neuroleptics

Depressed Mood

Work-up– Physical Exam (PE)
– Mental Status Exam (MSE)
– Blood alcohol
– Urine Toxicology (Urine Tox)

Major Depressive Disorder (MDD)

PresentationLast ≥ 2 weeks with ≥ 5 symptoms and MUST Include Depressed Mood or Anhedonia (loss of interest)
Sleep disturbance (↑ or ↓)
Interest Loss → MUST Include (or depressed mood)
Guilt → Feeling worthless or inappropriately guilty
Energy Loss → Fatigue
Concentration Loss → impaired concentration or indecisiveness
Appetite (weight) changes (↑ or ↓)
Psychomotor Changes (agitation or retardation)
Suicidal ideation → thoughts of death
Managementmild to mood:
– psychotherapy
– SSRIs 1st line meds

Persistent Depressive Disorder (Dysthymic)

PresentationMilder form of depression lasting at least 2 years → Not as severe or disabling
1. Hopelessness
2. Energy loss or fatigue
3. Self-esteem is low
4. 2 years minimum of depressed mood most of day, for more days than not
5. Sleep disorder (↑ or ↓)
6. Appetite change (↑ or ↓)
7. Decision-making or concentration impaired
Overview1. generalized loss of interest, social withdrawal, pessimism, decreased productivity
2. chronic depressed mood > 2 years in adults (> 1 year in children.adolescents) for most of the day, more days than not
-in that 2 year period, the patient is not symptom-free for > 2 months at a time
-may say things like “I’ve always been this way”
3. at least 2 of the following conditions must be present: insomnia or hypersomnia, fatigue, low self-esteem, decreased appetite or overeating, hopelessness, poor concentration, indecisiveness

-patients are usually able to function (may experience mild decreased productivity)
-MC in women, begins MC in late teens, early adulthood
-may progress over time to develop into MMD or bipolar
Management-similar to depression: psychotherapy principal treatment, SSRIs first-line medical treatment
-second line: SNRIs, bupropion, TCAs, and in some cases MAOI