Adjustment Disorder-
-Adjustment mood disorder usually comes with depression that occurs in response to an identifiable psychosocial cause (ex marital discord, job loss, academic failure, or persistent painful illness)
-The stressor can be a single event or can involve many psychosocial stressors
-Adjustment disorder describes patients suffering from significant symptoms that do not meet the criteria for a specific depressive disorder
-Diagnostic criteria for adjustment disorder is as follows:
1. Decreased mood, tearfulness, and feeling of hopelessness that occur in response to an identifiable stressor within 3 months of the onset of the stressor
2. Symptoms are clinically significant by at least one of the following:
-Significant distress that exceeds what would be expected given the nature of the stressor
-Impaired social or occupational functioning
3. The syndrome does not meet criteria for another psychiatric disorder
4. The syndrome does not represent an exacerbation of a preexisting psychiatric disorder
5. The syndrome does not represent bereavement
6. After the stressor has ended, the syndrome resolves within 6 months
-Patients may need counseling. Sometimes require SSRI's.
-Bipolar Disorder-
-Bipolar disorder is a mood disorder that is characterized by episodes of mania, hypomania, and major depression
-There is subtypes of bipolar disorder such as bipolar I and bipolar II
-Bipolar I- experience manic episoders and nearly always experience major depressive and hypomania episodes
-Bipolar II-is at least one hypomanic episode, at least one depression episode, and the absence of manic episodes
-Some patients will have euthymia between episodes and other patients will not have euthymia between cycles
-Many studies have demonstrated a promo and symptoms such as irritability, anxiety, mood lability, agitation, aggressiveness, sleep disturbance, and hyperactivity may precede a diagnosable disorder
-Mania episoders involve clinically significant changes in mood, behavior, energy, sleep, and cognition
-Hypomanic episodes involve changes in mood, behavior, energy, sleep, and cognition, that are similar to mania, but are less severe
-Psychosis such as delusions and hallucinations can occur during manic, major depression, and mixed episodes
-Biopolar disorder patients will often have comorbid disorders such as anxiety disorder, substance use disorders, ADHD, Eating Disorders, intermittent explosive disorders, and personality disorders
-Suicide attempts are common with bipolar disorder
-Bipolar I is diagnosed in patients with one or more manic episodes. Hypomania often occurs. Bipolar I disorder may not be better accounted for by schizoaffective disorder, schizophrenia, delusional disorder, or other unspecified schizophrenia spectrum and other psychotic disorder. The course of the illness is characterized by rapid cycling or a seasonal pattern, and whether the mood episodes are marked by psychotic features, catatonia, anxious distress, mixed features, melancholic features, atypical features, or peripartum onset.
-Bipolar II is diagnosed in patients with at least one episode of hypomania, at least one major depression episode, and no history of mania. Bipolar II disorder may not be better accounted for by schizoaffective disorder, schizophrenia, delusional disorder, or other unspecified schizophrenia spectrum and other psychotic disorder.
-The goal of treatment of acute mania and hypomania is remission.
-Drugs commonly used in acute mania and hypomania include: Lithium, Anticonvulsants, Antipsychotics, and Benzodiazepines.
-It is reasonable to allow up to two weeks in a treatment trial to determine if effective
-Patients that do not respond to 4-6 medication combinations for treating mania are candidates for ECT.
-Hypomania can usually be treated with monotherapy with Risperdal or Zyprexa
-Benzodiazepines are appropriate for patients that cannot tolerate lithium, anticonvulsants, or anti-psychotics
-Depressive symptoms can be treated with SSRI's but need to be started with a mood stabilizers
-Depression-
-The term depression refers a mood state which may be part of a syndrome. Depression may refer to a constellation of symptoms and signs. It may also refer to a mental disorder that identifies a distinct clinical condition (unipolar major depression)
-During an assessment of a depression patient you should assess suicide risk, agitation, history of mania.
-Unipolar Major Depression (Major Depression Disorder) is characterized by a history of one or more major depressive episodes with no history of mania or hypomania
-A major depressive episode is characterized by 5 or more of the symptoms occurring for at least two consecutive weeks; and at least one symptom either depressed mood or loss of interest or pleasure
1. Depressed mood for most of the day, nearly every day
2. Loss of interest or pleasure in most of all activities, nearly every day
3. Insomnia or hypersomnia nearly every day
4. Significant weight loss or weight gain (5 percent with a month)
5. Psychomotor retardation or agitation that is observable by others
6. Fatigue or low energy nearly every day
7. Decreased concentration
8. Thoughts of worthlessness or excessive guilt
9. Recurrent thought of death or suicide ideation, or a suicide attempt
-There are subtypes of of depressive episodes they include: anxious distress, atypical features, catatonia, melancholic features, mixed features, peripartum onset, seasonal onset, and psychotic features
-Most minor depressive episodes are treated by primary care clinicians
-For patients with minor depression who are moderately to severely ill psychotherapy should be considered first line therapy
-Moderate to severe episodes of minor depression that are not responsive to psychotherapy should have an antidepressant such as an SSRI introduced to regimen
-Patients should be referred when patients whom the diagnosis of depression or comorbidities are uncertain, depression that endangers the life of the patient or others, severe psychotic or catatonic depression, and depression that occurs within the context of bipolar disorder
-Dysthymia (Persistent Depressive Disorder)-DSM 5 Criteria
1. Depressed for most of the day, for most days than not for at least two years. Children and adolescents must be at least 1 year
2. The presence of a 2 or more of the following:
-Poor appetite or overeating
-Insomnia or hyperinsomnia
-Low energy or fatigue
-Low self esteem
-Poor concentration or difficulty making decisions
-Feelings of hopelessness
3. During the period of time the individual has not been without the symptoms for at least two months.
4. Criteria for major depression disorder may be continuous present for two years
5. There has never been any mania or hypomania
6. The disturbance is not better explained my a persistent schizoaffective disorder, schizophrenia, delusional disorder, or unspecified schizophrenia spectrum and other psychotic disorder
7. Symptoms are not attributable to substance abuse or other medical condition (hypothyroidism)
8. These symptoms cause a significant distress or impairment in social, occupational, or other areas of functioning
-Dysthymia is best treated with SSRI's or SNRI's and atypical antidepressants, serotonin modulators, tricyclic antidepressants
-Dysthymia really should have some combination of psychotherapy and antidepressants
-The stressor can be a single event or can involve many psychosocial stressors
-Adjustment disorder describes patients suffering from significant symptoms that do not meet the criteria for a specific depressive disorder
-Diagnostic criteria for adjustment disorder is as follows:
1. Decreased mood, tearfulness, and feeling of hopelessness that occur in response to an identifiable stressor within 3 months of the onset of the stressor
2. Symptoms are clinically significant by at least one of the following:
-Significant distress that exceeds what would be expected given the nature of the stressor
-Impaired social or occupational functioning
3. The syndrome does not meet criteria for another psychiatric disorder
4. The syndrome does not represent an exacerbation of a preexisting psychiatric disorder
5. The syndrome does not represent bereavement
6. After the stressor has ended, the syndrome resolves within 6 months
-Patients may need counseling. Sometimes require SSRI's.
-Bipolar Disorder-
-Bipolar disorder is a mood disorder that is characterized by episodes of mania, hypomania, and major depression
-There is subtypes of bipolar disorder such as bipolar I and bipolar II
-Bipolar I- experience manic episoders and nearly always experience major depressive and hypomania episodes
-Bipolar II-is at least one hypomanic episode, at least one depression episode, and the absence of manic episodes
-Some patients will have euthymia between episodes and other patients will not have euthymia between cycles
-Many studies have demonstrated a promo and symptoms such as irritability, anxiety, mood lability, agitation, aggressiveness, sleep disturbance, and hyperactivity may precede a diagnosable disorder
-Mania episoders involve clinically significant changes in mood, behavior, energy, sleep, and cognition
-Hypomanic episodes involve changes in mood, behavior, energy, sleep, and cognition, that are similar to mania, but are less severe
-Psychosis such as delusions and hallucinations can occur during manic, major depression, and mixed episodes
-Biopolar disorder patients will often have comorbid disorders such as anxiety disorder, substance use disorders, ADHD, Eating Disorders, intermittent explosive disorders, and personality disorders
-Suicide attempts are common with bipolar disorder
-Bipolar I is diagnosed in patients with one or more manic episodes. Hypomania often occurs. Bipolar I disorder may not be better accounted for by schizoaffective disorder, schizophrenia, delusional disorder, or other unspecified schizophrenia spectrum and other psychotic disorder. The course of the illness is characterized by rapid cycling or a seasonal pattern, and whether the mood episodes are marked by psychotic features, catatonia, anxious distress, mixed features, melancholic features, atypical features, or peripartum onset.
-Bipolar II is diagnosed in patients with at least one episode of hypomania, at least one major depression episode, and no history of mania. Bipolar II disorder may not be better accounted for by schizoaffective disorder, schizophrenia, delusional disorder, or other unspecified schizophrenia spectrum and other psychotic disorder.
-The goal of treatment of acute mania and hypomania is remission.
-Drugs commonly used in acute mania and hypomania include: Lithium, Anticonvulsants, Antipsychotics, and Benzodiazepines.
-It is reasonable to allow up to two weeks in a treatment trial to determine if effective
-Patients that do not respond to 4-6 medication combinations for treating mania are candidates for ECT.
-Hypomania can usually be treated with monotherapy with Risperdal or Zyprexa
-Benzodiazepines are appropriate for patients that cannot tolerate lithium, anticonvulsants, or anti-psychotics
-Depressive symptoms can be treated with SSRI's but need to be started with a mood stabilizers
-Depression-
-The term depression refers a mood state which may be part of a syndrome. Depression may refer to a constellation of symptoms and signs. It may also refer to a mental disorder that identifies a distinct clinical condition (unipolar major depression)
-During an assessment of a depression patient you should assess suicide risk, agitation, history of mania.
-Unipolar Major Depression (Major Depression Disorder) is characterized by a history of one or more major depressive episodes with no history of mania or hypomania
-A major depressive episode is characterized by 5 or more of the symptoms occurring for at least two consecutive weeks; and at least one symptom either depressed mood or loss of interest or pleasure
1. Depressed mood for most of the day, nearly every day
2. Loss of interest or pleasure in most of all activities, nearly every day
3. Insomnia or hypersomnia nearly every day
4. Significant weight loss or weight gain (5 percent with a month)
5. Psychomotor retardation or agitation that is observable by others
6. Fatigue or low energy nearly every day
7. Decreased concentration
8. Thoughts of worthlessness or excessive guilt
9. Recurrent thought of death or suicide ideation, or a suicide attempt
-There are subtypes of of depressive episodes they include: anxious distress, atypical features, catatonia, melancholic features, mixed features, peripartum onset, seasonal onset, and psychotic features
-Most minor depressive episodes are treated by primary care clinicians
-For patients with minor depression who are moderately to severely ill psychotherapy should be considered first line therapy
-Moderate to severe episodes of minor depression that are not responsive to psychotherapy should have an antidepressant such as an SSRI introduced to regimen
-Patients should be referred when patients whom the diagnosis of depression or comorbidities are uncertain, depression that endangers the life of the patient or others, severe psychotic or catatonic depression, and depression that occurs within the context of bipolar disorder
-Dysthymia (Persistent Depressive Disorder)-DSM 5 Criteria
1. Depressed for most of the day, for most days than not for at least two years. Children and adolescents must be at least 1 year
2. The presence of a 2 or more of the following:
-Poor appetite or overeating
-Insomnia or hyperinsomnia
-Low energy or fatigue
-Low self esteem
-Poor concentration or difficulty making decisions
-Feelings of hopelessness
3. During the period of time the individual has not been without the symptoms for at least two months.
4. Criteria for major depression disorder may be continuous present for two years
5. There has never been any mania or hypomania
6. The disturbance is not better explained my a persistent schizoaffective disorder, schizophrenia, delusional disorder, or unspecified schizophrenia spectrum and other psychotic disorder
7. Symptoms are not attributable to substance abuse or other medical condition (hypothyroidism)
8. These symptoms cause a significant distress or impairment in social, occupational, or other areas of functioning
-Dysthymia is best treated with SSRI's or SNRI's and atypical antidepressants, serotonin modulators, tricyclic antidepressants
-Dysthymia really should have some combination of psychotherapy and antidepressants
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