What is the basic pathophysiology of mood disorders? Mood disorders are heterogeneous clinically, a variety of pathoetiologies are possible, and the specific pathophysiology is not well understood. Most models of depression involve catecholamine (serotonin, dopamine, and norepinephrine) imbalances and involve dysfunctional medial frontal–subcortical networks.
How quickly do mood episodes switch in bipolar disorder with rapid cycling? Bipolar disorder with rapid cycling is defined by manic/hypomanic, mixed, or depressed episodes (which meet full criteria for such episodes) occurring four or more times in a year. The concept of ultrarapid cycling (URC) has been proposed to describe episodes alternating every several …
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Core diagnostic feature of a manic episode What is the core diagnostic feature and supporting symptoms for a manic episode? (Hint: the mnemonic DIGFAST may help.) A manic episode is the polar opposite of depression (hence, the name bipolar disorder ), and the core feature is a significant shift in mood persisting at least a week (4 days for …
Medications for acute psychosis What are the pharmacologic treatment options for acute psychosis? First-line agents include potent typical (e.g., haloperidol, perphenazine) and second-generation (e.g., risperidone, olanzapine, quetiapine, ziprasidone, or aripiprazole) antipsychotics with the selection depending on previous response, side-effect profiles and patient preference, and other pharmacodynamic and kinetic considerations. The availability of risperidone, olanzapine, aripiprazole, …
What is the prodromal phase of psychotic disorders? The development of full-syndrome schizophrenia and related psychotic disorders can be preceded by many months by a prodrome of social withdrawal and isolation, cognitive difficulties, suspiciousness and other attenuated psychotic symptoms, and suicidality. Patients are frequently (mis)diagnosed with a depressive disorder during this phase. What treatments at …
How are Huntingtons disease and schizophrenia distinguished Both Huntington’s disease and schizophrenia complicated by tardive dyskinesia may present with psychosis and chorea-like movements. How are these distinguished? Genetic testing will of course identify the Huntington’s disease gene, but clinically in TD the movements are generally more localized, stereotyped, and repetitive and only rarely involve the …
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What substances, medications, or toxins may cause psychosis? The following is a partial list of potentially psychotogenic substances divided by category: Substances: alcohol, sedatives, hypnotics, and anxiolytics (intoxication or withdrawal), hallucinogens (e.g., phencyclidine), inhalants Medications: anesthetics and analgesics, anticholinergic agents, antihistamines, anticonvulsants, antiparkinsonian medications, chemotherapeutic agents (e.g., cyclosporine, procarbazine), corticosteroids, muscle relaxants, phenylephrine, pseudoephedrine, disulfiram Toxins: anticholinesterase, organophosphate …