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Mood and Personality Disorders

Mood and Personality Disorders. Joe MacLellan PGY-3 July 28, 2011. Thank you. Dr. Colleen Carey Colleen Weir. Outline. Mood Disorders Depressed mood Elevated Mood Personality Disorders Cluster A, B, and C. MDE/MDD Dysthymia. Bipolar disorder I Bipolar disorder II Cyclothymia.

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Mood and Personality Disorders

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  1. Mood and Personality Disorders Joe MacLellan PGY-3 July 28, 2011

  2. Thank you • Dr. Colleen Carey • Colleen Weir

  3. Outline • Mood Disorders • Depressed mood • Elevated Mood • Personality Disorders • Cluster A, B, and C

  4. MDE/MDD Dysthymia Bipolar disorder I Bipolar disorder II Cyclothymia Mood Disorders

  5. Case 1 45 single F, presents to the ED c/o fatigue and abdominal pain. • Vitals Normal • Bloodwork is Normal • Abdominal exam is benign Next step?

  6. How do depressed patients present to the ED?

  7. 1) Suicidal Ideation 2) Depressed 3) Vague complaints 4) Anxiety

  8. Major Depressive Episode

  9. MDE Criteria • At least 5 of SIGECAPS* • Causes impairment, for >2 weeks • Not a mixed episode, not substance-induced or caused by a GMC, not bereavement

  10. How do adolescents and elderly differ in their presentation?

  11. Adolescents Misdiagnosed as ADD Boredom* Substance use/criminal activity Mood can be irritable Geriatrics Cognitive changes (dementia)

  12. Should we be prescribing anti-depressant medication in the ED?

  13. What disorders mimic Major Depression?

  14. Mimics • Medical Conditions • Medications • Substance Abuse/Withdrawal

  15. How does Dysthymia differ?

  16. Dysthymia • Chronic, low-grade depression • Responsive to anti-depressants • Increase risk of MDD

  17. Specifiers • Seasonal Affective • Postpartum • With other features: psychotic, atypical, melancholic

  18. Treatment Moderate-Severe: • Anti-depressants • Psychotherapy • ECT Mild: • Exercise, self-help books • Counseling

  19. Who needs to be admitted?

  20. Disposition • Who needs admission? • Risk of suicide/homicide • Lacks capacity to cooperate with treatment • Inadequate psychosocial support • Co-morbid condition requiring admission • Who can be discharged?

  21. Resources We will come back to this…

  22. All the kids are doing it…

  23. “I feel more alive. I feel more focused. I feel more energetic. My workouts are really intense.” “Every great movement begins with one man, and that’s me.” [Did you get out of control?] “Well yeah! I don’t have another gear!”

  24. How do manic patients typically present to the ED?

  25. Mania presents as • Dangerous activity • Trauma • Gambling • Binge Drinking

  26. Manic Episode • Elevated mood lasting 1 week • 3 or more of DIGFAST* • Not mixed, substance-induced, GMC • Causes impairment

  27. Mimics • Substance abuse/withdrawal • Medications • Delirium • Hyperthyroid

  28. How would you control an aggressive Manic patient • Initially: • Single room, offering medications • If necessary: • Haldol/lorazepam • restraints

  29. How does Hypomania differ?

  30. Hypomania • Elevated/irritable for 4+ days • 3 or more of DIGFAST • BUT… • Not signicant enough to cause marked impairment or to necessitate hospitalization

  31. Bipolar disorder • Bipolar I • Episode of mania, +/- MDE +/-, hypomania • Bipolar II • Hypomanic and MDE episodes • NO manic or mixed episodes

  32. Cyclothymia • 2 years of episodes of hypomania and depressive symptoms • Not meeting criteria for MDE, mania, or mixed episoder • Not substance-induced, GMC, schizophreniform

  33. Treatment • Acute depression: • SSRI’s • Acute mania: • Lithium • +/- antipsychotics, benzodiazepines • Maintenance: • lithium • Educational and psychosocial support

  34. Disposition • Who needs admission? • Who can be discharged?

  35. Resources We will come back to this…

  36. Personality Disorders

  37. “an enduring pattern of inner experience and behavior that deviates markedly from the expectations of the individual's culture, is pervasive and inflexible, has an onset in adolescence or early adulthood, is stable over time, and leads to distress or impairment”

  38. Is this a Personality Disorder?

  39. Is this?

  40. 2 people in this room have a PD

  41. = • Cluster A • Cluster B • Cluster C

  42. Conscientiousness Extraversion Neuroticism Openness Agreeableness

  43. Cluster A • Schizoid Personality Disorder • Schizotypal Personality Disorder • Paranoid Personality Disorder

  44. Cluster C • Dependant Personality Disorder • Avoidant Personality Disorder • Obsessive-compulsive Personality Disorder

  45. Personality Disorder Party Jason

  46. The Guest List Amber Kim Jason Crystle Tyler Skye

  47. Cheat Sheet • Harold - Schizoid • Kim - Paranoid • Skye - Dependant • Tyler - Schizotypal • Amber - OCPD • Crystle - Avoidant

  48. A • These patients rarely seek treatment. • Treatment largely psychotherapy • Use clear explanations, establish trust

  49. C • Typically present with another symptom* • Pharmacotherapy for symptom relief but mainstay is psychotherapy • Be supportive but set limits

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