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Differential Diagnosis of Mood Disorders - Coggle Diagram
Differential Diagnosis of Mood Disorders
Diagnosis of Depressive and bipolar Related Disroders
Clinical Diagnosis based on history, investigations to rule out other causes, Rating scales for screening, monitoring, determining the severity
Bipolar 1
Diagnpoostic Requirements
Euphoria wiht 3 of the following or Irritability with 4 of the following
DIGAST: Distractibility, indiscretion, Grandiosity, Flight of ideas, activity increase, sleep deficit, talkativeness
When to sustepct
Positive family history, hypomanic episode with NDE, post partum psychosis
Risk Factors
Thresholds or subthreshold manic symptoms, hypomanic episode with a MDE, +ve FHx, increasing number of episodes, treatment resistant depression, post partum psychosis
Bipolar 2
Hypomania + MDE
Hypomania
Same as mania, but for 4 days, no psychosis, no severe impairment, no hospitalization
Cyclothymic Disorder
Multiple subsyndrome hypomanic episodes and depressive episodes over 2 year period (not DSM 5 for mania or depression)
Presentation
Lack of Insight: Do not perceive that they are ill or in need of treatment
Change of appearance: May change dress/appearance to a more sexually suggestive/flamboyant style
Change of Behavrious: Some perceive sharper sense of smell, hearing, gambling and anti-social behavrious, increased hostility
Specifiers
Rapid Cycling: 4 or more mood episodes within a year
Mixed episode: Experience mania and depression during same period for week or more
Mimics
Medical Illness: Hyperthyroidism, malignancy, anorexia, renal failure, cerebral insults, multiple scelrosis
Substances: Alcohol, PCP, Sedative, Cocain
Medications: Steroids, immunosuppressants, antidepressants
Conditions with bipolar symptoms
Psychosis, ADHD, Personality disorder, Frontal Lobe dysfunction, Delirium
Depressive Disorders
Major Depressive DIsroder
Characteristics
2 week period of depressed mood or loss of interest or pleasure and 4 of the following: Sleep, appetite, Guild, Energy, Concentration, activity, suicide
Severity
Determined by degree of functional Impairment
Persistent Depressive Disorder (Dysthymia)
Core Symptoms
Depressed mood + 2 other depressive symptoms
Changes in sleep, Guilt, Fatigue, Decreased concentration, changes in appetitie or weight, changes in activity, death/suicide
Duration/Frequency
Symptoms persist for at least 2 years (1 year for children/adolescents)
Characteristics
May include periods of major depressive episodes
DDx
Medical condition, medications, substance use disorder, bipolar disorder, other depressive disorders
Disruptive Mood Dysregulation Disroder
Core Symptoms
Severe temper outbursts with underlying persistent angry or irritable mood
Duration/Frequency
Temper outbursts 3+ Times a week
Duration: Temper outburts and persistently irritable mood between outburts at least 12 months
Severity: Present in two settings and severe in at least 1
Other
Onset: Before age 10 but cannot diagnose before age 6
Cannot diagnose for first time after age 18
If oppositional defiant disorder present, do not diagnose
Differential
Medical Condition, medications, substance use disorder, bipolar disorder, intermittent explosive disorder, ADHD, autism spectrum disorder
Premenstrual Dysphoric Disorder
Core Symptoms
Emerge in week prior to menses and quickly disappear with onset of menses
Include 5 core Symptoms: Affective lability, irritability, depressed mood, anxiety/tension, decreased interest, poor concentration, fatigue, appetite change, hypersomnia/insomnia, overwhelmed
Duration/Frequency
Present in all menstrual cycles in the past year, documented for 2 menstrual cycles
Characterisitics
Clinically significant distress/impairment
DDx
Medical condition, medications, substance use disorder, bipolar, other depressive disorders
Other Differentials
Due to other medical conditions, substance idnuced depressive disorder, bereavement, adjustment disorder, personality disorders, non-pathological sadness
Due to medical condition
Characteristics
acute onset, absence of previous psychiatric history, unusualy presentation of known psychiatric disorders, fever, weight loss, treatment refractoriness, PMHx of certain medical disorders
Substance induced depressive Disorderes
Timing, At increased risk, concurrent or assocaited problems
'Depression' Like symptoms
Bereavement, Adjustment disorders, personality disorders
Bereavement vs Depression
Bereavement is more emptiness and loss, self-esteem preserved, feeling thoughts of joining decreasees, decreases with time, no functional impairment in >2 months in 12 months, transient hallucionatioins, loss of loved one
Adjustment Disorder
Similarities to depression
Both have stress and depressed mood
Differences
Criteria for MDE not met, onset of symptoms within 3 months of stressors, and resolution within 6 month of removal of stressor
Symptoms cause
Excess of what would be expected, and significant impairment in social or occupational functioning
Investigations
CBC, Thyroid indices, B12, Folate, Electrolytes (Rule out medical conditions)
Physical Exam
Other Indicated tests: Kidney function, liver function, fasting lipid/glucose, sleep test, EKG, EEG, Cortisol
Substance Abuse: Urine for cannabis, BAC
Treatment
Identify what is primary, Treat underlying conditions,a nd sometimes concurrent treamtent are needed