Vanderbilt University School of Medicine
VC3 – Vanderbilt Core Clinical Curriculum

Abnormalities of Mood

 

 

Prerequisites

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Describe and discuss:

  • basic  features of mood disorders, including the following:
  • dysthmia
  • major depressive disorder
  • bi-polar disorders
  • substance-induced mood disorders
  • mood disorder secondary to general medical condition
  • cyclothymia
  • clinical presentation of the various mood disorders
  • the etiology and pathophysiology of mood disorders
  • the impact of mood disorders on behavior and family

Demonstrate:

  • basic interview skills
  • basic communications skills
  • basic mental status examination including the mini-mental status examination
  • application of medical knowledge about abnormalities of mood related to the presence of a mood disorder in the clinical encounter
  • the skills to recognize the presence of a mood disorder and identify the appropriate diagnosis (either as the primary diagnosis or as a comorbid disorder) and management plan or know when to refer/obtain consultation
  • appropriate attitudes to facilitate care of patients with abnormalities of mood

 

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Apply Medical Knowledge in the Clinical Encounter

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1.     Recognize and describe the signs and symptoms of mood abnormalities and identify when the abnormality of mood is indicative of a mood disorder.

2.     Recognize and describe the clinical features that help distinguish normal grief reaction from a mood disorder.

3.     Recognize and describe the clinical features that help differentiate one form of mood disorder from another (DSM IV TR):

  • adjustment disorder with depressed mood
  • dysthmia
  • major depressive disorder
  • bipolar disorders
  • substance-induced mood disorders
  • mood disorder secondary to general medical condition
  • cyclothymia

4.     Describe the risk factors for suicide and recognize their presence or absence in patients with mood disorders.  Describe what should be done if risk factors are present.

5.     Describe the role of neuropsychological studies in the evaluation of patients with mood disorder; determine if neuropsychological studies are appropriate for patients that are seen with mood disorders, taking into account indications, limitations, and cost.

6.     Describe and discuss morbidity and mortality of the various mood disorders including the impact upon the management of primary medical disorders.

7.     Describe and discuss the epidemiology of mood disorders, including prevalence, incidence, and socio-economic features.

8.     Describe and discuss the biological (including genetics) and environmental bases of the mood disorder of the patient.

 

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Diagnose

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1.     Obtain, document, and present an age-appropriate medical history.

2.     Perform a complete mental status exam to include when appropriate a mini-mental status exam and record the results.

3.     Perform a neurological exam and record the results.

4.     Recommend when to order the following neuropsychiatric and laboratory tests, both prior to and after initiating treatment, based on the differential diagnosis. Justify ordering and interpret the results (with consultation):

  • thyroid function tests
  • urine drug screen
  • BMP
  • CMP
  • CBC
  • lipid profile
  • serum iron
  • serum B12
  • EEG
  • MRI
  • CAT scan
  • neuropsychological testing
  • lead level
  • prolactin level
  • urinalysis and specific gravity
  • EKG

5.     Generate a differential diagnosis recognizing specific history and testing results that suggest a form of mood disorder.

 

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Develop a Management Plan

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1.     Determine appropriate treatment plans for each form of mood disorder.  Explain indications for the following aspects of a treatment plan:

  • psychopharmacology
  • psychotherapy
  • inpatient vs. outpatient treatment setting
  • coordination with primary care physician or referral to/management by a psychiatrist
  • utilization of community resources
  • advocacy for patients with mood disorders who are lacking the energy and motivation to address the mood disorder and the primary medical disorders

2.     Describe and discuss the impact of medical co-morbidities on developing a differential diagnosis and determining a patient’s specific problem, and provide appropriate treatment for the medical co-morbidities.

3.     Demonstrate skills in communicating information about the disorder to the patient and family.  Formulate and communicate a prognosis for the patient with a mood disorder to the patient and family (as appropriate) in a caring and compassionate manner.

4.     Discuss preventive measures after stabilization such as stress management and supportive therapy.

5.     Demonstrate professional behavior and appropriate attitudes:

  • appreciate the disruption in life when abnormalities of mood occur
  • appreciate the negative impact that mood abnormalities have on medical illness
  • appreciate the significant morbidity and mortality that can occur in individuals with mood disorders
  • appreciate the challenges that patients with mood disorders face in terms of access to resources, cognitive challenges in maneuvering the medical system given the impact of mood disorders on executive functioning, and sense of hopelessness and loss of motivation that may be cardinal symptoms of the mood disorder disease itself
  • appreciate the disparity in resources available to treat mood disorders and the impact upon the care available to the patients
  • demonstrate compassion for the vulnerability of patients struggling with mood disorders

6.     Recognize the significance of transference and counter-transference in the doctor patient relationship, specifically recognizing how your reaction to a patient can affect the care provided to the patient.

 

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Differential Diagnosis

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  • adjustment disorder with depressed mood
  • cyclothymia
  • dysthmia
  • major depressive disorder
  • bipolar disorder
  • substance-induced mood disorders
  • mood disorder secondary to general medical condition