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28. Neuromusculoskeletal and Psychiatry Exam 1 > 4. Clinical Approach to Mood Disorders > Flashcards

4. Clinical Approach to Mood Disorders Flashcards

1
Q

There is 3-5% prevalence of Bipolar, 3-8% for generalized anxiety disorder, 1-4% of people have panic disorders and 3-6% have panic attacks. What is the MC psychiatric illness, which has a higher prevalence in females? (17% of people)

A

Depression

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2
Q

Major depressive disorder is the second most disabling disease after heart disease and there are 1 million suicides worldwide per year. 25% of patients with a mood disorder have a 1st degree relative with one, 50% of patients with bipolar disorder have?

A

A first degree relative with a mood disorder

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3
Q

Adoption studies have been done along with linkage studies to identify specific chromosomal regions related to depression and bipolar disorder. Mood disorders are largely due to neurochemical issues, such as lack of NE, dec/inc levels of dopamine and?

A

decreased levels of serotonin (5HT) seen in depression and more commonly anxiety

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4
Q

NE neurotransmitters down regulate beta receptors, noradrenergic function is abnormal (lack of) in depression, dopamine is decreased in depression and increased in mania, GABA is an inhibitory NT- site of action for benzos and other drugs, what is an excitatory NT which is involved in dementia?

A

Glutamate (NMDA glutamate receptor involved in current studies - take a trip on LSD to improve depression)

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5
Q

Mood disorders can also be due to psychosomatic medicine, and life and environmental stress— it often proceeds first mood episode due to death of spouse or child, unemployment or death of?

A

a parent before the age of 11

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6
Q

What is defined as 5 of the following symptoms for a 2 week period with at least one of either a depressed mood or loss of interest or pleasure?

A

Major depressive Episode

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7
Q

Major Depressive Episode needs 5 of the following symptoms to be diagnosed, including depressed mood for most of the day, diminished interest, weight loss* (sometimes weight gain), insomnia/hypersomnia, psychomotor agitation, fatigue/loss energy, cant concentrate, thoughts suicide. What is a hallmark symptom of depression?

A

Early morning wakening from sleep (insomnia)

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8
Q

symptoms of Major depressive Episode cause clinically significant distress or impairment in social/occupation/ functioning, symptoms are not caused by direct effects of substance and are not accounted for by?

A

bereavement/ greif

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9
Q

someone with Major depressive Episode would be given a PHQ9 survery to fill out, which can lead you to see if they are actually depressed, if there are at least how many checks in the shaded boxes what can be expected?

A

If there are 5 checks (out of 9 questions), Major depressive *disorder can be expected

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10
Q

What disorder requires the presence of one or more major depressive episodes and the absence of any manic, hypomanic, or mixed episodes?

A

Major depressive disorder

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11
Q

Major depressive disorder has associated features that include psychotic, anxious distress, melancholic (extreme sadness), catotonic (inability to move normally), mixed features (anxiety+depression) or?

A

Peripartum Onset

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12
Q

Where is the associated feature of catatonic most commonly seen?

A

Bipolar disorder

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13
Q

DDx for Major depressive disorder includes substance induced DOs, mood disorders from general medical condition, and normal?

A

bereavement/greif (as this can last from 2 months to 2 years)

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14
Q

Normal greif/bereavement can last up to 2 years, usually following loss of a loved one, sx similar to major depressive disorder, should not include hallucinations/delusions or impairment of function, tx doesnt include antidepressants. What are the 5 steps of Kubler Ross Stages of Grieving?

A 
Denial
Anger
Bargaining
Depression
Acceptance
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15
Q

Treatment for Major depressive disorder includes hospitalization if the patient is suicidal or psychotic, otherwise somatic (pharm) therapies work such as MOAIs, SSRIs, and more, what TCA did he say he most used?

A

Nortiptyline

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16
Q

All antidepressants for tx of Major depressive disorder are equally effective but differ in SE, trazodone MC SE is priapism, bupropion causes low energy in females and weight gain, SNRIs (venlafaxin/duloxetine) used for depression and anxiety together, and mirtazapine is used at night to sleep, but has what main SE?

A

Weight gain

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17
Q

What therapy is used to treat TREATMENT RESISTANT Major depressive disorder, causes short term memory loss, induces a seizure and is safe and effective, no contraindications and 75-80% have a tc response?

A

Electroconvulsive Therapy (ECT)

shock tx done every other day for 6-12 times, might get HA/neck ache after

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18
Q

What is a newer treatment for Major depressive disorder, though at first to be almost as effective as ECT, but is 50% as effective, can be done in the doctor’s office- takes 1 hour qd for 30 days?

A

Transcranial magnetic stimulation

both ‘reset’ all NT

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19
Q

What drug is used for Major depressive disorder, which produces dissociate anesthesia and is a NMDA antagonist, overdose may lead to panic attacks/aggresive behavior, similar to PCP but is shorter acting and less toxic, 50% reduction in suicidal thoughts in 24hrs?

A

Ketamine (off label for treatment resistant depression, 45-60min infusion time by psychiatrist)

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20
Q

What is used to treat Major depressive disorder, via nasal spray and monitoring program, 800 centers have been approved, rapid acting, EXPEN$IVE?

A

Spravato (esketamine)

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21
Q

What disorder is aka Dysthymia, and is a depressed mood for most of the day for at least 2 years for adults and 1 year for children that has not been severe enough to meet criteria for Major depressive episode?

A

Persistent Depressive Disorder (Dysthymia)

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22
Q

Persistent Depressive Disorder (Dysthymia) during the 2 years before being diagnosed, cannot be without symptoms for >2 months at a time (must be continuous), pts must never have met criteria for manic, hypomanic or mixed episode, and can have double depression which is?

A

Dysthmyic Disorder and major depression (occur simultaneously)

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23
Q

Treatment for Persistent Depressive Disorder (Dysthymia) can be more difficult to treat, with either cognitive behavioral therapy or with pharamcology such as SNRIS, MOAIs, or MC?

A

SSRIs

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24
Q

What has an essential feature of the onset and remission of major depressive episodes at characteristic times of the year such as from fall to winter or change of the seasons, where pts sleep/eat more and are tired - tx w light therapy?

A

Depression with Seasonal pattern aka (Seasonal Affective disorder SAD)

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25
Q

What disorder is known as mood instability with anxiety, depression, irritability, occur the week before menses, with a consistent pattern over the year, tx includes exercise diet, relaxation, SSRIs (sertraline/fluoxetine) treated during cycle or two week prior?

A

Premenstrual Dysphoric Disorder PMDD

26
Q

What is considered abnormally and persistently elevated, expeansive, or irritable mood lasting at least 1 weeks with 3 of the following: grandiosity/inflated self esteem, decreased need for sleep, more talkative, racing thoughts, distractable, increased goal oriented behavior, excessive spending?

A

Manic Episode (bipolar type 1)

27
Q

Manic Episode can cause a mood disturbance severe enough to cause marked impairment in occupational functioning or in usual social activities/relationships, symptoms can not be caused by general medical condition or?

A

direct effects of a substance

28
Q

What medication can trigger Mania, so be sure to take a good history to determine if they are bipolar?

A

Anti-depressants

29
Q

What is similar to Manic Episode but is less severe and episodes only need to last 4 days and must not include psychotic features, there are no social/occupational impairments?

A

Hypomanic Episode (considered Bipolar type II)- more common than type 1

30
Q

What is diagnosed by only having a single manic episode, with at least* one manic or mixed episode (depressed), major depressive episode not required for dx, but is usually the episode that presents first, can be psychotic episode w delusions/hallucinations, worse diagnose than MDD?

A

Bipolar I Disorder (not curable- patient only needds on ‘pole’ of bipolar for diagnosis)

31
Q

What disorder is where patients have had at least one major depressive episode and on hypomanic episode in the absence of any manic or mixed episodes, more prevelant than Bipolar type I?

A

Bipolar II Disorder

32
Q

Tx for bipolar disorders include mood stabilizers which are the first line choice, such as valproic acid (depakote) or what, which takes 2 weeks to kick in with a narrow therapeutic window- easily causing toxicity?

A

Lithium

33
Q

Tx for bipolar disorders also include carbamazepine, and SGA, such as olanzapine/risperidone, however these cause weight gain and DM/ metabolic issues. What drug is used for bipolar with depression, is an anticonvulsive (“lithium lite”) and has a severe SE of Steven Johnson Syndrome**?

A

Lamotrigine

34
Q

What disorder is characterized as dysthymic disorder with intermitent hypomanic periods, a pt who over last 2 yrs experiences repeated episodes of hypomania and depression?

A

Cyclothymic Disorder- Rare/uncommon

Tx: mood stabilizing, antidepresants cause manic sx, supportive psychotherapy

35
Q

Substance related disorders are either due to substance induced or withdrawal, and can lead to bipolar and what disorder?

A

Major depressive DO

meth induced psychosis

36
Q

What disorder has psychological symptoms of apprehension, worry, sense of doom or panic, hypervigilence, difficulty concentrating, derealization, and physical sx of HA, dizzy, lightheaded, palpitations, lump in throat, restless, SOB, dry mouth and sweating?

A

Anxiety Disorders

37
Q

Physical signs of anxiety disorders include diaphoresis, cool/clamy skin, tachycardia, flushing, hyperreflexia, tremor and?

A

fidgeting

38
Q

What type of anxiety is involved worry about actual circumstances events or conflicts, often accompanies panic anxiety, and has symptoms that fluctuate more than those of panic anxiety?

A

Generalized Anxiety

39
Q

Diagnostic catergories of anxiety include separation anxiety, panic disorder, agoraphobia, GAD, OCD, phobias / social phobias, and?

A

PTSD

40
Q

What disorder is a type of anxiety which needs both of the following: recurrent unexpected attacks, and at least one attack followed by 1 month or more of one of the following: concern about addtnl attacks, worry about the implications, significant change in behavior due to the attack?

A

Panic Attacks

41
Q

Panic Attack is a discrete period of intense fear or discomfort in which four of more of the following developed abruptly and reached peak within *10 minutes and lasts less than 25 mins: palpitations, sweating, trembling/shaking, SOB, dizzy, fear of dying, paresthesias, chills, hot flashes and MC presents to hospital as?

A

chest pain****MC

42
Q

Panic disorder is 2-3 times more likely in women and the average age is 25 years old, there is a strong genetic component in which 50% of all patients have at least?

A

one affected relative

43
Q

What is the term for anxiety about being in situation from which escape might be difficult of embarrassing or for which help may not be availible in the event of panic ex: being away from home, sitting in middle seat, elevator, plane- associated with panic disorder?

A

Agoraphobia (named as panic disorder with or without agoraphobia)

44
Q

What is known as the fear, anxiety, or avoidance being persistent for 6+ months, fear of social performance and humiliating themselves or show anxiety sx, exposure to feared situation causes predisposed panic attack, person recognized fear as unreasonable or excessive, feared situations are avoided?

A

Social Phobia (social anxiety disorder)

45
Q

What is an excessive anxiety and worry (apprehensive expectation) occuring more days than not for at least *6 months, for most of the day about a number of events or activities?

A

Generalized Anxiety Disorder

46
Q

Generalized Anxiety Disorder is difficult to control the worry, anxiety and worry are associated with at least 3 of the following persisting for the past 6 months: restless, easily fatigued, irritability, muscle tension, sleep disturbance and?

A

difficulty concentrating

47
Q

OCD is the most disabling disorder. Obsessions are recurrent and persistent thoughts, impulses or images which cause marked anxiety/distress, person knows they are a product of his own mind. What are repetitive BEHAVOIRS or mental acts that the person feels, aimed at preventing distress or preventing the dreaded situation?

A

Compulsions (thing they do)

person recognizes as unreasonable, interfere with functioning and take up >1hr/day

48
Q

OCD and related disorders include hoarding, trichotillomania (hair pulling), excoriation disorder (skin picking), substance medication induced OCD, or OCD due to another?

A

medical condition

49
Q

Be careful not to confuse OCD with what, which is where they dont perceive they have a problem? (OCD pts know their compulsions and obsessions are not reasonable)

A

OCPD = Obsessive Compulsive *Personality Disorder

50
Q

Obsessions range from contamination (fear of dirt/germs), to safety/harm, unwanted acts of aggresion, unacceptable sexual or religious thoughts and a need for symmetry or?

A

exactness

51
Q

Compulsions include excessive cleaning, checking ordering and arranging rituals, counting, repeating routine activities, some are performed as unobservable mental rituals such as silent recitation of nonsense words to?

A

vanquish a horrific image

52
Q

Arachnophobia is fear of spiders, iatrophobia is fear of doctors, acrophobia is fear of heights, and what is AKA social anxiety disorder and is the fear of being judged/ public speaking?

A

Social Phobia - givem xanax

53
Q

Tx for anxiety range from supportive therapy to psychodynamic psychotherapy (dr doesnt use) to cognitive behavioral therapy which can help retrain?

A

the negative thoughts

54
Q

Psychopharmacology tx for anxiety include SNRIs, TCAs, MAOIs, Buspirone (5HT partial agonist), benzos (alprazolam and clonazepam - uncommon), antipsychotics and most commonly?

A

SSRIs

55
Q 
Think depression if the following are met SIG E CAPS
Sleep (lack of)
Interest (adhedonia- lack)
Guilt
Energy (lack)
Concentration (lack)
Appetitie (lack/dec)
P?
S?
A

Psychomotor (decreased)

Suicidal ideation

56
Q 
Think manic if the following is met DIG FAST
Distractibility
Inflated Self esteem/ IMpulsive
Grandiosity (pretentious)
Flight of ideas (racing thoughts)
Activity (increased)/ Agitation
S?
T?
A

Speech (pressured)

Thoughtlessness

57
Q 
Think dysthymic if the following is met CHASES
Concentration (poor)
Hopelessness
Appeptite (poor)
Sleep (lack/insomnia)
Energy (low)
S?
A

Self esteem (low)

58
Q

It is important to rule out underlying substance, medication or medical condition causing depression, especially if the patient has no hx of depression. More than 50% of patients who have had one episode of major depression will have?

A

recurrent episodes

59
Q

The risk of further episodes of major depression increases with the number of prior epsidoes, the treatment that was successful for prior episodes has a higher likelihood in?

A

future episodes- meaning if the patients current drug is no longer working, ask about past medications that have worked and try those again- may work

60
Q

Selective serotonin reuptake inhibitors are all first line treatment options for major depressive disorder, including venlafaxine, mirtazapine and?

A

bupropion

28. Neuromusculoskeletal and Psychiatry Exam 1 (21 decks)

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