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NMSK Exam 1 > 4. Mood Disorders > Flashcards

4. Mood Disorders Flashcards

1
Q

What is the etiology of mood disorders?

A
  1. Genetics and environment: 10-25% w/ Mood Disorder have a 1st degree relative w mood disorder; 50% for Bipolar Disorder; adoption studies and linkage studies show specific regions on chromosome
  2. Neurochemical
  3. Caused by a medical illness
  4. Stress
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2
Q

3 main NTs involved in Mood Disorders

A
  1. NE: ↓ in B-receptors
  2. DA is ↓ in depression and ↑ mania
  3. 5HT is ↓ in depression
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3
Q

Besides NE, DA and 5HT, what other NTs are ABNL in mood disorders?

A
  1. GABA inhibitory NT
  2. Glutamate excitatory NT and its NMDA receptor
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4
Q

What is the site of action of anxiolytic drugs and benzos?

A

GABA-R

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5
Q

What NT is involved in dementia?

A

Glutamate

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6
Q

What situations are life and environmental stress most often to cause mood disorders, which often proceed the 1st mood episode than later ones.

A
  1. Death of parent/grandparent before 11 YO
  2. Dealth of spouse/child
  3. Unemployment
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7
Q

What is the criteria for diagnosing a major depressive episode?

A

[Depressed mood most of day/q day OR anhedonia] + [at least 5 of the following] for 2 weeks:

SIG E CAPS

  1. Sleep disturbances (insomnia or hypersomnia)*
    1. Most often: depression = wake up early morning; anxiety = problem falling asleep
  2. Loss of interest/pleasure (anhedonia)
  3. Guilt/feeling of worthlessness *
  4. Energy loss and fatigue *
  5. Concentration/thinking problems *
  6. Appetite/weight changes (most often WL) *
  7. Psychomotor retardation/agitation almost q day. *
  8. Suicidal Ideation

Sx cause significant distress/impairment in social/occupational/ functioning and NOT due to substances or bereavement.

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8
Q

What questionnaire do PCP’s use to assess for a major depressive episode?

A

Patient Health Questionnaire 9 (PHQ-9)

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9
Q

Diagnosis of major depressive disorder requires what?

A

1 or more major depressive episodes W/O any manic, hypomanic, or mixed episodes

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10
Q

Major Depressive Disorder can have what associated features?

A
  1. Psychotic
  2. Anxious distress
  3. Melancholic
  4. Catonic
  5. Peripertum onset
  6. Mixed features
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11
Q

What questions are important to ask to ask if suspects a mood disorder?

A
  1. Any big life changes?
  2. FHx of mood disoder, suicides, substance abuse
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12
Q

DDx for Major Depressive Disorder

A
  1. Substance-induced disorders (benzos, alcohol)
  2. Mood disorder due to a general medical condition
  3. Normal grief (bereavement), which can last 2 months => 1-2 years, causing similar sx to MDD but does not cause hallucinations/delusions or impair fx
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13
Q

What is the tx for normal grief (bereavement)?

A

Grief counseling; do NOT give them antidepressants

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14
Q

Treatment of MDD

A
  1. Anti-depressants: all equally effective, with different SE.
  2. If suicidal, hospitilzation.
  3. ECT/TMS
  4. Ketamine/esketamine (Spravato)
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15
Q

BOARD Q: What is a SE of the anti-depressant trazodone, a triazolopyridine?

A

Priaprism: persistent and painful boner.

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16
Q

What is the most effective tx for depression and is often used in tx-resistant depression?

A

Electroconvulsive Therapy (ECT) = 75-80% treatment response

  • Induce a 30 second tonic-clonic seizure while patient is under anesthesia and neuromuscular block (succinylcholine) => resetting NTs: short-term memory loss causes pt not to remember (long-term loss = rare)
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17
Q

ECT sounds scary, but is it dangerous?

A

No: safe in pregnant and elderly; NO absolute CI

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18
Q

What is transcranial magnetic stimulations (TMS)?

A
  • Newer treatment for MDD that can be done in docs office, at first thought to be effective for ECT, but only 50% as effective.
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19
Q

Ketamine, is a _______ that has an off-label use for treatment of _________, causing _______________.

What drug is it similar to?

A
  • NMDA ANT that has an off-label use for treatment of [treatment-resistant depression], causing a 50% in suicidal thoughts in 24-hours.
  • VERY similary to PCP, but: shorter-acting & less toxic & cause_s dissociative anesthesia_
    *
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20
Q

OD on ketamine =

A

Panic attacks and aggressive behaviors

(rarely seizures, ↑ ICP and cardiac arrest)

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21
Q

How is Ketamine administered for the off-label use of treatment-resistent depression?

A
  • Psychiatrists gives 4-6 infusions over 2-3 times for 45-60 minutes.
  • Maintenance infusion is required.
  • 400-600$/ infusion.
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22
Q

What rapid-acting, nasal spray drug was approved by the FDA on March 5th for the treatment-resistant depression?

How is it administered/cost?

A
  • Spravato (esketamine)
  • Nasal spray given at health center approved to adminster (cant take home or give at home).
  • Very expensive
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23
Q

What is the criteria for Persistent Depressive Disorder (Dysthymia)?

A
  1. Depressed mood for most of the day for at least 2 years in adults and 1 year in children that is not severe enough to meet criteria for MDD.
  2. During 2 years, cannot be sx-free for >2 months at a time (is continuous)
  3. PT cannot EVER met criteria for: manic/mixed/hypomanic episodes.
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24
Q

What is Double Depression?

A

Dysthmic Disorder + MDD that occurs at the same time.

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25
Q

TEST Q: What is the key word for Persistent Depressive Disorder (Dysthymia)?

A

Low - moderate levels of depression for at least 2 years.

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26
Q

Dysthymic disorder can be more difficult to tx: what are some options?

A

CBT + Drugs: SSRIs, SNRIs, MAOIs

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27
Q

MDD with Seasonal Pattern (formerly, known as _____)

  • Essential feature?
  • Symptoms?
  • Treatment?
A
  • Depression with Seasonal Pattern = SAD (Seasonal Affective Disorder)
  • Essential feature: Onset of major depressive episodes when season changes from fall => winter, and remission in summer.
  • Symptoms: sleep/eat more(hypersomnia/hyperphagia), fatigued
  • Tx: Light therapy + wellbutrin/buproprion from Sept => March.
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28
Q

What is PMDD (Premenstrual Dysphoric Disorder)?

Treatment?

A
  • Mood instability (anxiety, depression and irritability) that occurs 1 week before period, consistent over the year
  • Tx:
    • Exercise/diet/relaxation therapy + SSRIs (Sertraline, fluoxetine or paroxetine) during cycle or 2 weeks before period.
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29
Q

What is the criteria for diagnosis of a Manic Episode?

A
  • ABNL and persistently elevated, expansile, or irritable mood that lasts at least 1 week with at least 3 of the following:
  • Manics DIG FAST
  1. Distracted
  2. Impulsivity/indiscrection: excessive involvment in pleasure w/o regard to consquences (hedonistic)
  3. Grandiosity: inflated self-esteem
  4. Flight of Ideas: racing thoughts
  5. Agitation: increased goal-oriented behavior
  6. ↓ need for sleep
  7. Talks too much, fast and pressured

Sx cause significant distress/impairment in social/occupational/ functioning and NOT due to substances or bereavement.

30
Q

What is the criteria for diagnosis of a Hypomanic Episode?

A
  • Similar to a manic episode (same criteria), but not severe enough to cause social/occupational impairment or need hospitilization
  • Episodes only need to last:
  • 4 consecutive days
  • No psychotic features
31
Q

Hypomanic episodes are more associated with which type of bipolar disorder?

A

Bipolar type II

32
Q

What is the criteria for Bipolar I Disorder?

A

≥1 manic/mixed episode with or W/O a hypomanic or depressive episode seperated by any length of time (only need 1 pole of bipolar to dx)

  • Major depressive episode not required, but if so: presents 1st!
33
Q

What is the criteria for Bipolar II Disorder?

A

At least 1 major depressive episode AND 1 hypomanic episode, with NO history of manic/mixed episodes.

34
Q

What has worse prognosis: MDD or Bipolar 1?

A

Bipolar 1

35
Q

Which is more prevelent: Bipolar 1 or 2?

A

Bipolar 2

36
Q

Describe a patient who has Bipolar 2

A
  • Major depressive episode + Hypomanic episode, without a mixed/manic episode; between episodes, patients mood and functioning normalizes.
37
Q

Treatment for Bipolar Disoder

A

DO NOT TREAT WITH ANTIDEPRESSANTS = can destabilize mood and ↑ suicide risk.

  • 1. 1st line of choice: Mood stabilizers = lithium, valproic acid, carbamazepines, lamotrigine
  • 2. Second Generation Antipsychotics
  • Once on mood stabilizer and under control, take off antipsychotics 1-2 months later.
38
Q

What drug is used to treat [Bipolar with depression]?

A

Lamotrigine

39
Q

2nd generation antipsychotics that end in -pine have what SE?

A

-PINE = PIG: WG and DB

40
Q

What is the criteria for Cyclothymic disorder?

A
  • Dysthymic disorder (milder depression) + intermittent hypomanic episodes for ≥2 years (adults) and 1 year (children)
  • W/O major depressive, manic or mixed episodes.
41
Q

Treatment of Cyclothymic Disorders

A
  1. Supportive psychotherapy (CBT) + mood-stabilizers + antidepressants before manic sx.
42
Q

What are Substance-Related Disorders?

A

Bipolar or MDD due to substances OR withdrawal

43
Q

What are Anxiety Disorders?

A

Inappropriate worry/fear and its physical manifestations that are not congruent with the magnitude of the stressor.

44
Q

What psychological symptoms do anxiety disorders cause?

A
  1. Worry/apprehension/problem concentrating
  2. Sense of doom/panic
  3. Hypervigilence
  4. Derealization (World seems strange)
45
Q

What somatic (physical) symptoms do anxiety disorders cause?

A
  1. HA/dizziness/ light headedness
  2. Palpitations, SOB, sweating
  3. Lump in throat
  4. Restlessness
46
Q

What physical signs do anxiety disorders cause?

A
  1. Diaphoresis, cool/clammy skin
  2. Tachycardia
  3. Flushing and fidgeting
  4. Hyperreflexia and tremor
47
Q

What is the difference in the fluctuation of sx’s between

generalized anxiety and panic disorder?

A

Sx’s in generalized anxiety fluctuate more than those of panic anxiety

48
Q

The criteria for diagnosis of panic disorder requires what?

A

Recurrent, unexpected panic attack (with or without agoraphobia) with 1 of the attacks followed by 1 month or more of 1 or more of the following sx:

  1. Persistent worry of another attack
  2. Worrying about consequencs of attack (i.e., losing control, MI, etc.)
  3. Behavioral change related to attack

NOT due to substances, general medical condition and not better explained by another mental disorder..

49
Q

What is the criteria for diagnosis of a panic attack?

A
  • Discrete period of intense fear or discomfort that last < 25 minutes and peak in 10 minutes, in which ≥4 of the following developed abruptly: P3AN[ICS]3
  • <u>Paresthesias</u>, <u>palpitations</u>, depersonalization
  • Abdominal distress
  • Nausea
  • Intense fear of dying, losing control, or going crazy
  • <u>CP</u>, <u>chills/hot-flash</u>, choking
  • Sweating, shaking , SOB
50
Q

Etiology of Panic Disorder

A
  • Strong genetic component (at least 50% have a affected relative)
  • MC in: 25YO W
51
Q

Which type of anxiety disorder has a strong genetic component?

A

Panic disorder: 50% of all pt’s have at least one affected relative

52
Q

Criteria for Diagnosis of Agoraphobia

A

Marked fear or anxiety in 2 or more of the following (LAP-TOC) because they fear escape is hard/embarrasing or help is not available if pt has panic attack

  1. Lines (standing in line/crowd)
  2. Alone (being outside home alone)
  3. Public Transportation
  4. Open spaces
  5. Closed spaces

Associated with panic disorder

53
Q

Criteria for Diagnosis of Social Anxiety Disorder (Social Phobia)

A
  1. Exaggerated fear of embarrassment in 1 or more social situations/performance situations that can expose person to that last 6 or more months***
  2. Exposure to feared situations => almost always causes anxiety, which cause situationally bound or situationally predisoposed panic attack
  3. Person knows fear is excessive and not reasonable
  4. Person avoids feared situations or endures them with intense anxiety/distress.
54
Q

Criterial for Diagnosis of GAD

A
  • Excessive anxiety and worry that is hard to control about different aspects of life for most days/ most of the day for ≥6 months with ≥3 of the following sx in adults (≥2 in kids):

FIRM-DS

    • Fatigue
    • Irratibility
    • Restlessness
    • Muscle tension
    • Difficulty concentrating
    • Sleep disturbance
55
Q

What is Obsessive-Compulsive Disorder?

A
  • Obsessions, compulsions or both
    • Obsessions = recurring, intrusive thoughts, urges or images that are inappopriate (not real-life shit) that cause anxiety/distress.
      • Person knows they made them up and tries to ignore/supress.
    • Compulsions = repetitive behaviors or mental acts that person feels driven to perform to prevent/reduce distress or dreaded situation/event.
  • Person knows both are unreasonable.
  • Both are time-consuming (>1 hr/day), causing marked distress and fuck up functioning.
56
Q

What are the types of OCD Related disorders?

A
    1. Hoarding Disorder
    1. Trichotillomania (hair pulling)
    1. Excoriation Disorder (skin picking)
    1. Substance-medication induced OCD and related-disorder
    1. OC and related disorder due to another medical condition
57
Q

BOARD Q:

What is a big difference with OCPD (obsessive-compulsive personality disorder) vs. OCD?

A
  1. OCPD: pt does NOT think they have a problem (ego-syntonic = behavior is consistent w beliefs/attitudes)
  2. OCD: they know their compulsions and obsessions are not reasonable (most of the time) (ego-dystonic = behavior is NOT consistent w ones beliefs/attitudes)
58
Q

Which is ego-dystonic vs syntonic: OCPD and OCD

A
  • Ego-dystonic = OCD
  • Ego-syntonic = OCPD
59
Q

What types of obsessions can one have?

A
  1. Contamination (fear of dirt/germs, illness)
  2. Safety/harm (being responsible for a fire)
  3. Unwanted acts of aggression (killing a loved one)
  4. Unacceptable sexual or religious thoughts (have sex with god)
  5. Need for symmtry or exactness
60
Q

What is the problem with curing obessions?

A

once cured one obsession => pt develops another

61
Q

What are specific phobias

A

Persistent, excessive or unreasonable fear cued by the [prescence or anticipation] of a specific object or situation (flying, heights, animals, blood) for at least 6 months, if under 18 YO.

  • Exposure = immediate anxiety, which can cause situationally bound or predisposed panic attacks.
  • Person avoids situations or endures them with intense distress, => interfering with NL routine, functioning or social activities/relationships.
  • Anxiety, panic attack or avoidance is not d/t another mental disorder.
62
Q

Fear of spiders

A

arachnophobia

63
Q

Fear of doctors

A

iatrophobia

64
Q

fear of heights

A

acrophobia

65
Q

Tx of panic disorder

A
  • 1st line =
    1. CBT
    2. SSRIs (paroxetine or paxil)
    3. Venlafaxine (SNRI)
  • Acute settings =
    1. benzos (xanex = alprazolam)

Doc said: SSRI + alprazolam for MRGNCIES

66
Q

Tx of GAD

A

1st line =

  1. CBT
  2. SSRIs (paroxetine or paxil)
  3. SNRI

2nd line =

  1. Buspirone
  2. TCA
  3. Benzo
67
Q

Tx for Social Anxiety Disorder

A

1st line =

  1. CBT
  2. SSRIs
  3. Venlafaxine (SNRI)

If performance type = B-blockers or benzos prn

68
Q

Tx for Agoraphobia

A

1st line = CBT + SSRI

69
Q

Tx for OCD

A

1st line =

  1. CBT
  2. SSRI

2nd line =

  1. Clomapramine
  2. Venlafaxine
70
Q

when dx a pt, what is important to do if the pt does NOT have a hx prior hx of depression

A

rule out underlying substance abuse, medication or medical condition (thyroid/endocrine)

NMSK Exam 1 (22 decks)

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