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Board Studying. > Bipolar and Depression > Flashcards

Bipolar and Depression Flashcards

1
Q

overlapping sx req for mixed episodes

A

3

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2
Q

sleep changes in MDD

A

decreased slow wave sleep
increased sleep onset latency
total sleep time dec
dec REM latency
inc number of eye movements in REM

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3
Q

prophylactic bipolar tx in pregnant won to reduced relapse rates

A

lithium at 36 weeks or no later than 48 hours following delivery

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4
Q

rapid cycling in bipolar

A

at least 4 major depressive, manic, or hypomanic episodes in past year.
must be distinct- have partial remissions for 2 mo or switch directly into opposite type of episode

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5
Q

completed suicide rate in bipolar pts

A

10-15%

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6
Q

percentage of pts with parkinsons with depression

A

40-50%

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7
Q

SSRIs cause more of this in the elderly

A

SIADH, 3x greater risk

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8
Q

slows progression of parkinson’s disease

A

selegiline

temporarily decreases amot of levopdopa and cabidopa needed to control sx as well as increasing dopamine

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9
Q

man age onset for first manic or depressive episode of bipolar 1 do

A

18

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10
Q

associated with mania in geriatric patients

A

right hemispheric or subcortical lesions

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11
Q

ECT more likely to cause delirium in this population

A

elderly

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12
Q

definiton of remission during acute-phase treatment from an episode of MDD

A

at least 3 weeks with absence of both sad mood and reduced interest and no more than 3 remiaing sx of depressive episode

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13
Q

time of teratogenic effects of depakote

A

3-6 weeks

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14
Q

incidence of depression on isotretinoin

A

4-11%

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15
Q

FDA approved for bipolar depression

A

quetiapine IR or XR
latuda
cariprazine
olanzapine plus fluoxetine

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16
Q

percentage of bereaved ppl who meet criteria for MDD

A

20%

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17
Q

risk of SSRIs in pregnancy according to studies

A

preterm birth

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18
Q

percentage of children with intial depressive episodes that have spontaneous resolution

A

40%

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19
Q

minimum duration of sx to diagnose hypomanic episode

A

4 days

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20
Q

scales to follow depression treatment responses

A

Hamilton Depression Scale (Ham-d)
Montgomery Asberg Depression Rating Scale (MADRS)

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21
Q

minimum time to diagnose persitent depressive do in adults

A

2 years

1 year for cyclothymic in kids

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22
Q

HIV med that inc risk of depression

A

non nucleoside reverse transcriptase

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23
Q

exposure level of common antidepressants in breast milk

A

zoloft and paxil are low to undetectable

celexa and prozac are higher.

24
Q

PMDD

A

for most menatrual cycles, patients need 5/11 specific symptom in the final week before the onset of mensus

criteria B, one of more must be present:

marked affective lability
marked irritability
marked depressed mood
marked anxiety

criteria C, one of more must additionally be present:
decreased interest
trouble concentrating
lethargy
changes in appetite
hypersomnia or insomnia
sense of being out of control
physical sx of mentruation

25
Q

PDD, persistent depressive disorder

A

6% of adults

mild depressive sx that persist for 2 years or more with no more than 2 mo without sx.

can also have MDD, use specifier with persistent major depressive episode, with intermittent major depressive episodes, with current episodes, etc.

26
Q

foods to avoid while on MAOI

A

cheese (Except cottage and cream
caviar
liver
smoked/picked/cured fish and meat
ripe avocados
canned figs, yeast extract, chianti red wide, fava beans, raisins, prunes, beer with yeast.

in moderation:
chocolate
coffee

27
Q

meds to avoid with MAOI

A

cold meds, allergy meds, decongestants, cough meds, stiumulants, meperidine, SSRI, buproprion, remeron, nefazodone, trazodone, effexor

28
Q

best treatment for atypical depression

A

monoamine oxidase inhibitors like selegiline.

atypical sx: emotional reactivity, hypersensitivity to loss of rejection, hypersomnia, hyperphagia.

29
Q

first episode of bipolar in both women and men is usually…

A

depressive

30
Q

adverse effects to newborn following SSRI/SNRI exposure in 3rd trimester

A

respiratory distress, cyanosis, apnea, seizures, temperature instability, feeding difficulty, vomitting, hypoglycemia, hypo or hypertonia, hyperreflexia, jitterness, irritability, constant crying, tremor

31
Q

percentage of pts with BP1 who have recurrence of mood sx after single manic episode

A

> 90%

32
Q

selegine can cause this to show in UDS

A

methamphetamine

is metabolized into l-methamphetamine and l-amphetamine

33
Q

ECT

A

produces a generalized seizre for 30-60 sexonds, unknown mechanism

FDA approved: catatonia, treatment resistant severe depression

3 days pwer week from 7-12 treatments in an acute series

common SEs- acute confusion, memory loss, HA, jaw pains, nausea

34
Q

efficacy for management of chronic anxiety in pts with severe lung disease
can assist iwth improvement in respiratory status

A

buspirone

35
Q

FDA approval for paroxetine

A

MDD, OCD, Social anxiety, GAD, panic DO, PTSD, PMDD, menstrual hot flashes.

more SEs than other SSRIs: sexual dysfuntion, weight gain, constipation , sedation.

half life is ~ 21 hrs,

36
Q

preferred for breastfeeding mothers with post partum depression

A

zoloft, paxil due to low amount in breast milk

37
Q

medical conditions that cause sx of mania

A

CNS tumors
syphillis
delirium
encephalitis
influenza
multiple sclerosis
q fever

38
Q

meds that can cause manic sx

A

meds: amphetamines, cocaine, isoniazid, sterioids

39
Q

minimum duration of symptoms for hypomanic episode

A

4 days

40
Q

liver fucntion test every 6-12 mo

A

carbamazepine and depakote

41
Q

selegine patch

A

bypasses gastric tract. lessening nee for dietary restriction at lowest dose

42
Q

most effective treatment for major depression

A

ECT- induces generalized tonic clonic seizures

ECT has no absolute risk

43
Q

less effective ECT electrode placement but reduces side effects

A

unilateral NONdominant.

the other modality is bilateral

44
Q

Type of ECT memory loss

A

MC is anterograde

inability to form new memories

most persistent type of memory loss is retrograde amnesia

to solve: inc interval, change type ie bilateral to unilateral electrode placement, use ultra brief pulse instead of brief.

45
Q

percentage of bereaved ppl that meet criteria for depression

A

20

46
Q

persistent complex bereavement DO

A

12 mo adults
6 mo children

pt has to deal with 6 sx of reactive distress or social/identity disruption

47
Q

Meds CI with ECT

A

theophylline- can cause seizures and status

other meds to use with caution or avoid:

hypoglycemics

Beta blockers (can cause asystole)

lidocaine (can reduce seizure induction)

lithium (can cause prolonged seizure and confusion)

benzos

48
Q

PMDD

A

5 out of 11 symptoms in final week before menses

12 month prevalence is 1.8% -5.8%

49
Q

cyclothymic disorder time req

A

1 year for kids

2 years for adults

numerous perods with hypomanic symptoms that do not meet criteria for manic episodes AND numerous periods with depressive sx that do not meet critera for depressive epiosde.

criteria for MDD and mania cannot be met

15-50% develop bipolar DO.

50
Q

atypical depression

A

weight gain
inc appetite
marked mood reactivity
leaden paralysis
interpersonal rejection sensitvity

51
Q

TMS

A

electromagnetic coil that creates strong magnetic field for microseconds at a time.

52
Q

activating antidepressants

A

prozac
wellbutrin
zoloft

53
Q

% of chidlren with depressive epsiode that will resolve spontaneously

A

40%

54
Q

average duration of ECT

A

10 weeks on average

gradually shift from weekly to monthly. and then maintaining monthly for at least 6 mo after remission.

indications for continuation:
1. hx of recurrent episodes responsive to ECT
2. ineffective med trials
3. patient preference

55
Q

hepatitis treatment that inc risk for depression

A

interferon alpha

inc risk by 20-40%

56
Q

DZ with greatest number of disability days

A

MDD

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