Bipolar and Depression Flashcards
overlapping sx req for mixed episodes
3
sleep changes in MDD
decreased slow wave sleep
increased sleep onset latency
total sleep time dec
dec REM latency
inc number of eye movements in REM
prophylactic bipolar tx in pregnant won to reduced relapse rates
lithium at 36 weeks or no later than 48 hours following delivery
rapid cycling in bipolar
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
completed suicide rate in bipolar pts
10-15%
percentage of pts with parkinsons with depression
40-50%
SSRIs cause more of this in the elderly
SIADH, 3x greater risk
slows progression of parkinson’s disease
selegiline
temporarily decreases amot of levopdopa and cabidopa needed to control sx as well as increasing dopamine
man age onset for first manic or depressive episode of bipolar 1 do
18
associated with mania in geriatric patients
right hemispheric or subcortical lesions
ECT more likely to cause delirium in this population
elderly
definiton of remission during acute-phase treatment from an episode of MDD
at least 3 weeks with absence of both sad mood and reduced interest and no more than 3 remiaing sx of depressive episode
time of teratogenic effects of depakote
3-6 weeks
incidence of depression on isotretinoin
4-11%
FDA approved for bipolar depression
quetiapine IR or XR
latuda
cariprazine
olanzapine plus fluoxetine
percentage of bereaved ppl who meet criteria for MDD
20%
risk of SSRIs in pregnancy according to studies
preterm birth
percentage of children with intial depressive episodes that have spontaneous resolution
40%
minimum duration of sx to diagnose hypomanic episode
4 days
scales to follow depression treatment responses
Hamilton Depression Scale (Ham-d)
Montgomery Asberg Depression Rating Scale (MADRS)
minimum time to diagnose persitent depressive do in adults
2 years
1 year for cyclothymic in kids
HIV med that inc risk of depression
non nucleoside reverse transcriptase
exposure level of common antidepressants in breast milk
zoloft and paxil are low to undetectable
celexa and prozac are higher.
PMDD
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
PDD, persistent depressive disorder
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.
foods to avoid while on MAOI
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
meds to avoid with MAOI
cold meds, allergy meds, decongestants, cough meds, stiumulants, meperidine, SSRI, buproprion, remeron, nefazodone, trazodone, effexor
best treatment for atypical depression
monoamine oxidase inhibitors like selegiline.
atypical sx: emotional reactivity, hypersensitivity to loss of rejection, hypersomnia, hyperphagia.
first episode of bipolar in both women and men is usually…
depressive
adverse effects to newborn following SSRI/SNRI exposure in 3rd trimester
respiratory distress, cyanosis, apnea, seizures, temperature instability, feeding difficulty, vomitting, hypoglycemia, hypo or hypertonia, hyperreflexia, jitterness, irritability, constant crying, tremor
percentage of pts with BP1 who have recurrence of mood sx after single manic episode
> 90%
selegine can cause this to show in UDS
methamphetamine
is metabolized into l-methamphetamine and l-amphetamine
ECT
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
efficacy for management of chronic anxiety in pts with severe lung disease
can assist iwth improvement in respiratory status
buspirone
FDA approval for paroxetine
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,
preferred for breastfeeding mothers with post partum depression
zoloft, paxil due to low amount in breast milk
medical conditions that cause sx of mania
CNS tumors
syphillis
delirium
encephalitis
influenza
multiple sclerosis
q fever
meds that can cause manic sx
meds: amphetamines, cocaine, isoniazid, sterioids
minimum duration of symptoms for hypomanic episode
4 days
liver fucntion test every 6-12 mo
carbamazepine and depakote
selegine patch
bypasses gastric tract. lessening nee for dietary restriction at lowest dose
most effective treatment for major depression
ECT- induces generalized tonic clonic seizures
ECT has no absolute risk
less effective ECT electrode placement but reduces side effects
unilateral NONdominant.
the other modality is bilateral
Type of ECT memory loss
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.
percentage of bereaved ppl that meet criteria for depression
20
persistent complex bereavement DO
12 mo adults
6 mo children
pt has to deal with 6 sx of reactive distress or social/identity disruption
Meds CI with ECT
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
PMDD
5 out of 11 symptoms in final week before menses
12 month prevalence is 1.8% -5.8%
cyclothymic disorder time req
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.
atypical depression
weight gain
inc appetite
marked mood reactivity
leaden paralysis
interpersonal rejection sensitvity
TMS
electromagnetic coil that creates strong magnetic field for microseconds at a time.
activating antidepressants
prozac
wellbutrin
zoloft
% of chidlren with depressive epsiode that will resolve spontaneously
40%
average duration of ECT
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
hepatitis treatment that inc risk for depression
interferon alpha
inc risk by 20-40%
DZ with greatest number of disability days
MDD
