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Psych II > Bipolar, anxiety > Flashcards

Bipolar, anxiety Flashcards

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1
Q

What are bipolar and related d/o?

A

Episodic mood shifts into

  • mania,
  • MDD,
  • hypomania
  • mixed mode states
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2
Q

What treatments are used for acute mania/hypomania?

A

Mood stabilizers

  • lithium
  • valproic acid (1st line)

Antipsychotics
- used as a bridge for lithium

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3
Q

What makes valproic acid the 1st line?

A

No blood monitoring (unlike lithium)

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4
Q

bipolar I vs bipolar II

A

bipolar I

  • Manic episodes
  • Followed by depression

Bipolar II

  • hypomanic episodes
  • w/o frank mania
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5
Q

Describe a manic episode

A
  • elation w hyperactivity
  • over involvment in life’s activities
  • increased irritability
  • flight of ideas
  • easy distractibility
  • little need for sleep
  • rash things ($$, gabling, sex)
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6
Q

What are some atypical symptoms of mania?

A
  • Gross delusions
  • Paranoid ideation
  • Auditory hallucinations
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7
Q

What is a rapid cycler?

A

4+ mania episodes per year

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8
Q

What is cyclothymic d/o?

A
  • Episodes of Sub-syndromal depression and hypomania

- must have 2+ yr duration

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9
Q

Meds that can cause bipolar?

A
  • Reserpine
  • Corticosteroids
  • Oral contraceptives
  • Antihypertensives (methyldopa, guanethidine, clonidine)
  • Antiparkinson (levodopa)
  • Interferon
  • Stimulants (when withdrawn)
  • ETOH, sedatives, opoids and psychodellics are all depressants
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10
Q

Can medical conditions cause bipolar?

A

Any illness (severe or mild) can cause sig depression but especially common in

  • cancer
  • RA
  • major chronic diseases
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11
Q

What are anxiety d/o’s?

A

Persistent excessive anxiety or chronic fear and associated behavioral disturbances

Can be psychologic or somatic

Lack of structure contributes to it

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12
Q

What is separation anxiety?

A

Inappropriate and excessive fear or anxiety concerning separation from something

Minimum of 3 of:

  • recurrent excessive distress w/ anticipation or experience of separation
  • persistent and excessive worry about loss of ____
  • persistent and excessive worry about untoward event (kidnapping etc)
  • refusal to go to ___ b/c of fear of separation
  • cant sleep away from home
  • nightmares about separation
  • physical symptoms from separation
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13
Q

How long must separation anxiety continue to be diagnosed?

A

Children - 4 weeks

Adults - 6 months

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14
Q

Ddx for separation anxiety?

A 
GAD
Panic d/o
Agoraphobia
Conduct d/o
Social anxiety d/o
PTSD
Illness anxiety d/o
Bereavement 
Depressive/bipolar
Oppositional defiant d/o
Psychotic d/o
Personality d/o
Comorbidity
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15
Q

What are specific phobias?

A

A fear of a specific object

- lasting 6 mo or more

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16
Q

Pharm tx for specific phobias?

A

SSRI’s - paroxetine, sertraline, flovoxamine
SNIR’s - venlafaxine
Gabapentin - anxiolitic action
Beta-blocker

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17
Q

How are beta blockers given for specific phobias?

A

They are preemptive

- give 1 hr prior to known exposure

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18
Q

Behavior tx for specific phobias?

A

Relaxation techniques

Desensitization

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19
Q

talk tx for specific phobias?

A

CBT
Group therapy

Support groups

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20
Q

Prognosis for specific phobias?

A
  • Long standing and difficult to treat

Vary by age:
Childhood/adolescence - tend to wax and wane
Persist into adulthood - unlikely to remit

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21
Q

What is social anxiety (social phobia)?

A

Fear or anxiety about one or more social situation

  • worry about scrutiny of others
  • fears will be negatively evaluated by others

6 months or more

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22
Q

What is panic d/o?

A

Panic attacks that include chronic fear of the recurrence and avoidance of triggers

At least 1+ month of:

  • worry about panic attack
  • maladaptive change in behavior (avoiding things etc)
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23
Q

Clinical findings with panic d/o?

A

Panic attacks
Agoraphobia
Anticipatory anxiety
Sleep panic attacks

24
Q

Tx for panic d/o?

A

Antidepressants are mainstay

  • SSRI (fluoxetine, paroxetine sertraline)
  • SNRI (venlafaxine)

Benzo’s (be careful with them)
- use as a bridge

25
Q

What is a panic attack?

A

Recurrent unpredictable episode of intense surges of anxiety w physiologic manifestations

With trigger - expected panic attack
No trigger - unexpected panic attack

26
Q

Panic attack vs anxiety?

A

Panic attack is fast

  • occurs w/in minutes
  • discrete nature
  • greater in severity
27
Q

What is agoraphobia?

A

Fear places where escape is difficult

Fear of 2 or more of:

  • public places
  • open spaces (parking lots)
  • enclosed spaces
  • lines or crowds
  • being outside the home
28
Q

How many pts with anxiety develop generalized anxiety disorder?

A

About 1/2

29
Q

What is generalized anxiety d/o?

A

Anxiety symptoms that re present more days than not for 6 months

Excessive anxiety or worry about a number of events or activities that is “out of proportion”

30
Q

Clinical findings for GAD?

A

3 of the following (1 for kids):

  • restlessness, keyed up, on edge
  • easy fatigue
  • difficulty concentrating/ blank mind
  • irritability
  • muscle tension
  • sleep disturbance
31
Q

DDX for GAD?

A

Must r/o underlying medical d/o

  • cardiac
  • endocrine
  • etc
32
Q

Tx for GAD?

A

Pharm

  • SNRI (venlafaxine and duloxetine)
  • SSRI (escitalopram and paroxetine)
  • TCA/MAOI (3rd line)
  • Buspar (makes a good bridge)
33
Q

When treating GAD dont use?

A

Bupropion

34
Q

Other causes of anxiety?

A

Substance/med-induced anxiety d/o

  • happens after meds (give or take away)
  • med must be capable of producing anxiety

Anxiety d/o due to medical condition
- caused by psyiologic consequence of med condition (not the med)

35
Q

Common depression findings are?

A
  • Mood varies from mild sadness to total abandon
  • difficulty thinking, concentrating, acting
  • loss of interest
  • somatic complaints
36
Q

Severe depression can present w?

A
  • Psychomotor retardation or agitation
  • Delusions
  • Withdrawal
  • Physical symptoms
  • SI
37
Q

With mania you may see?

A
  • Mood varies from euphoria - irritability
  • sleep disruption
  • hyperactivity
  • racing thoughts
  • grandiosity/extreme over confidence
38
Q

Contrast grief and depression

A

Grief - intact self-esteem

Depression - sense of guilt and worthlessness

39
Q

4 major types of depression?

A
  • adjustment d/o w depressed mood
  • depressive d/o
  • bipolar
  • mood d/o 2/2 illness/meds
40
Q

Types of depression in depressive d/o?

A

MDD
Dysthymia
Premenstrual dysphoric d/o

41
Q

MDD, atypical depression and seasonal affected disorder typical tx?

A

SSRI

Bupropion

42
Q

Melancholic depression tx?

A

ECT
TCA
SNRI

43
Q

If a pt has SI they never get?

A

TCA or MAOI

44
Q

Tx that is specific to SAD?

A

Phototherapy

45
Q

How effective is ECT?

A

70-85% effective

- especially good in the elderly

46
Q

What is disruptive mood disregulation d/o?

A

Sever recurrent temper outbursts manifested verbally or behaviorally in kids age 6-18
- grossly out of proportion to situation

3x per week

Mood between outbursts is irritable or angry

Symptoms must be >12 months

47
Q

Clinical findings for MDD?

A 
Anhedonia
Loss of concentration
Fatigue
Anxiety
Worthlessness
Somatic complaints
Diurnal variation
48
Q

MDD can include what types of depression?

A

MD w atypical features
Melancholic MD
MDD w SAD
MD w peripartum onset

49
Q

MD w peripartum is found in?

A

80% of peripartum depression

50
Q

Pt population for psychotic MD?

A

Older - 14% more common over 50

51
Q

MDD must have 5 symptoms from?

Also, must have symptom 1 or 2

A
  1. Depressed mood (most of day)
  2. Markedly diminished interest or pleasure
  3. Weight change
  4. Insomina/hypersomnia
  5. Psychomotor agitation/retardation
  6. Fatigue or loss of energy
  7. Feelings of worthlessness
  8. Diminished ability to think/concentrate
  9. Thoughts of death
52
Q

What is persistent depressive d/o?

A

Chronic depression
- 2+ years w a relatively persistent course

Symptoms are usually milder but dont get better

53
Q

What is premenstrual dysmorphic d/o?

A

Depression during the luteal phase

- looks like a duck but it starts around 5 days pre bleed and improves after day 1

54
Q

What else can cause depression?

A

Substances and medical d/o

55
Q

What is unspecified depressive d/o?

A

Depression that doesnt meet the criteria for the other types

  • recurrent brief depression
  • short-duration depressive episode
  • depressive episodes w insufficient symptoms
56
Q

What is depression w mixed features?

A

At least 3 manic/hypomanic symptoms are present

57
Q

What is melencholic depression?

A

Depression with an almost complete loss of interest or pleasure in everything

Psych II (10 decks)

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