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)

Bipolar, anxiety Flashcards by michael english

What are bipolar and related d/o?

Episodic mood shifts into

mania,
MDD,
hypomania
mixed mode states

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What treatments are used for acute mania/hypomania?

Mood stabilizers

lithium
valproic acid (1st line)

Antipsychotics
- used as a bridge for lithium

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What makes valproic acid the 1st line?

No blood monitoring (unlike lithium)

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bipolar I vs bipolar II

bipolar I

Manic episodes
Followed by depression

Bipolar II

hypomanic episodes
w/o frank mania

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Describe a manic episode

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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What are some atypical symptoms of mania?

Gross delusions
Paranoid ideation
Auditory hallucinations

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What is a rapid cycler?

4+ mania episodes per year

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What is cyclothymic d/o?

Episodes of Sub-syndromal depression and hypomania

- must have 2+ yr duration

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Meds that can cause bipolar?

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Stimulants (when withdrawn)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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Can medical conditions cause bipolar?

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

cancer
RA
major chronic diseases

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What are anxiety d/o’s?

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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What is separation anxiety?

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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How long must separation anxiety continue to be diagnosed?

Children - 4 weeks

Adults - 6 months

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Ddx for separation anxiety?

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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What are specific phobias?

A fear of a specific object

- lasting 6 mo or more

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Pharm tx for specific phobias?

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

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How are beta blockers given for specific phobias?

They are preemptive

- give 1 hr prior to known exposure

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Behavior tx for specific phobias?

Relaxation techniques

Desensitization

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talk tx for specific phobias?

CBT
Group therapy

Support groups

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Prognosis for specific phobias?

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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What is social anxiety (social phobia)?

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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What is panic d/o?

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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Clinical findings with panic d/o?

Panic attacks
Agoraphobia
Anticipatory anxiety
Sleep panic attacks

Tx for panic d/o?

Antidepressants are mainstay

SSRI (fluoxetine, paroxetine sertraline)
SNRI (venlafaxine)

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

What is a panic attack?

Recurrent unpredictable episode of intense surges of anxiety w physiologic manifestations With trigger - expected panic attack No trigger - unexpected panic attack

Panic attack vs anxiety?

Panic attack is fast - occurs w/in minutes - discrete nature - greater in severity

What is agoraphobia?

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

How many pts with anxiety develop generalized anxiety disorder?

About 1/2

What is generalized anxiety d/o?

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”

Clinical findings for GAD?

3 of the following (1 for kids): - restlessness, keyed up, on edge - easy fatigue - difficulty concentrating/ blank mind - irritability - muscle tension - sleep disturbance

DDX for GAD?

Must r/o underlying medical d/o - cardiac - endocrine - etc

Tx for GAD?

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

When treating GAD dont use?

Bupropion

Other causes of anxiety?

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)

Common depression findings are?

- Mood varies from mild sadness to total abandon - difficulty thinking, concentrating, acting - loss of interest - somatic complaints

Severe depression can present w?

- Psychomotor retardation or agitation - Delusions - Withdrawal - Physical symptoms - SI

With mania you may see?

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

Contrast grief and depression

Grief - intact self-esteem | Depression - sense of guilt and worthlessness

4 major types of depression?

- adjustment d/o w depressed mood - depressive d/o - bipolar - mood d/o 2/2 illness/meds

Types of depression in depressive d/o?

MDD Dysthymia Premenstrual dysphoric d/o

MDD, atypical depression and seasonal affected disorder typical tx?

SSRI | Bupropion

Melancholic depression tx?

ECT TCA SNRI

If a pt has SI they never get?

TCA or MAOI

Tx that is specific to SAD?

Phototherapy

How effective is ECT?

70-85% effective | - especially good in the elderly

What is disruptive mood disregulation d/o?

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

Clinical findings for MDD?

``` Anhedonia Loss of concentration Fatigue Anxiety Worthlessness Somatic complaints Diurnal variation ```

MDD can include what types of depression?

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

MD w peripartum is found in?

80% of peripartum depression

Pt population for psychotic MD?

Older - 14% more common over 50

MDD must have 5 symptoms from? Also, must have symptom 1 or 2

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

What is persistent depressive d/o?

Chronic depression - 2+ years w a relatively persistent course Symptoms are usually milder but dont get better

What is premenstrual dysmorphic d/o?

Depression during the luteal phase | - looks like a duck but it starts around 5 days pre bleed and improves after day 1

What else can cause depression?

Substances and medical d/o

What is unspecified depressive d/o?

Depression that doesnt meet the criteria for the other types - recurrent brief depression - short-duration depressive episode - depressive episodes w insufficient symptoms

What is depression w mixed features?

At least 3 manic/hypomanic symptoms are present

What is melencholic depression?

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