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Neuromusculoskeletal & Psychiatry I Exam #1 > Clinical Approach to Mood Disorders > Flashcards

Clinical Approach to Mood Disorders Flashcards

1
Q

What is the NE activity in a patient with depression?

A

Down-regulate beta-receptors; noradrenergic function abnormal in depression.

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2
Q

What is the DA activity in a patient with depression vs. mania?

A

Decreased in depression; increased in mania.

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3
Q

What is the 5-HT activity in a patient with depression?

A

Decreased in depression

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4
Q

What disease process does glutamate play in integral role?

A

Dementia

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5
Q

What is the requirement to diagnose a major depressive episode?

In addition, it requires…

A

At least 5 symptoms for a 2-week period, with at least one either (1) depressed mood or (2) loss of interest or pleasure.

One or more major depressive episodes and the absence of any manic, hypomanic or mixed episodes.

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6
Q

What might be on the DDx for major depressive disorder?

A

Substance-induced d/o

Mood disorders from a general medical condition

Normal grief (bereavement): may last beyond 2 mo. and up to 1-2 yrs.

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7
Q

What might be used as treatment for major depressive disorder?

A

Hospitalization

Somatic therapies

  • TCAs
  • MAOIs
  • SSRIs
  • Trazodone
  • Bupropion
  • SNRIs
  • all are pretty effective.

ECT/TMS

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8
Q

What is electroconvulsive therapy (ECT) used for?

What mild side-effect can occur as a result of the treatment?

What ALWAYS happens during administration?

It is considered to be…

A

Treatment resistant depression.

May cause a short-term memory loss (long-term less common).

Induction of a seizure.

Safe and effective - no absolute contraindications and has a 75-80% response to treatment.

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9
Q

What is transcranial magnetic stimulation (TMS)?

A

A newer treatment that was thought at first to be almost as effective as ECT, but is more likely closer to 50% as effective.

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10
Q

What is Ketamine’s MOA?

What does it produce in a patient?

Overdose may lead to…

It is very similar chemically to which other drug?

What does it help with?

A

NMDA antagonist

Produces dissociative anesthesia

Overdose may lead to panic attacks and aggressive behavior; rarely seizures, increased ICP and cardiac arrest

Similar to PCP, but shorter acting and less toxic

Leads to a 50% reduction in suicidal thoughts in 24 hrs

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11
Q

How is Ketamine given?

How frequently?

A

By a psychiatrist for 45-60 min. at a time. There are 4-6 infusions over a 2-3 period of time.

The problem with the drug is that it is highly costly ($400-1000 per infusion).

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12
Q

How must Esketamine (Spravato) be given?

How quickly does it work?

A

Must be given at an approved health center and is given via a nasal spray formulation.

It is rapid acting, but also highly pricey.

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13
Q

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

A

Depressed mood for most of the day (for at least 2 years in duration for adults and 1 year for kids) that has not been severe enough to meet criteria for major depressive episode.

During the 2 years, there cannot be a >2 mo. period the patient is symptom-free.

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14
Q

What is “double depression”?

A

Dysthymic disorder and major depression that occur simultaneously.

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15
Q

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

A

The same as other forms of depression, but tends to be more difficult to treat.

Meds: SSRIs, SNRIs, MAOIs
CBT

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16
Q

What is the “essential feature” of Depression with Seasonal Pattern (SAD)?

What are symptoms of the disorder?

What level of treatment is indicated?

A

The onset and remission of major depressive episodes at characteristic times of the year.

Patients tend to sleep and eat more; increased fatigue.

Only light therapy is indicated.

17
Q

What is Premenstrual Dysphoric Disorder (PMDD)?

What is the treatment?
How should pharmalogical be done (timing, etc.)?

A

Mood instability with anxiety, depression and irritability that occurs the week prior to menses. It has a consistent pattern over the year.

Treatment

  • exercise, diet and relaxation therapy
  • SSRIs: Sertraline, Fluoxetine, Paroxetine
  • treat during cycle or 2 wks. prior to menses
18
Q

What is the diagnosis of a Manic Episode require?

Overall, it is a…

A

Abnormally and persistently elevated, expansive or irritable mood lasting at least 1 week, with at least 3 other features (inflated self-esteem, decreased need for sleep, more talkative, racing thoughts, distractibility, more goal-oriented, excessive involvement in pleasurable activities) - “DIGFAST”.

It is a mood disturbance severe enough to cause marked impairment in occupational functioning or in usual social activities/relationships.
-the symptoms are not caused by the direct effects of a substance or a general medical condition.

19
Q

What is a Hypomanic Episode?

A

It is similar to a manic episode, but is less severe. Episodes only need to last 4 days and must not include psychotic features.

There is no social/occupational impairment.

20
Q

What is required for a diagnosis of Bipolar I Disorder?

What is NOT required for a diagnosis, but might be the first symptom?

What is the prognosis?

A

A single manic episode is necessary (only one “pole” needed) AND at least 1 manic or mixed episode.

A major depressive episode is not required for diagnosis, but typically presents first.
Can be a psychotic episode - delusions and/or hallucinations.

Prognosis is worse than major depressive disorder.

21
Q

What is required for diagnosis of Bipolar II Disorder?

A

Patients have had at least one major depressive episode and one hypomanic episode in the absence of any manic or mixed episodes.

22
Q

Which is more prevalent: BID or BIID?

A

BIID

23
Q

What is the first-line treatment for Bipolar Disorders?

A

Mood stabilizers: Li+ or Valproic acid

24
Q

What is Cyclothymic disorder?

What is the requirement for diagnosis?

A

It is characterized by Dysthymic Disorder with intermittent hypomanic periods.

Patients who, over past 2 years (1 year for kids), experience repeated episodes of hypomania and depression (not severe enough to be major depressive disorder).

25
Q

What are the 2 areas of therapy for Cyclothymic disorder?

What can cause significant manic symptoms in these patients?

A

Mood-stabilizing drugs
Supportive psychotherapy

Antidepressants frequently cause mania.

26
Q

Substance-related disorders can have symptoms of which other 2 disorders?

It is due to…

A

Bipolar and major depressive disorders

Either due to substance-induced or withdrawal

27
Q

Generalized anxiety is characterized by… (3)

A

Worriness about acual circumstances, events or conflicts.

Often accompanies panic anxiety.

Symptoms of generalized anxiety fluctuate more than those of panic anxiety.

28
Q

Diagnosis of Panic Disorder requires…

A
  1. Recurrent unexpected panic attacks.
  2. At least one attack followed by 1 month or more of one or more:
    - persistent worry about additional attacks.
    - worry about implications of an attack.
    - significant change in behavior related to the attacks.
29
Q

What characterizes a Panic Attack?

A

A discrete period of intense fear or discomfort, which 4 symptoms (palpitations, sweating, CP, SOB, etc.) develop abruptly and reach a peak within 10 min. and last <25 min.

30
Q

Who is most likely to have a Panic Disorder?

What is the average age?

There is a strong…

A

Women are 2-3x more likely than men.

25 y/o

Strong genetic component (50% have affected parents)

31
Q

What is Agoraphobia?

What is it associated with?

A

Anxiety about being in situations from which escape might be difficult or in which help is not available (ex: won’t leave home due to fear of a panic attack).

Panic disorder

32
Q

What allows for the diagnosis of Social Phobia (Social Anxiety Disorder)?

A

The fear, anxiety or avoidance is persistent, typically lasting >6 mo. The patient understands their fear is unreasonable.

33
Q

What is needed for a diagnosis of Generalized Anxiety Disorder?

A

Excessive anxiety and worry occurring more days than not for at least 6 mo. for most of the day.

It is difficult to control the worry.

The anxiety and worry are associated with at least 3 symptoms for more days than not for of the past 6 mo. (restlessness, fatigue, trouble concentration, irritability, muscle tension, sleep problems).

34
Q

Do OCD patients understand their disease?

What is most difficult about OCD?

A

Yes, they know it is unreasonable.

Obsessions and compulsions cause marked distress, are time consuming (>1 hr./day) and interfere with daily life.

35
Q

What is the difference between OCPD and OCD?

A

OCPD - patient does not perceive they have a problem.

OCD - patient knows they have a problem.

36
Q

Iatrophobia =

Acrophobia =

A

Iatrophobia = fear of doctors

Acrophobia = fear of heights

37
Q

The risk of further episodes of major depressive disorder increases with…

The treatment that was successful for prior episodes.

A

The number of prior episodes

Has a greater chance of being useful in future episodes

Neuromusculoskeletal & Psychiatry I Exam #1 (20 decks)

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