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Behavioral Med 1 > Depression, Bipolar, and other Mood D/o > Flashcards

Depression, Bipolar, and other Mood D/o Flashcards

1
Q 
Median age of onset for 
Depression:
Persistent depressive d/o:
Bipolar I:
Bipolar II:
A

Depression: 32 y/o
Persistent depressive d/o: 31 y/o
Bipolar I: teens to 20’s (mean = 18 y/o)
Bipolar II: mid 20’s

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2
Q

General mood disorders are usually episodic and demarcated by either _______ or______

A

Switching to opposite state (manic to depressive) or 2 months or more of partial/full remission after an episode

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3
Q

Major Depressive D/o (MDD) dx criteria needs ____ out of _____ sx over a _____ week period and one of those sx must be either ________ or ______

A

5/9 sx over a 2 week period

anhedonia or depressed mood (subjective or observed)

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4
Q

Can a dx of MDD be made if the pt has evidence of mania, hypomania or a mixed episode?

A

No

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5
Q

In elderly pts with MDD, they may present with what type of new sx?

A

Elderly will often manifest new somatic complaints

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6
Q

__(fraction)__ of severely depressed pts may have psychotic sx (i.e. voices)

A

1/5

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7
Q

What is a very common complaint in patients with MDD?

A

Insomnia

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8
Q

Name the insomnia type!
______ insomnia: difficulty falling asleep, tossing and turning
______ insomnia: early morning awakening, unable to return to sleep
______ insomnia: awakening in middle of the night, up for a few hrs, back to sleep

A

Initial
Terminal
Middle

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9
Q

Which type of insomnia is associated with severe depression?

A

Terminal insomnia

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10
Q

Do pts with MDD feel worse after waking/later in the day?

Do pts with MDD feel better after waking/later in the day?

A

Often a diurnal variation

pts feel their worst/hopeless upon wakening and gradually feel better throughout the day

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11
Q

What would the lab workup look like for a pt with MDD?

A

CBC, thyroid fxn, LFT, electrolytes, B12, folate, UA, urine drug screen
Additional screening: Neuro consult, CXR, EKG, CT

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12
Q

Does MDD begin suddenly or gradually?

A

Both!

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13
Q

___-___% all pts hospitalized for depression will successfully commit suicide

A

10-15%

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14
Q

Risk factors for committing suicide in pts with MDD?

A

Divorced, living alone, EtOH/substance abuse, >40 y/o, previous suicide attempt, expressing SI

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15
Q

Even w/o tx, most cases of MDD resolve spontaneously in ___ mo

A

6 mo

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16
Q

Tx for Light-moderate MDD –> …
Tx for Mod-severe MDD –> …
Tx for Depression w/ psychotic features –> …. gold standard?

A

Tx for Light-moderate MDD: Psychotherapy, meds depending on pt preference

Mod-severe: Meds w/ or w/o psychotherapy, electroconvulsive therapy (ECT)

Dep w/ psych features: Combo antidepressant + antipsychotic
gold standard→ ECT

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17
Q

What are 1st line pharmacotherapy options for tx of MDD?

A

SSRIs: fluoxetine, citalopram, escitalopram, sertraline, paroxetine
SNRIs: Venlafaxine, duloxetine
TCAs: amitriptyline, nortriptyline, imipramine, desipramine

18
Q

Many pts with MDD who are receiving pharmacotherapy tx, will show improvement in __-__ wks, but continue first med choice for at least __-__ wks before increasing dose or changing to a different antidepressant

A

1-2 wks

4-8 wks

19
Q

What is ECT? Is it approved for tx of MDD?

A

Electroconvulsive therapy; Yes

80-90% remission rate; 50-80% relapse rate (6 mos out
Side Effects: MSK, HA, memory impairment)

20
Q

What are some “other” options for tx of MDD?

A

Light therapy if seasonal component, social therapy, vocational rehab, social skills training

21
Q

Is Persistent Depressive D/o (Dysthymia) more common in men or women?

A

Female > Male (2-3:1)

22
Q

What is the dx criteria for Persistent Depressive D/o (Dysthymia)?

A

Depressed mood for at least 2 yrs, more days than not
Never w/o the sx for >2 mo at one time
x2 of the x6 sx
No Major Depressive Episode (MDE) is present for the first 2 yrs

23
Q

How do you tx Dysthymia?

A

Tx w/ psychotherapy and possibly antidepressants

24
Q

What is a manic episode defined as?

A

Abnormal persistent elevated, expansive or irritable mood lasting at least 1 wk
Any duration of elevated mood if hospitalization is required
At least x3 of the listed sx (x4 if mood is irritable)

25
Q

What is hypomania defined as?

A

Abnormal persistent elevated, expansive/irritable mood lasting at least 4 days (< 7 days)
Similar sx as mania, but all less severe
Overall, similar to mania but milder and briefer
No episodes of delusions or hallucinations

26
Q

Hypomania often occurs w/ classic depression episodes, more so than ______

A

Bipolar I

27
Q

What is the criteria for a dx of Bipolar I?

A

At least 1 manic episode, or mixed episode; usually recurrent depression and mania
(commonly have more Major Depressive Episodes but not required for dx)

28
Q

What is the criteria for a dx of Bipolar II?

A

x1 or + major depressive episodes and at least x1 episode of hypomania
No past Manic or Mixed Episode

29
Q

Are males or females more likely to be dx with Bipolar I or II?

A

Both are equal occurrence in both sexes

30
Q

What is the average age of onset for a dx of Bipolar I? Bipolar II?

A

I: Age of onset teens to 20s (average 18 y/o)
II: Age of onset in mid 20s

31
Q

What is the average age for a pt’s first manic episode in Bipolar I d/o? Bipolar II?

A

32 y/o

32
Q

Does Bipolar I or Bipolar II usually begins as a depressive episode and are dx’d as major depression 1st, then pt has a hypomanic episode

A

Bipolar II

33
Q

If a pt has a manic episode, are they automatically dx’d with Bipolar I or II?

A

Bipolar I

34
Q

What are medication options for tx of an Acute Manic Episode?

A

Lithium, divalproex, olanzapine, risperidone, quetiapine, Quetiapine XR, aripiprazole, ziprasidone
Taper and d/c antidepressants

35
Q

What are medication options for tx of an Acute Major Depressive Episode?

A

Lithium, lamotrigine, quetiapine, quetiapine XR

36
Q

What are medication options for maintenance tx of Bipolar I or II?

A

Lithium, lamotrigine (limited efficacy in preventing mania), divalproex, olanzapine, quetiapine, risperidone LAI, aripiprazole (mainly for preventing mania)

37
Q

Should an antidepressant be used as monotherapy for a pt with an Acute Manic Depressive d/o?

A

No

38
Q

In a pt with Bipolar I, what sx should be treated ASAP?

A

Mania

39
Q

What is considered the mildest form of bipolar d/o?

A

Cyclothymic d/o

40
Q

In a pt with cyclothymin d/o, they will experience mild swings between mild _____ and _____

A

depression and hypomania

41
Q

What are three diagnostic criteria for cyclothymic d/o?

A

Numerous periods of hypomanic and depressive sx for at least 2 yrs
Never w/o sx for > 2 mo
No evidence of psychotic sx

Behavioral Med 1 (8 decks)

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