Depressive/Anxiety Disorders and Bipolar with related disorders Flashcards
If a patient comes in with loss of interest in things they used to enjoy (anhedonia) what should you think first?
Depression
How do dopamine levels differ in mania vs. depression
Dopamine decreases in depression and increases in mania
How are serotonin levels in depression? what drugs are effective anti-depressants that help with this?
Decreased, SSRIs
What was the main example he gave as a life event that can precede the first mood episode?
- death of a family member (think caregiver- could be a parent, grandparent) before age 11
- the death of a child may also be the case
How do you classify Major Depressive Episode?
At least five of the following for a 2-week period with at least one either (1) depressed mood or (2) Loss of interest (anhedonia)
- depressed mood
- diminished interest
- weight loss or gain
- insomnia or hypersomnia
- psychomotor agitation or retardation
- fatigue or loss of energy
- fellings of worthlessness
- diminished thinking/concentration
- recurrent thought of death or suicide
How do we classify Major Depressive Disorder?
Diagnosis requires the presence of one or more major depressive episodes and the absence of any manic, hypomanic, or mixed episodes
- Associated features
psychotic, anxious, melancholic, Catatonic (shock them), peripartum onset, mixed features
What are somatic therapies used for Major Depressive Disorders?
TCAs - Hill used nortriptyline
MAOIs
SSRIs
Triazolopyridines - trazadone (priapism)
buproprion (seizure risk)
SNRIs
Mirtazapine
What is ECT and what is it used for?
Electroconvulsive therapy - used for resistant depression and has great efficacy
75-80% treatment response
(Exam) - how do we classify Persistent Depressive Disorder
- Depressed mood for most of the day (at least 2 years in duration for adults and 1 year for children) that has not been severe enough to meet criteria for major depressive episode
- During 2 years, cannot be w/o sx for 2>months at a time should be continuous
What is depression with seasonal pattern? what are some of its characteristics?
Essential feature is the onset and remission of major depressive episodes at charcteristic times of the year (fall/winter)
What is premenstrual dysphoric disorder (PMDD)?
- Mood instability with anxiety, depression, irritability and will occur the week before menstruation.
- Tx: SSRIs, exercise, diet, relaxation therapy
How do we classify a manic episode?
Abnormally and persistently elevated, expansive, or irritable mood lasting at least 1 week with at least three of the following:
During the mood disturbance and increased energy, three of the following:
- inflated self esteem (grandiosity)
- Decreased need for sleep
- more talkative (pressured/push of speech)
- flight of ideas and racing thoughts
- distractibility
- increased Goal-oriented behavior
- excessive involvement in pleasurable activities
What is a hypomanic episode?
- Similar to manic episode but is less severe, episode only need to last 4 days and must not include psychotic features
- unlike manic episode there is no social/occupational impairment
What is Bipolar 1 Disorder?
- Single manic episode is necessary to diagnose. (patient only needs on “pole” of the bipolar for this diagnosis)
How does Bipolar 1 Disorder usually present first?
Major depressive episode, note: that you do not have to have depression for diagnosis
How do we classify/diagnose Bipolar 2 disorder?
Patients have had at least one major depressive episode and one hypomanic episode in the absence of any manic or mixed episodes
Note: this is more prevalent than Bipolar 1
What is the treatment for Bipolar Disorders?
Mood stabilizers
- lithium
- Valproic acid
Carbamazepine
SGAs
Lamotrigine - Side effect SJS-TEN rash up the neck and is life threatening
What is Cyclothymic Disorder?
- characterized as dysthymic disorder with intermittent hypomanic periods.
- Patient who, over the last 2 years (1 year for children), experiences repeated episodes of hypomania and depression (not severe enough to meet criteria for major depressive disorder)
How do we classify Panic Disorder?
1 - Reccurent unexpected panic attacks
2 - At least one attack followed by 1 month or more of one or more:
- persisten concern about additional attacks
- worry about the implications of the attack or its consequences
- significant change in behavior related to the attacks
How do we classify panic attacks?
A discrete period of intense fear or discomfort, in which four or more of the following developed abruptly and reached peak within 10 minutes and usually last <25 minutes: now specific as “unexpected and expected” panic attacks.
- palpitations, sweating, trembling, SOB, chest pain, dizzy, fear of losing control or going crazy/death, paresthesias, chills or hot flashes
What is the average of onset for panic disorder and which gender is more affected?
2-3x more prevelant in females, average age of onset is 25
What is Generalized Anxiety Disorder?
- Excessive worry and anxiety (apprehensive expectation), occuring more days than not or at least 6 months, for most of day, about a number of events or activities
- It is difficult control the worry
- The anxiety and worry are associated with at least three persisting for more days than not of the past 6 months:
- restlessness or on edge
- easily fatigued
- difficulty concentrating
- irritability
- muscle tension
- sleep disturbances
How do we classify obsessions?
- recurrent or persistent thought, impulses, or images experienced as intrusive and inappropriate and causing marked anxiety or distress
- person attempts to ignore or suppress thoughts
How do we classify compulsions?
What is the goal of the compulsions?
- repetitive behaviors or mental acts that the person feels drive to perform.
- Aimed at preventing or reducing distress or preventing some dreaded event/situation
How do obsessions and compulsions effect patients life?
marked distress consuming > 1hour per day and interferes with functioning.
Depression Mnemonic - SIG E CAPS what does it stand for?
S - sleep-lack of
I - Interest lack of (anhedonia)
G - Guilt
E - Energy lack of
C - concentration lack of
A - appetite changes
P - psychomotor (catatonic)
S - Suicidal ideation
Mnemonic for Manic - DIG FAST
D - Distractibility
I - inflated self-esteem, impulsive
G - grandiosity
F - Flight of ideas
A - Activity (increased) / agitation
S - Speech - pressured or pushed
T - Thoughtlessness
Dysthymic Mnemonic - CHASES
C - Concentration - poor
H - Hopelessness
A - Appetite - poor
S - sleep (insomnia)
E - energy low
S - self esteem low
