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Psychiatry Exam 1 > Depressive/Bipolar Disorders > Flashcards

Depressive/Bipolar Disorders Flashcards

1
Q

MDD Diagnostic Criteria

A

5+ for more than 2 wks
- One must be depressed mood or anhedonia
Others (4+):
- Significant weight change
- Sleeping change nearly every night
- Psychomotor changes
- Fatigue
- Feelings of worthlessness/excessive built
- Diminished concentration, ability to make decisions
- Recurrent thoughts of death, suicide, or suicide attempt
(Present every day w/ weight and sleeping exceptions)

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2
Q

SIGECAPS

A

Depression mnemonic for 4+ symptoms/anhedonia:

Sleep disturbance
Interest
Guilt
Energy
Concentration
Appetite
Psychomotor
Suicide
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3
Q

MDD

A

One or more MDEs

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4
Q

MDD Delusions

A

“I am worthless” “I will be dying shortly”

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5
Q

MDD Perceptual Distubances

A

“You are worthless” “You should kill yourself”

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6
Q

Assc. Features of MDD

A

Somatic complaints, irritability, decreased libido, negative ruminations, hoplessness/helplessness, tend to smoke, less physically active, obesity

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7
Q

Sleep problems in depression

A

Prolonged/increased sleep latency, decreased REM latency, decreased nREM

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8
Q

PFC MDD Correlates

A

Concentration, interest , pleasure, psychomotor fatigue (mental), guilt, suicidality, worthlessness, mood

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9
Q

Amygdala MDD Correlates

A

Guilt, suicidality, worthlessness, mood

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10
Q

Hypothalamus MDD Correlates

A

Sleep, appetite

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11
Q

NA MDD Correlates

A

Pleasure, interests, fatigue/energy

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12
Q

Striatum MDD Correlates

A

Psychomotor fatigue (physical)

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13
Q

Cerebellum MDD Correlates

A

Psychomotor

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14
Q

Spinal cord MDD Correlates

A

Fatigue (physical)

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15
Q

MDD PET Scan

A

Hypoactivity of cortex compared to nondepressed

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16
Q

MDD Risk Factors for BPAD I

A

Onset of illness in adolescence, psychotic features, family history of BPAD

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17
Q

MDD factors assc w/ worse prognosis

A

Younger pt, personality disorders, symptom severity, psychotic features, prominent anxiety, current episode duration, multiple episodes

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18
Q

Remission

A

Return to pts baseline level of symptom severity and fxn (HAMD-17 <7)

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19
Q

Time between MDE to be considered separate?

A

2 months

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20
Q

Stages of tx for MDD

A

Acute, continuation, maintenance

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21
Q

Acute stage of tx of MDD

A

Time from diagnosis –> initial reductino of symptoms – response defined as >50% reduction in symptom severity; meet 2x q/mo; medication tx typically for 6-8wks

22
Q

Indications for MDD Hospitalization

A

Suicide/homicide risk, inability to care for self, rapidly progressive symptoms, lack of social supports, need for diagnostic procedures

23
Q

Continuation phase of MDD tx

A

After remission has been achieved, 6mo-1yr of pharmacotherapy (see pt q2wks or qmo); goal to prevent relapse and consolidate response –> remission

24
Q

Maintenance phase of MDD tx

A

Primary goal to prevent relapse (reactivation of index episode)/recurrence (new episode of illness); meet qmo or q3mo

25
Q

PDD Mnemonic

A

HCASES (Depressed mood and 2+ for most days x2yrs):

Hopelessness
Concentration
Appetite
Sleep
Energy
Self esteem
26
Q

PMDD Diagnostic Criteria

A

In week prior to most menstrual cycles over last yr (at least 2 cycles), 5+ of:
1+ MUST be present:
- Affective lability
-Irritability/anger/increased IP conflicts
- Depressed mood, hopelessness, self-deprecating thoughts
-Anxiety, tension
Other:
- Anhedonia, fatigue, inability to concentrate
- Change in appetite or sleep
- Overwhelmed/feel out of contorl
- Physical symptoms (breast tenderness/swelling, joint/muscle pain, sensation of “bloating” or wt gain)

27
Q

Tx of PMDD

A

Lifestyle: exercise, nutrition (less Na and caffeine); supplements: B6, E, Ca2+, Mg2+; pharmacotherapy: SSRIs

28
Q

Manic episode diagnostic criteria

A

At least 1 wk of distinct period of abnormally/persistently elevated, expansive, or irritable mood AND persistently increased goal-directed activity or energy, and 3+ of:
DIGFAST

Distractability
Indiscretion
Grandiosity
Flight of ideas/racing thoughts
Activity increase
Sleep deficit (decreased need)
Talkativeness (pressured speech)
29
Q

Hypomanic diagnostic criteria

A

Same as manic but at least 4 days (not 1 wk), assc w/ change in fxn uncharacteristic for pt instead of significant impairment, can NOT have psychotic symptoms

30
Q

BPAD I

A

At least 1 manic episode (can/cannot have MDE)

31
Q

BPAD II

A

At least 1 hypomanic and 1 MDE

32
Q

Triggers for manic episodes

A

Sleep disturbance, or psychosocial trigger

33
Q

Rapid cycling

A

4+ BPAD I episodes in 1 yr

34
Q

Manic episode BPAD I Pharmacotherapy

A

Li, Valproic Acid, antipsychotics (sedation w/ benzo or antipsychotic if severe)

35
Q

Maintenance BPAD I tx

A

Li, Valproic Acid, antipsychotics, carbamazepine, lamotrigine (combo if severe)

36
Q

Tx of BPAD I MDE

A

Li, lamotrigine, atypical antipsychogtics, antidepressants (MUST HAVE ADEQUATE MOOD STABILIZATION OR RISK RAPID CYCLING)

37
Q

Tx of BPAD I Psychosis

A

Antipsychotic

38
Q

Cyclothymia Diagnostic Criteria

A

For 2+ yrs, numerous episodes of hypomania and dysthmia (don’t meet MDE criteria); cannot be w/o symptoms for >2mos; clinically significant distress or impairment in social, occupations, or other fxning

39
Q

Common assc medical illnesses to BPAD and MDD

A

Alzheimers, Huntingtons, Parkinsons, CVA, MS, TBI, thyroid/parathyroid/adrenal dysfxn, hepatitiis, HIV, pancreatic cancer

40
Q

Substances assc w depression

A

Antidepressants, anticonvulsants, anti-migraine, antipsychotics, antivirals, cardiovascular, hormonal (steroids, OCP), interferon, retinoic acid derivatives, smoking cessation

41
Q

Substances assc w mania

A

Antidepressants, amphetamines, L-dopa, steroids

42
Q

Criteria differences for children with MDE or PDD

A

MDE: irritability can replace depression, inability to make weight gains instead of weight loss
PDD: one year instead of 2

43
Q

Criteria differences for children with BPAD and cyclothymia

A

BPAD: NONE
Cyclothymia: one year instead of two

44
Q

Anxious distress specifier (disorders and criteria)

A 
Disorders: MDE, mania, hypomania
Diagnostic criteria -- 2+ for majority of episode:
- Keyed up or tense
- Unusually restless
- Difficulty concentrating due to worry
- Fear that something awful will happen
- Fear of losing control

Assc w increased suicide risk, longer duration illness, and great tx non-response

45
Q

Mixed features specifier (disorders and criteria)

A

Disorders: MDE, mania, hypomania
Criteria: Combo of symptoms of mania/hypomania and MDE simultaneously

Assc w/ MDE increases risk of BPAD I or II

46
Q

Seasonal pattern specifier (disorders and criteria)

A

Disorders: MDD, BPAD I and II
Cirteria:
- Regular assc between onset and time of year OR
- Full remission or change to mania/hypomania at a specific time of year

  • During past 2 yrs, 2+ episodes demonstrate pattern and no-nonseasonal episodes have occurred (seasonal episode outweight non-seasonal in total)
47
Q

Psychotic features specifier (disorders and criteria)

A

Disorders: MDE, mania
Criteria: delusions and hallucinations (usually mood congruent)

48
Q

Catatonic features specifier (Disorders and criteria)

A 
Disorders: MDE, mania
Criteria:
- Immobility: catalepsy or stupor
- Excessive purposeless activity
- Extreme negativism
- Mutism
- Posturing, stereotypies, prominent mannerisms or grimacing
- Echolalia or echopraxia
49
Q

Atypical features specifier (Disorders and criteria)

A 
Disorder: MDE only
Criteria: 
- Mood reactivity
- Significant weight gain/increase in appetitie
- Hypersomnia
- Leaden paralysis
- Long standing rejection sensitivity
50
Q

Melancholic features (Disorders and criteria)

A

Disorder: MDE only
Criteria:
- Loss in pleasure in all/almost all activities
- Lack of mood reactivity
- Distinct quality of depressed mood (worse in AM, early morning awakening, marked psychomotor abnormalities/feels slowed down, significant anorexia/weight loss, excessive guilt)

51
Q

Peripartum onset (Disorders and criteria)

A

Disorders: MDE, manic, hypomanic
Criteria: symptoms during pregnancy or w/in 4 wks of delivery

Psychiatry Exam 1 (9 decks)

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