depressive disorders and bipolar related disorders

Question 1

a 27-year-old man accompanied by his girlfriend. In the office, he seems to be running from topic to topic without a clear message. His speech is pressured. The patient’s girlfriend reports that he took steroids recently for a bad sinus infection and since he started them, his behavior has been abnormal. After discontinuing the medication, he has still been having symptoms. He has not had a normal night of sleep for the past ten days, and he just bought a new sports car though he has no need for one or the money to afford it. She also reports that she has caught him with multiple other women in the past few days, though they were in a committed relationship. The physical exam is benign and the patient’s vital signs are within normal limits.

This is the presentation of someone with what kind of psychiatric disorder?

Answer 1

Bipolar 1 disorder

Question 2

A patient who is squandering savings, destroys relationships, neglecting work activities etc. is thought to have what kind of psychiatric disorder?

Answer 2

Bipolar 1 disorder

Question 3

How does the DSM describe Mania?

Answer 3

a mood disturbance sufficiently severe to cause marked impairment in occupational functioning or in usual social activities or relationships with others to necessitate hospitalization

Question 4

What is the first line tx for bipolar disorder?

Answer 4

Lithium

Question 5

What are some tx options for acute mania?

Answer 5

Lithium, valproate, SGAs (olanzapine, aripiprazole), carbamazepine

Question 6

What are some tx options for mania maintenance?

Answer 6

SGAs, Gabapentin, lamotrigine (Lamictal)

Question 7

If someone has agitation along with bipolar disorder what medications can you add along with lithium?

Answer 7

Antipsychotics (haloperidol, risperidone), or benzos

Question 8

Of course what other options are there (non-pharmacological) to treat bipolar disorder?

Answer 8

family/group/cognitive therapy

Question 9

A patient with bouts of sadness and distractibility and an episode of decreased need for sleep, a flight of ideas, and buying sprees. This describes a patient with what type of psychiatric disorder?

Answer 9

bipolar II disorder

Question 10

Big difference between bipolar I and II is that bipolar I has a ________ episode

Answer 10

maniac, bipolar II does NOT have a maniac episode

Question 11

What is the first line treatment for bipolar II disorder?

Answer 11

Lithium is considered first line tx

Question 12

if someone is experiencing depressive episodes you can add on what medications?

Answer 12

SSRI’s
Quetiapine
Olanzapine
Fluoxetine

Than of course Family/group/cognitive therapy

Question 13

a 24-year-old male with c/o episodes of depression alternating with times of increased energy, restlessness, and decreased sleep for 2 years.

What disorder does this pt have?

Answer 13

Cyclothymic disorder

Question 14

Alternating hypomanic episodes with a long-standing low mood state. Describes what?

Answer 14

Cyclothymic disorder

Question 15

How long does someone need to have episodes of depression and hypomania to have cyclothymic disorder?

Answer 15

2 years

Question 16

define major depressive disorder (basically just time frame)

Answer 16

A mood disorder in which a person experiences, in the absence of drugs or a medical condition, two or more weeks of significantly depressed moods, feelings of worthlessness, and diminished interest or pleasure in most activities.

Question 17

define persisten depressive disorder aka dysthymia

Answer 17

Mood disorder involving persistently depressed mood, with low self-esteem, withdrawal, pessimism, or despair, present for at least 2 years, with no absence of symptoms for more than 2 months.

Question 18

define premenstrual dysphoric disorder

Answer 18

A disorder marked by repeated episodes of significant depression and related symptoms during the week before menstruation

Question 19

What does sigecaps stand for?

Answer 19

Sadness 
Intrest 
Guilt 
energy 
concentration 
appetite 
psychomotor activity 
suicidal

Question 20

diagnostic criteria for major depressive disorder?

Answer 20

five or more sigecaps for greater than 2 weeks nearly everyday and one of the sigecaps is depressed mood or anhedonia

Question 21

what class of antidepressants are first line for major depressive disorder?

Answer 21

SSRI’s

Question 22

how often should you increase the dose of an SSRI?

Answer 22

every three or four weeks until symptoms in remission

Question 23

How often should you have a patient reutrn after staring an SSRI

Answer 23

About one month later, than every 2 weeks until symptoms improve then every month to monitor medication changes