Depressive Disorders and Bipolar Related Disorders Flashcards
what do you think when you see a 27 yo m who presents with pressured speech who is squandering savings, destroying relationships, and neglecting work activities
bipolar 1
definition of bipolar I
a manic episode with OR without major depressive episodes
according to DSM5, in order for the diagnosis of mania, what characteristics must be met (2)
affects occupation or relationships with others
OR
requires hospitalization
1st line med for bipolar 1
lithium
tx options for acute mania (4)
lithium - 1st line
valproate
SGA’s
carbamazepine
name 2 SGA’s
olanzapine
aripiprazole
tx for mania maintenance (3)
SGA’s
gabapentin
lamotrigine
tx for mania w. agitation
add antipsychotics (haldol vs risperidone) OR
benzos
t/f: family/group/CBT is effective for bipolar I
t!
what do you think when you see a pt who presents w. bouts of sadness and distractibility plus an episode of decreased need for sleep with a flight of ideas and buying sprees
bipolar II
definition of bipolar II
at least one hypomanic episode
AND
at least one major depressive episode
PLUS
the absenve of manic episodes
definition of hypomania
not severe enough to cause marked impairment in social or occupational functioning or to necessitate hospitalization
1st line tx for bipolar II
lithium
tx for bipolar II depressive episodes (3)
SSRIs
quetiapine
olanzapine + fluoxetine
t/f: CBT/fam/group therapy is effective for bipolar II
t!
what do you think when you see a patient who presents w. episodes of depression alternating with times of increased energy, restlessness, and decreased sleep x 2 years
cyclothymic disorder
less intense, but often longer-lasting version of bipolar disorder
in order for dx of cyclothymic disorder, symptoms must be present for at least
2 years
what is dysthymia
persistent mild dpn
a person with dysthymia never experiences _ (2)
mania
major dpn
4 types of depressive disorders
major depressive
persistent depressive
premenstrual dysphoric
suicidal/homicidal behaviors
mood disorder in which a person experiences (in the absence of drugs or medical condition), two or more weeks of significantly depressed moods, feelings of worthlessness, and diminished interest or pleasure in most activities
major depressive disorder
mood disorder involving persistently depressed mood w. low self-esteem, withdrawal, pessimism, or despair - present for at least 2 years
persistent depressive disorder
for dx, persistent depressive disorder must be present for at least _ with no absenve of symptoms for more than _
2 years
2 months
disorder makred by repeated episodes of significant dpn and related symptoms during the week before menstruation
premenstrual dysphoric disorder
mood disturbances, somatic complaints, feelings of hopelessness, worthlessness, or helplessness
suicidal/homicidal behaviors
what do you think when you see a pt who c.o fatigue and decreased interest in the things that used to make her happy - is forcing herself to eat, spending less time w. kids, and feels guilty about lack of energy/enthusiasm
major depressive disorder
what is SIGECAPS
sadness
interest/anhedonia
guilt
energy
concentration
appetite
psychomotor activity
suicidal
dsm 5 for mdd
5 or more SIGECAPS for 2 weeks or more nearly every day
at least 1 of sx is depressed mood OR anhedonia
what is anhedonia
inability to feel pleasure
first line tx for mdd
SSRIs
how do you titrate SSRIs
continue to increase dose q 3-4 weeks until sx are in remission
how long do SSRI’s take to be effective
4-6 weeks
how long until you see sx improvement w. SSRIs
2-4 weeks
what do you think when you see a pt who feels down most of the time x 3 years - experiences intrusive thoughts of inadequacy despite success - tries to overcompensate by taking on more than he can handle, which leads to failure and worse feelings of inadequacy
persistent depressive disorder
dsm 5 for persistent depressive disorder (3)
-chronic dpn > 2 years
-pt has never been w.o depressive sx for > 2 mnonths at a time
-there has never been a manic or hypomanic episode
tx for persistent depressive disorder (3)
SSRI’s
psychotherapy
PA
s.e of lithium (7)
tremor
sedation
acne
heart block
hypothyroidism
diabetes insipidus
leukocytosis
3 contraindications for lithium
renal failure
hyponatremia
dehydration
increase risk for toxicity
4 conditions frequently associated w. bipolar disorder
SAD
ADD/ADHD
anxiety disorders
other mood disorders
t/f: dpn in the setting of other comorbid conditions leads to increased mortality
t!
hypomania w. more dpn
bipolar II
more manic w. some dpn
bipolar I
class of medication you never give to bipolar I
antidepressants
-dpn with a change from previous functioning
-difficult to perform ADLs
mdd
what condition manifests as a chronically depressed mood for more than 2 years
persistent depressive d.o
