Depressive Disorders and Bipolar Related Disorders

Question 1

What are the characteristics of Bipolar 1 disorder?

Answer 1

Patient who is squandering savings, destroying relationships, neglecting work activities etc.
-a manic episode with or without depressive episodes

Question 2

How does DSM describe mania?

Answer 2

a mood disturbance sufficiently severe to cause marked impairment in occupational functioning or in usual social activities or relationships with others or to necessitate hospitalization to prevent harm to self or others, or there are psychotic features

Question 3

What is the tx of bipolar I disorder?

Answer 3

lithium is considered first-line mediation for bipolar disorder and has been more widely studied than any other maintenance treatment for bipolar disorder and is consistently supported across multiple randomized trials

• acute marina - lithium, valproate, SGAs (olanzapine, aripiprazole), carbamazepine
• mania maintenance - SGAs, gabapentin, lamotrigine (lacictal)
• if agitation - add antipsychotics (haloperidol, risperidone) or benzodiazepines
• family/group/cognitive therapy

Question 4

What are the characteristics of bipolar II disorder?

Answer 4

a patient with bouts of sadness and distractibility and an episode of decreased need for sleep, a flight of ideas, and buying sprees

• at least one hypomanic episode and at least one major depressive disorder
• there has never been a manic episode

Question 5

How does DSM describe hypomania?

Answer 5

a mood disturbance is not severe enough to cause marked impairment in social or occupational functioning, or to necessitate hospitalization, and there are no psychotic features

Question 6

What is the tx of bipolar II disorder?

Answer 6

lithium is considered a first-line medication for bipolar disorder and has been more widely studied than any other maintenance treatment for bipolar disorder and is consistently supported across multiple randomized trials

• depressive episodes - SSRIs, quetiapine or olanzapine + fluoxetine
• MAOIs, TCAs - least likely used
• family/group/cognitive therapy

Question 7

What is a cyclothymic disorder?

Answer 7

alternative hypomanic episodes with a long-standing low mood state (dysthymia)

• a chronic mood disorder characterized by episodes of depression and hypomania for at least 2 years
• this is less intense but often longer-lasting version of bipolar disorder
• a person with cyclothymia has both high and low mood, but never as severe as either mania or major depression

Question 8

What are the signs and symptoms of major depressive disorder?

Answer 8

Five or more SIEGECAPS for > 2 weeks nearly every day and at least one of the symptoms is depressed mood or anhedonia 
SIGECAPS
-sadness
-interest/anhedonia 
-guilt
-energy
-concentration 
-appetite 
-psychomotor activity 
-suicidal

Question 9

What is the tx of major depressive disorder?

Answer 9

SSRIs are the first-line treatment - although both TCA and MAOI classes of antidepressants are often helpful in depression, the SSRI class is associated with less morbidity, and drugs in this class are generally considered first-line treatment

• continue to increase dosage q 3-4 weeks until symptoms in remission
• the full medication effect is complete in 4-6 weeks, augmentation with 2nd medication may be necessary
• see within 2-4 weeks of starting medication and q2wk until improvement, then monthly to monitor medication changes

Question 10

What is persistent depressive disorder?

Answer 10

a patient with chronic depression for two years or more

• chronic depressions - depressive symptoms for > 2 years
• the individual has never been without the depressive symptoms in for more than 2 months at a time
• there has never been a manic episode or a hypomanic episode

Question 11

What is the tx for persistent depressive disorder?

Answer 11

• SSRIs and other antidepressants
• psychotherapy
• physical exercise