Depressive disorders, Anxiety disorders, and Bipolar and related Disorders (Hill)

Question 1

Genetics of Major depressive disorder? Bipolar disorder?

Answer 1

25% pts with Major Depressive disorder have 1st degree relative w/mood disorder

50% pts w/Bipolar disorder have 1st degree relative w/mood disorder

Basically, just know there is heritability of these

Question 2

How long do you have to show depressed mood or loss of interest or pleasure to Dx Major Depressive Episode (in addition to laundry list criteria)?

Answer 2

2 week period

Question 3

In Major Depressive Episode, what happens to social/occupational/functioning?

Answer 3

symptoms cause clinically significant distress or impairment in social/occupational/functioning

Question 4

How long should a pt with Manic Episode have symptoms to be Dx with it?

Answer 4

Abnormally and persistently elevated, expansive, or irritable mood lasting AT LEAST 1 WEEK w/at least 3 of the following:

• Inflated self-esteem or grandiosity
• decreased need for sleep
• more talkative (pressured/push of speech)
• flight of ideas/ racing thoughts
• distractibility
• increased goal-oriented behavior
• excessive involvement in pleasurable activities

Question 5

Hypomanic episodes are similar to manic episode but is less severe. Episodes only need to last __ days and must not include psychotic features. No social/occupational impairment

Answer 5

4

Question 6

Major depressive disorder requires the presence of 1 or more major depressive episodes and the absence of __

Answer 6

any manic, hypomanic, or mixed episodes

Question 7

SE associated with Trazodone?

Answer 7

Boner for hours w/o stimulation (Priapism)

Question 8

SE w/ Mirtazapine?

Answer 8

weight gain

Question 9

ECT is used in major depressive order when?

Answer 9

Tx-resistant depression

75-80% tx response, No absolute contraindications

Question 10

__=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 without symptoms for >2 months at a time

Answer 10

Persistent depressive disorder (Dysthymia)

Pts must never have met criteria for manic episode, mixed episode, or hypomanic episode

Question 11

Tx for Dysthymic disorder (Persistent depressive disorder)?

Answer 11

Can be more difficult to tx

-Pharm: SSRIs, SNRIs, MAOIs, Cognitive therapy, behavior therapy

Question 12

Name the disorder:

• Mood instability with anxiety, depression, irritability
• Occur the week before menses
• Consistent pattern over the year

Answer 12

Premenstrual Dysphoric Disorder (PMDD)

Question 13

Name the disorder:

• Single Manic episode is necessary to Dx
• AT LEAST 1 MANIC OR MIXED EPISODE
• +/- Major depression but not required for Dx (but is usually symptom that presents first)
• Can be psychotic episode (delusions and/or hallucinations)
• Worse prognosis than MDD

Answer 13

Bipolar I

Question 14

Name the disorder:

-Pts have had AT LEAST 1 MAJOR DEPRESSIVE EPISODE and 1 HYPOMANIC episode in the absence of any manic or mixed episodes

Answer 14

Bipolar II

Question 15

Which Bipolar more prevalent?

Answer 15

Bipolar II

Question 16

1st line tx of choice for Bipolar?

Answer 16

Mood stabilizers –> Lithium, Valproic acid

Question 17

Name the disorder:

• Dysthymic disorder with intermittent hypomanic periods
• Pt 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)
• During 1st 2 years, may not have major depressive, manic, or mixed episode

Answer 17

Cyclothymic disorder

Question 18

Tx for cyclothymic disorder?

Answer 18

Mood-stabilizers
Antidepressants frequently precipitate manic symptoms
Supportive psychotherapy

Question 19

This disorder characterized by:

• Excessive anxiety and worry (apprehensive expectation) OCCURING MORE DAYS THAN NOT for at least 6 MONTHS, FOR MOST OF DAY, about a number of events or activities
• Difficult to control worry

Answer 19

Generalized anxiety disorder

Question 20

If you have both of these, you have this Dx:

(1) Recurrent unexpected panic attacks
(2) At least 1 ATTACK FOLLOWED BY 1 MONTH or more of 1 or more: persistent concern about add’l attacks, Worry about implications of attack or its consequences, significant change in behavior related to attacks

Answer 20

Panic disorder

Question 21

When do you reach peak in panic attack? how long do they usually last?

Answer 21

Reach PEAK WITHIN 10 MINS

Usually last <25 mins

Question 22

Anxiety of being away from home, sitting in the middle of row of theater seats, being in an elevator, traveling in a plane, etc is known as __

Answer 22

Agoraphobia

Associated with Panic Disorder

Question 23

__=Ego-syntonic (they don’t perceive they have a problem)

__=Ego-dystonic (they know their compulsions & obsessions are not reasonable)

Answer 23

OCPD –> Obsessive-Compulsive Personality disorder

OCD –> Obsessive Compulsive Disorder

Question 24

Tx for PTSD?

Answer 24

SSRIs

Cognitive Processing therapy

Question 25

PTSD have increased risk of what?

Answer 25

substance abuse –> Avoid addictive Rx such as Benzos

Question 26

Charlie Sheen is good at __

Answer 26

winning