Depressive Disorders; Bipolar Flashcards
Bipolar I Path: Pt: Dx: Tx:
Path: manic predominant
Pt: mania = “E” (elevated mood) + 3 sxs
duration >/= 1 week
Dx: DIG FASTER distractibility insomnia grandiosity flight of ideas agitation/activities sexual exploits talkative elevated mood racing thoughts R/O: bipolar II, cyclothymia
Tx: ED-> benzos (haldol)-> psychosis or agitation Mood stabilizers: 1st-> lithium 2nd-> valproic acid 3rd-> carbamazepine, lamotrigine 4th-> Quetiapine Others-> ECT, MAOIs, SSRIs, TCAs (antidepressant meds may precipitate mania)
Bipolar II Path: Pt: Dx: Tx:
Path: hypomania AND major depression
Pt: hypomania = mania, but less
Dx: R/O bipolar I (catatonia, psychotic features)
Tx: Similar to Bipolar I
acute mania: mood stabilizers-> lithium, valproate, 2nd generation antipsychotics
depression: lithium, valproate, carbamazepine, 2nd generation antipsychotics
Mixed: atypical antipsychotics, valproate
Cyclothymic Disorder
Path:
Pt:
Tx:
Path: Mild bipolar II
Pt:
Recurrent hypomania cycling w/ relatively mild depressive episodes for at least a 2 year period
Symptom free periods don’t last longer than 2 months
Tx: Similar to bipolar I
- Mood stabilizers
- Neuroleptics
Major depressive disorder
Pt:
Dx:
Tx:
Pt: Depressed mood OR anhedonia (lost of interest)
AND duration >/= 2 weeks
AND 5 SIGECAPS
Dx: SIGECAPS sleep interest guilt energy concentration appetite psychomotor retardation suicide
Tx: \+ suicidal ideations -With a plan-> Hospitalized -No plan or means to carry out the plan -> contract for safety (Sign a paper saying they will not kill themselves and call you if they want to) No suicidal ideations -SSRIs, SNRIs x1-2 months -Psychotherapy -Combo of drugs + psychotherapy BEST tx-> ECT (electroconvulsive therapy) -Refractory -Catania -Psychosis
Persistent depressive disorder (dysthymia)
Dx:
Tx:
Dx: depressed mood within 2 year period but duration less than 2 months at a time
r/o hypothyroidism
Tx: SSRI
