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Psych EOR > Depressive Disorders, Bipolar and Related Disorders > Flashcards

Depressive Disorders, Bipolar and Related Disorders Flashcards

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1
Q

What is a manic episode?

A
  • Abnormally persistently elevated, expansive, or irritable mood AND ↑ activity or energy lasting ≥ 1 week (any duration if hospitalized)
  • ≥ 3 sx (4 if mood is only irritable)
  • significant impairment or requires hospitalization or +psychotic features
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2
Q

What is a hypomanic episode?

A
  • Abnormally persistently elevated, expansive, or irritable mood AND ↑ activity or energy lasting ≥ 4 days
  • ≥ 3 sx (4 if mood is only irritable)
  • No psychotic features
  • No significant impairment or hospitalization
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3
Q

What is a mixed episode?

A

≥ 3 manic/hypomanic symptoms + depression

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4
Q

What is DIGFAST and what does it stand for?

A

Symptoms of mania/hypomania
* Distractibility
* Impulsivity
* Grandiosity
* Flight of ideas
* Activity/agitation
* Sleep (↓ need)
* Talkativeness

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5
Q

What is the strongest RF for bipolar disorders?

A

Family history

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6
Q

What is biolar I?

A

1+ manic episode +/- MDD

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7
Q

What is bipolar II?

A

1+ major depressive episode PLUS 1+ hypomanic episode

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8
Q

What is cyclothymic bipolar disorder?

A

hypomanic sxs + periods of depression for ≥ 2 yrs (≥ 1 yr in children)

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9
Q

What is the first line treatment for bipolar disorders?

A

Lithium
* Valproic acid or Carbamazepine for rapid cycling (≥ 4 mood episodes w/in 12 months) or mixed features

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10
Q

What is 2nd line treatment for bipolar disorders?

A

2nd generation (atypical) antipsychotics
* Risperidone, Quetiapine, Olanzapine, Ziprasidone
* Effective as monotherapy or w/ mood stabilizer (most effective)

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11
Q

What medications can be used for bipolar depression?

A

Lurasidone, Cariprazine, Quetiapine, Olanzapine-Fluoxetine

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12
Q

What are side effects of lithium?

A
  • GI upset
  • Tremors
  • Polyuria
  • Weight gain
  • Leukocytosis
  • Hyper: PTH, Ca, Mg
  • Hypothyroidism
  • Diabeties incipidus
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13
Q

What is the BBW for lithium?

A

toxicity
* Pre-lithium workup: CBC, T4, TSH, BUN, serum creatinine & electrolytes, UA, ECG
* Therapeutic range: 0.8-1.2 mEq/L
* Toxicity > 2 mEq/L
* Monitoring: q4-5 days & after changes in dose → q1-2 months → q6-12 months if stable

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14
Q

What is SIGECAPS?

A

Sxs of depression
* Sleep
* Interest
* Guilt
* Energy
* Concentration
* Appetite
* Psychomotor agitation/retardation
* Suicide

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15
Q

What is the diagnostic criteria for MDD?

A

≥ 5 sxs for ≥ 2 wks (must include depressive mood or anhedonia)
* Cause significant functional distress or impairment

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16
Q

How is MDD treated?

A

CBT + SSRIs

17
Q

What is the diagnostic criteria for persistent depressive disorder?

A

chronic depressive mood for ≥ 2 yrs PLUS ≥ 2 sxs (≥ 1 yr in children)
* Has not been symptom-free for > 2 months

18
Q

How is persistent depressive disorder treated?

A

CBT + SSRI

19
Q

What is the diagnostic criteria for premenstural dysphoric disorder?

A

≥ 5 sxs during luteal phase for ≥ 1 year a/w significant distress & interfere w/ usual activities

20
Q

How is PMDD treated?

A

exercise + diet modification
* Depression/anger/anxiety: SSRIs (Fluoxetine, sertraline)
* Severe or unable to take SSRIs: OCPs w/ drospierenone
* Bloating/fluid retention/breast tenderness: spironolactone

21
Q

What is the diagnostic criteria for disruptive mood dysregulation disorder?

A

recurrent temper outbursts inconsistent w/ developmental level ≥ 3/week for ≥ 12 months in 2 settings and ≥ 6 y/o
* Btwn outbursts, pt has persistently irritable or angry mood
* Has not been without sxs for ≥ 3 months
* Symptom onset before age 10 → cannot be diagnosed before age 6 or after age 18
* Settings: home, school, w/ peers

22
Q

How is disruptive mood dysregulation disorder treated?

A

psychotherapy (parent management training) +/- medications for sxs/comorbid conditions

23
Q

What are symptoms of persistent complex bereavement disorder?

A
  • identity disruption (feeling as if part of oneself has died)
  • sense of disbelief about the death
  • avoidance of reminders of deceased, intense emotional pain (anger, bitterness, sorrow)
  • difficulty reintegrating into relationships/activities
  • emotional numbness
  • feeling that life is meaningless
  • intense loneliness
24
Q

What is the diagnostic criteria for persistent complex bereavement disorder?

A

≥ 1 month of intense yearning/longing or preoccupation w/ thoughts/memories of the deceased after a death ≥ 12 months PLUS ≥3 sxs
* Death ≥12 months ago (≥6mo for children/adolescents)

25
Q

How is persistent complex bereavement disorder treated?

A

CBT, support groups

26
Q

What screening tool can be used for postpartum depression?

A

Edinburgh Postnatal Depression Scale (EPDS) AND consider hypothyroidism!!

27
Q

What is the diagnostic criteria for postpartum depression?

A

≥2 weeks of feeling depressed or hopeless w/in 1 month to 1 year of birth PLUS ≥ 5 sxs (must include depressive mood or anhedonia)

28
Q

How is postpartum depression treated?

A

Psychotherapy + SSRI/SNRIs
* No Paroxetine in 1st trimester → risk congenital heart defect!

29
Q

What SSRI is most likely to cause discontinuation syndrome?

A

Paroxetine

30
Q

What SSRI is least likely to cause discontuination syndrome?

A

Fluoxetine

31
Q

What are symptoms of discontinuation syndrome?

A

dizziness, paresthesias, dysphoric mood, agitation, flu-like sxs w/in 24-48 hrs of discontinuation

32
Q

How is discontinuation syndrome treated?

A

resume medication at prescribed dose & taper over weeks-months
* OR substitute the SSRI w/ 1-2 doses of fluoxetine

33
Q

What is serotonin syndrome?

A

Can occur with overdose or combination of ≥ 2 serotonergic agents
* SSRIs, SNRIs, TCAs, MAOi, bupropion, St. Johns wort

34
Q

What are symptoms of serotonin syndrome?

A

TRIAD → autonomic dysfxn + neuromuscular dysfxn + mental status changes
* Hyperthermia & labile BP + clonus & hyperreflexia + agitation & delirium

35
Q

How is serotonin syndrome treated?

A

stop offending agent, IVF, BZDs (Lorazepam)
* If sxs fail to improve: cyproheptadine

Psych EOR (9 decks)

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