Depressive Disorders, Bipolar and Related Disorders Flashcards
What is a manic episode?
- 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
What is a hypomanic episode?
- 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
What is a mixed episode?
≥ 3 manic/hypomanic symptoms + depression
What is DIGFAST and what does it stand for?
Symptoms of mania/hypomania
* Distractibility
* Impulsivity
* Grandiosity
* Flight of ideas
* Activity/agitation
* Sleep (↓ need)
* Talkativeness
What is the strongest RF for bipolar disorders?
Family history
What is biolar I?
1+ manic episode +/- MDD
What is bipolar II?
1+ major depressive episode PLUS 1+ hypomanic episode
What is cyclothymic bipolar disorder?
hypomanic sxs + periods of depression for ≥ 2 yrs (≥ 1 yr in children)
What is the first line treatment for bipolar disorders?
Lithium
* Valproic acid or Carbamazepine for rapid cycling (≥ 4 mood episodes w/in 12 months) or mixed features
What is 2nd line treatment for bipolar disorders?
2nd generation (atypical) antipsychotics
* Risperidone, Quetiapine, Olanzapine, Ziprasidone
* Effective as monotherapy or w/ mood stabilizer (most effective)
What medications can be used for bipolar depression?
Lurasidone, Cariprazine, Quetiapine, Olanzapine-Fluoxetine
What are side effects of lithium?
- GI upset
- Tremors
- Polyuria
- Weight gain
- Leukocytosis
- Hyper: PTH, Ca, Mg
- Hypothyroidism
- Diabeties incipidus
What is the BBW for lithium?
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
What is SIGECAPS?
Sxs of depression
* Sleep
* Interest
* Guilt
* Energy
* Concentration
* Appetite
* Psychomotor agitation/retardation
* Suicide
What is the diagnostic criteria for MDD?
≥ 5 sxs for ≥ 2 wks (must include depressive mood or anhedonia)
* Cause significant functional distress or impairment
How is MDD treated?
CBT + SSRIs
What is the diagnostic criteria for persistent depressive disorder?
chronic depressive mood for ≥ 2 yrs PLUS ≥ 2 sxs (≥ 1 yr in children)
* Has not been symptom-free for > 2 months
How is persistent depressive disorder treated?
CBT + SSRI
What is the diagnostic criteria for premenstural dysphoric disorder?
≥ 5 sxs during luteal phase for ≥ 1 year a/w significant distress & interfere w/ usual activities
How is PMDD treated?
exercise + diet modification
* Depression/anger/anxiety: SSRIs (Fluoxetine, sertraline)
* Severe or unable to take SSRIs: OCPs w/ drospierenone
* Bloating/fluid retention/breast tenderness: spironolactone
What is the diagnostic criteria for disruptive mood dysregulation disorder?
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
How is disruptive mood dysregulation disorder treated?
psychotherapy (parent management training) +/- medications for sxs/comorbid conditions
What are symptoms of persistent complex bereavement disorder?
- 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
What is the diagnostic criteria for persistent complex bereavement disorder?
≥ 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)
How is persistent complex bereavement disorder treated?
CBT, support groups
What screening tool can be used for postpartum depression?
Edinburgh Postnatal Depression Scale (EPDS) AND consider hypothyroidism!!
What is the diagnostic criteria for postpartum depression?
≥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)
How is postpartum depression treated?
Psychotherapy + SSRI/SNRIs
* No Paroxetine in 1st trimester → risk congenital heart defect!
What SSRI is most likely to cause discontinuation syndrome?
Paroxetine
What SSRI is least likely to cause discontuination syndrome?
Fluoxetine
What are symptoms of discontinuation syndrome?
dizziness, paresthesias, dysphoric mood, agitation, flu-like sxs w/in 24-48 hrs of discontinuation
How is discontinuation syndrome treated?
resume medication at prescribed dose & taper over weeks-months
* OR substitute the SSRI w/ 1-2 doses of fluoxetine
What is serotonin syndrome?
Can occur with overdose or combination of ≥ 2 serotonergic agents
* SSRIs, SNRIs, TCAs, MAOi, bupropion, St. Johns wort
What are symptoms of serotonin syndrome?
TRIAD → autonomic dysfxn + neuromuscular dysfxn + mental status changes
* Hyperthermia & labile BP + clonus & hyperreflexia + agitation & delirium
How is serotonin syndrome treated?
stop offending agent, IVF, BZDs (Lorazepam)
* If sxs fail to improve: cyproheptadine
