DEPRESSIVE DISORDERS; BIPOLAR AND RELATED DISORDERS Flashcards
What is the diagnostic criteria for Bipolar 1 disorder
- MUST HAVE 1 or more manic episodes
- Nearly always also have hypomanic and major depressive episodes
What is the diagnostic criteria for Bipolar 2 disorder
- 1 or more hypomanic episodes
- 1 or more major depressive episodes
- No manic episodes
what is the diagnostic criteria for cyclothymia
- Periods of hypomanic symptoms - fall short of criteria for a hypomanic episode
- Periods of depressive symptoms - fall short of criteria for a major depressive episode
- continuous for 2+ years with no more than 2 months symptom free
What is the criteria for a manic episode?
7+ days with 3+ of the following WITH impaired functioning!!
- Inflated self-esteem or grandiosity
- Decreased need for sleep
- More talkative than usual / pressured speech
- Racing thoughts or flight of ideas
- Distractibility
- Increase in goal-directed activity or psychomotor agitation
- Excessive involvement in activities with high potential for bad consequences / “risky” behavior
what is the criteria for hypomanic episode
same as mania except 4+ days and NO functional impairment
what demographics are MC in bipolar disorders (both 1 and 2)
high socioeconomic status!
Men are more likely to have manic types, women are more likely to have depressive types
what are the 8 subtypes of bipolar disorder?
what questionnaire screens for manic episodes
Mood Disorder Questionnare
which drugs are used in the treatment of manic symptoms
Lithium, Valproate, Carbamazepine, Depakote
(Lamictal prevents mania but does not treat acute mania)
also antipsychotics!
which antipsychotics are used in the treatment of mania
quetiapine (Seroquel), lurasidone (Latuda)
Others (less studied) - aripiprazole (Abilify), cariprazine (Vraylar), risperidone (Risperdal), ziprasidone (Geodon), olanzapine (Zyprexa)
what is the treatment for ACUTE manic or hypomanic symptoms
when should you check lithium levels after a patient is started on lithium
4-5 days after start or change in dose.
what are the contraindications of lithium
- Severe CKD, dehydration, sodium depletion - ↑ risk of lithium toxicity
- Severe cardiovascular disease - can cause dysrhythmias
- Pregnancy - can cause teratogenesis; associated with Ebstein’s anomaly¹
what is Ebsteins anomaly
a congenital heart defect resulting in an abnormal, leaking tricuspid valve and ASD (atrial septal defect)
What are the side effects of lithium?
LITH PA
L - leukocytosis
I - nephrogenic (insipidus)
T - tremor/teratogenicity
H - hypothyroidism
P - Hyperparathyroidism
A - Arrhythmia
what baseline labs should you order for patients on lithium
- renal panel
- thyroid panel
- EKG
- Pregnancy test
what are symptoms of lithium toxicity
Early - N/V/D
Late - tremor, ataxia, confusion, encephalopathy, seizures
what is the treatment for lithium toxicity
- IV hydration
- benzos for seizures
what is the MOA of valproate
anticonvulsant; increases GABA levels
what are severe side effects of valproate
hepatotoxicity, pancreatitis, thrombocytopenia
what labs should be obtained prior to starting valproate
LFTs
what is the MOA of lamotrigine
anticonvulsant; inhibits release of glutamate
Reminder:
Indicated to help prevent manic episodes, but not to treat acute mania
what is the severe side effects of lamotrigine
SJS
carbamazepine contraindications
- pregnancy
- bone marrow suppression
- Use within 14 days of MAOI
Severe SE of carbamazepine
- aplastic anemia
- agranulocystosis
- SJS
- hyponatremia
what are SE of antipsychotics
- tardive dyskinesia
- GI
- dyslipidemia
- hyperglycemia
- headache
- sedation
Quetiapine - HTN
Lurasidone - akasthesia
What demographics are most common for major depressive disorders
- young adults (25-44 age group MC)
- 2-3x more common in women
- low socioeconomic status
what is the diagnostic criteria for major depressive disorder
Depressed mood or anhedonia + >/=4 of SIG E CAPS for >2 weeks
what questionnaires aid in diagnosing MDD
- PHQ-9
- PHQ2
- Zung self-rated depression scale
What is the MOA of SSRIs
inhibits reuptake of serotonin, causing increased serotonin in the synapse.
what are general side effects of SSRIs
- GI upset
- headaches
- insomnia/hypersomnia
- sexual dysfunction
- increased suicide risk
- weight gain
- QT prolong
- serotonin syndrome
what is the presentation of serotonin syndrome
- diarrhea
- hyperreflexia/tremor/clonus
- dry mucous membranes
- HTN
- seizures
what is the treatment for serotonin syndrome
IV hydration
benzos
dc med that caused it
which SSRI has the longest half life
fluoxetine
which SSRI causes anticholinergic SE such as orthostatic hypotension
paroxetine
which SSRI has the shortest half life
fluvoxemine
which SSRI is MOST associated with QT prolongation
escitalopram/citalopram
what is the MOA of SNRIs
blocks reuptake of NE and serotonin
what are the SE of SNRIs
same as SSRIs except less weight gain and more HTN
which SNRI is MOST associated with HTN
venlefaxine
which SNRI is LEAST associated with HTN
duloxetine
what are the atypical antidepressents
bupropion and mirtazipine
what is the MOA of bupropion
Acts as a dopamine-norepinephrine reuptake inhibitor (also antagonizes nicotinic receptors)
what is the MOA of mirtazipine
causes increased release of serotonin and norepinephrine
what are the perks of bupropion
- smoking cessation
- weight loss
- no sexual dysfunction
- gives a “boost”
what are the CI of bupropion
- seizure risk pts
- eating disorder pts
what are the SE of mirtazipine
- weight GAIN (carb craving)
- drowsy
- sexual dysfunction
what are the perks of mirtazipine
- good for insomnia (makes drowsy)
- good for old people refusing to eat (makes hungry)
what are the SE for trazodone
- priapism
- arrhythmias
- drowsiness
- dry mouth/constipation
which MAOI is used in depression with parkinsons
segeline
MAOI severe side effect:
hypertensive crisis when high amounts of tyramine are consumed (cheese, wine, cured meats)
what is the MOA of TCAs
inhibits reuptake of serotonin and NE
what do the TCAs end in
-tyline and -amine
then theres also doxepin
what is the unique CI for TCAs
cant be used in patients recovering from MI
what are the SE of TCAs
- anticholinergic
- cardiac toxicity
- sexual dysfunction
- weight gain
terrible
what is the diagnostic criteria for dysthymia
- Patients with ongoing depressive symptoms for two years or longer
- have not gone >2 months without symtpoms
what is the diagnostic criteria for adjustment disorder
depression in response to a stressor (within 3 months of stressor occurrance) that resolves within 6 months of onset.
