DEPRESSIVE DISORDERS; BIPOLAR AND RELATED DISORDERS

Question 1

What is the diagnostic criteria for Bipolar 1 disorder

Answer 1

• MUST HAVE 1 or more manic episodes
• Nearly always also have hypomanic and major depressive episodes

Question 2

What is the diagnostic criteria for Bipolar 2 disorder

Answer 2

• 1 or more hypomanic episodes
• 1 or more major depressive episodes
• No manic episodes

Question 3

what is the diagnostic criteria for cyclothymia

Answer 3

• 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

Question 4

What is the criteria for a manic episode?

Answer 4

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

Question 5

what is the criteria for hypomanic episode

Answer 5

same as mania except 4+ days and NO functional impairment

Question 6

what demographics are MC in bipolar disorders (both 1 and 2)

Answer 6

high socioeconomic status!

Men are more likely to have manic types, women are more likely to have depressive types

Question 7

what are the 8 subtypes of bipolar disorder?

Answer 7

Question 8

what questionnaire screens for manic episodes

Answer 8

Mood Disorder Questionnare

Question 9

which drugs are used in the treatment of manic symptoms

Answer 9

Lithium, Valproate, Carbamazepine, Depakote

(Lamictal prevents mania but does not treat acute mania)

also antipsychotics!

Question 10

which antipsychotics are used in the treatment of mania

Answer 10

quetiapine (Seroquel), lurasidone (Latuda)
Others (less studied) - aripiprazole (Abilify), cariprazine (Vraylar), risperidone (Risperdal), ziprasidone (Geodon), olanzapine (Zyprexa)

Question 11

what is the treatment for ACUTE manic or hypomanic symptoms

Answer 11

Question 12

when should you check lithium levels after a patient is started on lithium

Answer 12

4-5 days after start or change in dose.

Question 13

what are the contraindications of lithium

Answer 13

• Severe CKD, dehydration, sodium depletion - ↑ risk of lithium toxicity
• Severe cardiovascular disease - can cause dysrhythmias
• Pregnancy - can cause teratogenesis; associated with Ebstein’s anomaly¹

Question 14

what is Ebsteins anomaly

Answer 14

a congenital heart defect resulting in an abnormal, leaking tricuspid valve and ASD (atrial septal defect)

Question 15

What are the side effects of lithium?

Answer 15

LITH PA
L - leukocytosis
I - nephrogenic (insipidus)
T - tremor/teratogenicity
H - hypothyroidism
P - Hyperparathyroidism
A - Arrhythmia

Question 16

what baseline labs should you order for patients on lithium

Answer 16

1. renal panel
2. thyroid panel
3. EKG
4. Pregnancy test

Question 17

what are symptoms of lithium toxicity

Answer 17

Early - N/V/D
Late - tremor, ataxia, confusion, encephalopathy, seizures

Question 18

what is the treatment for lithium toxicity

Answer 18

• IV hydration
• benzos for seizures

Question 19

what is the MOA of valproate

Answer 19

anticonvulsant; increases GABA levels

Question 20

what are severe side effects of valproate

Answer 20

hepatotoxicity, pancreatitis, thrombocytopenia

Question 21

what labs should be obtained prior to starting valproate

Answer 21

LFTs

Question 22

what is the MOA of lamotrigine

Answer 22

anticonvulsant; inhibits release of glutamate

Reminder:
Indicated to help prevent manic episodes, but not to treat acute mania

Question 23

what is the severe side effects of lamotrigine

Answer 23

SJS

Question 24

carbamazepine contraindications

Answer 24

• pregnancy
• bone marrow suppression
• Use within 14 days of MAOI

Question 25

Severe SE of carbamazepine

Answer 25

* aplastic anemia * agranulocystosis * SJS * hyponatremia

Question 26

what are SE of antipsychotics

Answer 26

* tardive dyskinesia * GI * dyslipidemia * hyperglycemia * headache * sedation Quetiapine - HTN Lurasidone - akasthesia

Question 27

What demographics are most common for major depressive disorders

Answer 27

* young adults (25-44 age group MC) * 2-3x more common in women * low socioeconomic status

Question 28

what is the diagnostic criteria for major depressive disorder

Answer 28

Depressed mood or anhedonia + >/=4 of SIG E CAPS for >2 weeks

Question 29

what questionnaires aid in diagnosing MDD

Answer 29

1. PHQ-9 2. PHQ2 3. Zung self-rated depression scale

Question 30

What is the MOA of SSRIs

Answer 30

inhibits reuptake of serotonin, causing increased serotonin in the synapse.

Question 31

what are general side effects of SSRIs

Answer 31

* GI upset * headaches * insomnia/hypersomnia * sexual dysfunction * increased suicide risk * weight gain * QT prolong * serotonin syndrome

Question 32

what is the presentation of serotonin syndrome

Answer 32

* diarrhea * hyperreflexia/tremor/clonus * dry mucous membranes * HTN * seizures

Question 33

what is the treatment for serotonin syndrome

Answer 33

IV hydration benzos dc med that caused it

Question 34

which SSRI has the longest half life

Answer 34

fluoxetine

Question 35

which SSRI causes anticholinergic SE such as orthostatic hypotension

Answer 35

paroxetine

Question 36

which SSRI has the shortest half life

Answer 36

fluvoxemine

Question 37

which SSRI is MOST associated with QT prolongation

Answer 37

escitalopram/citalopram

Question 38

what is the MOA of SNRIs

Answer 38

blocks reuptake of NE and serotonin

Question 39

what are the SE of SNRIs

Answer 39

same as SSRIs except less weight gain and more HTN

Question 40

which SNRI is MOST associated with HTN

Answer 40

venlefaxine

Question 41

which SNRI is LEAST associated with HTN

Answer 41

duloxetine

Question 42

what are the atypical antidepressents

Answer 42

bupropion and mirtazipine

Question 43

what is the MOA of bupropion

Answer 43

Acts as a dopamine-norepinephrine reuptake inhibitor (also antagonizes nicotinic receptors)

Question 44

what is the MOA of mirtazipine

Answer 44

causes increased release of serotonin and norepinephrine

Question 45

what are the perks of bupropion

Answer 45

* smoking cessation * weight loss * no sexual dysfunction * gives a "boost"

Question 46

what are the CI of bupropion

Answer 46

* seizure risk pts * eating disorder pts

Question 47

what are the SE of mirtazipine

Answer 47

* weight GAIN (carb craving) * drowsy * sexual dysfunction

Question 48

what are the perks of mirtazipine

Answer 48

* good for insomnia (makes drowsy) * good for old people refusing to eat (makes hungry)

Question 49

what are the SE for trazodone

Answer 49

* priapism * arrhythmias * drowsiness * dry mouth/constipation

Question 50

which MAOI is used in depression with parkinsons

Answer 50

segeline

Question 51

MAOI severe side effect:

Answer 51

hypertensive crisis when high amounts of tyramine are consumed (cheese, wine, cured meats)

Question 52

what is the MOA of TCAs

Answer 52

inhibits reuptake of serotonin and NE

Question 53

what do the TCAs end in

Answer 53

-tyline and -amine then theres also doxepin

Question 54

what is the unique CI for TCAs

Answer 54

cant be used in patients recovering from MI

Question 55

what are the SE of TCAs

Answer 55

* anticholinergic * cardiac toxicity * sexual dysfunction * weight gain terrible

Question 56

what is the diagnostic criteria for dysthymia

Answer 56

* Patients with ongoing depressive symptoms for two years or longer * have not gone >2 months without symtpoms

Question 57

what is the diagnostic criteria for adjustment disorder

Answer 57

depression in response to a stressor (within 3 months of stressor occurrance) that resolves within 6 months of onset.