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Psych EOR (billie) > DEPRESSIVE DISORDERS; BIPOLAR AND RELATED DISORDERS > Flashcards

DEPRESSIVE DISORDERS; BIPOLAR AND RELATED DISORDERS Flashcards

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1
Q

What is the diagnostic criteria for Bipolar 1 disorder

A
  • MUST HAVE 1 or more manic episodes
  • Nearly always also have hypomanic and major depressive episodes
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2
Q

What is the diagnostic criteria for Bipolar 2 disorder

A
  • 1 or more hypomanic episodes
  • 1 or more major depressive episodes
  • No manic episodes
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3
Q

what is the diagnostic criteria for cyclothymia

A
  • 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
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4
Q

What is the criteria for a manic episode?

A

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
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5
Q

what is the criteria for hypomanic episode

A

same as mania except 4+ days and NO functional impairment

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6
Q

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

A

high socioeconomic status!

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

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7
Q

what are the 8 subtypes of bipolar disorder?

A
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8
Q

what questionnaire screens for manic episodes

A

Mood Disorder Questionnare

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9
Q

which drugs are used in the treatment of manic symptoms

A

Lithium, Valproate, Carbamazepine, Depakote

(Lamictal prevents mania but does not treat acute mania)

also antipsychotics!

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10
Q

which antipsychotics are used in the treatment of mania

A

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

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11
Q

what is the treatment for ACUTE manic or hypomanic symptoms

A
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12
Q

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

A

4-5 days after start or change in dose.

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13
Q

what are the contraindications of lithium

A
  • Severe CKD, dehydration, sodium depletion - ↑ risk of lithium toxicity
  • Severe cardiovascular disease - can cause dysrhythmias
  • Pregnancy - can cause teratogenesis; associated with Ebstein’s anomaly¹
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14
Q

what is Ebsteins anomaly

A

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

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15
Q

What are the side effects of lithium?

A

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

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16
Q

what baseline labs should you order for patients on lithium

A
  1. renal panel
  2. thyroid panel
  3. EKG
  4. Pregnancy test
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17
Q

what are symptoms of lithium toxicity

A

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

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18
Q

what is the treatment for lithium toxicity

A
  • IV hydration
  • benzos for seizures
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19
Q

what is the MOA of valproate

A

anticonvulsant; increases GABA levels

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20
Q

what are severe side effects of valproate

A

hepatotoxicity, pancreatitis, thrombocytopenia

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21
Q

what labs should be obtained prior to starting valproate

A

LFTs

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22
Q

what is the MOA of lamotrigine

A

anticonvulsant; inhibits release of glutamate

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

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23
Q

what is the severe side effects of lamotrigine

A

SJS

24
Q

carbamazepine contraindications

A
  • pregnancy
  • bone marrow suppression
  • Use within 14 days of MAOI
25
Q

Severe SE of carbamazepine

A
  • aplastic anemia
  • agranulocystosis
  • SJS
  • hyponatremia
26
Q

what are SE of antipsychotics

A
  • tardive dyskinesia
  • GI
  • dyslipidemia
  • hyperglycemia
  • headache
  • sedation

Quetiapine - HTN
Lurasidone - akasthesia

27
Q

What demographics are most common for major depressive disorders

A
  • young adults (25-44 age group MC)
  • 2-3x more common in women
  • low socioeconomic status
28
Q

what is the diagnostic criteria for major depressive disorder

A

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

29
Q

what questionnaires aid in diagnosing MDD

A
  1. PHQ-9
  2. PHQ2
  3. Zung self-rated depression scale
30
Q

What is the MOA of SSRIs

A

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

31
Q

what are general side effects of SSRIs

A
  • GI upset
  • headaches
  • insomnia/hypersomnia
  • sexual dysfunction
  • increased suicide risk
  • weight gain
  • QT prolong
  • serotonin syndrome
32
Q

what is the presentation of serotonin syndrome

A
  • diarrhea
  • hyperreflexia/tremor/clonus
  • dry mucous membranes
  • HTN
  • seizures
33
Q

what is the treatment for serotonin syndrome

A

IV hydration
benzos
dc med that caused it

34
Q

which SSRI has the longest half life

A

fluoxetine

35
Q

which SSRI causes anticholinergic SE such as orthostatic hypotension

A

paroxetine

36
Q

which SSRI has the shortest half life

A

fluvoxemine

37
Q

which SSRI is MOST associated with QT prolongation

A

escitalopram/citalopram

38
Q

what is the MOA of SNRIs

A

blocks reuptake of NE and serotonin

39
Q

what are the SE of SNRIs

A

same as SSRIs except less weight gain and more HTN

40
Q

which SNRI is MOST associated with HTN

A

venlefaxine

41
Q

which SNRI is LEAST associated with HTN

A

duloxetine

42
Q

what are the atypical antidepressents

A

bupropion and mirtazipine

43
Q

what is the MOA of bupropion

A

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

44
Q

what is the MOA of mirtazipine

A

causes increased release of serotonin and norepinephrine

45
Q

what are the perks of bupropion

A
  • smoking cessation
  • weight loss
  • no sexual dysfunction
  • gives a “boost”
46
Q

what are the CI of bupropion

A
  • seizure risk pts
  • eating disorder pts
47
Q

what are the SE of mirtazipine

A
  • weight GAIN (carb craving)
  • drowsy
  • sexual dysfunction
48
Q

what are the perks of mirtazipine

A
  • good for insomnia (makes drowsy)
  • good for old people refusing to eat (makes hungry)
49
Q

what are the SE for trazodone

A
  • priapism
  • arrhythmias
  • drowsiness
  • dry mouth/constipation
50
Q

which MAOI is used in depression with parkinsons

A

segeline

51
Q

MAOI severe side effect:

A

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

52
Q

what is the MOA of TCAs

A

inhibits reuptake of serotonin and NE

53
Q

what do the TCAs end in

A

-tyline and -amine

then theres also doxepin

54
Q

what is the unique CI for TCAs

A

cant be used in patients recovering from MI

55
Q

what are the SE of TCAs

A
  • anticholinergic
  • cardiac toxicity
  • sexual dysfunction
  • weight gain

terrible

56
Q

what is the diagnostic criteria for dysthymia

A
  • Patients with ongoing depressive symptoms for two years or longer
  • have not gone >2 months without symtpoms
57
Q

what is the diagnostic criteria for adjustment disorder

A

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

Psych EOR (billie) (10 decks)

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