EOR - pysch Flashcards
Dx MDD
depressed mood/anhedonia w/ 5 associated symptoms almost every day for most days for @ least 2 wks. Symptoms cause clinical distress or impairment in social, occupational or other important area of fxn. Absence of mania or hypomania.
What is atypical depression? txt?
shares typical symptoms but pts experience mood reactivity (improved mood in response to positive events). Symptoms include significant weight gain/appetite increase, hypersomnia, heady/leaden feelings in arms/legs, oversensitive to personal rejection. Txt: MAO inhibitors.
melancholia affect on sleep?
(increased REM time and reduced sleep. May lead to early morning awakening or mood worse in AM).
what is catatonic depression?
motor immobility, stupor, extreme w/drawal.
Pharm txt options for MDD
SSRIs (first choice), SNRIs, bupropion + mirtazapine, TCAs and MAOIs 3rd line. Continued for minimum of 3-6wks to determine efficacy.
major depressive episode
2+weeks of major depressive symptoms.
manic episode
an emotional state characterized by a period of at least one week where an elevated, expansive, or unusually irritable mood. Feeling euphoric often w/ a directed goal. Can lead to serious consequences. Can have a break w/ reality - psychotic symptoms of delusions, hallucinations + paranoia. Can require hospitalization.
-Usually crash after the episode with depression… may take weeks to months to get out of depression. Between “phase” they are euthymic.
how many cycles per year is a typical manic episode?
2-3
hypomanic episode
at least four days of more mild mania, increased energy. Causes problems in life but not to the extent of mania + does not ever require hospitalization.
mixed episode
“manic or hypomanic episode w/ mixed features” - full criteria or manic or hypomanic episode + at least 3 depressive symptoms. (or >3 manic or hypomanic symptoms + depression)
medication options for bipolar I and II
mood stabilizers: LITHIUM!!! (also valproic acid aka depakote, carbamazepine aka tegretol)
2nd gen antipsychotics (olanzapine)
1st gen antipsychotics (haloperidol)
+ antiepileptics (quetiapine, lamotrigine aka lamictal), +benzos for agitation/pyschosis. +/- ECT, MAOIs, SSRIs, TCAs, but…. Antidepressants may precipitate mania!
how is biplar II different from bipolar I?
II: >1 hypomanic (rather than manic) episode + >1 major depressive episode. Mania or mixed are ABSENT. Does not include racing thoughts or excessive psychomotor agitation
Dx and treatment for cyclothymic d/o
Dx: recurrent hypomanic that don’t meet criteria for hypomania “cycling” w/ relatively mild depressive episodes (that dont meet MDD criteria). For at least 2 years (1 in kids). Symptom free periods dont last over 2 months at a time. No manic or mixed.
Txt: similar to bipolar I - mood stabilizers + neuroleptics.
Dx of adjustment d/o
Emotional or behavioral rxn to an IDENTIFIABLE stressor (job loss, physical illness, leaving home, divorce, etc) or an event that causes DISPROPORTIONATE response that would normally be expected w/in 3mo of stressor (does not include bereavement) + resolves w/in 6mo of stressor.
txt for adjustment d/o
psychotherapy
3 phases of schizophrenia
prodromal (or beginning), acute (or active - hallucinations, delusions, psychosis) and recovery (or residual -psychosis muted but some symptoms still present). These phases tend to occur in order and cycle throughout the course of the illness
timeline needed for Dx schizophrenia
> 6 months w/ 1month of acute symptoms along with functional decline. At least one symptom must be hallucination, delusion or disorganized speech. Must have >2 symptoms.
what are the 5 SSRIs?
citalopram, escitalopram, fluoxetine, fluvoxamine, paroxetine, sertraline
what are the MC ADRs of SSRIs and which ones have the highest likliehood?
insomnia (fluoxetine - prozac, sertraline-zoloft)
orthostatic hypotension - paroxetine (paxil)
GI issues - sertraline
weight gain - paroxetine
sexual dysfunction - ALL
what are two atypical antidepressant meds?
bupropion and mirtazipine
major ADR of bupropion?
insomnia/agitation (more w/ immediate release)
what are the major ADRs of mirtazapine?
drowsiness, weight gain
what are the 5 SNRI meds?
desvenlafaxine, venlafaxine
duloxetine
levomilnacipran, milnacipran,
what is the one ADR of SNRIs?
GI toxicity (upset)