First Aid for the Psychiatry Clerkship - "Mood Disorders"

Question 1

To qualify as a major depressive episode, you must meet what criteria?

Answer 1

• Have five of the SIGECAPS criteria with at least one being anhedonia or depressed mood
• Not be due to a medical illness or substance
• Display symptoms for at least two weeks

Question 2

More than 50% of manic people also have ______________.

Answer 2

signs of psychosis

Question 3

What are the time criteria for mania and hypomania?

Answer 3

• Hypomania: must last at least four days

* Mania: must last at least seven days

Question 4

Other than the time criteria, what are some differences between mania and hypomania?

Answer 4

• Mania is characterized by impairing basic life functions (like work), while hypomania is not
• Mania can have psychotic features; hypomania will not
• Mania sometimes requires hospitalization, while hypomania does not generally require hospitalization

Question 5

What metabolic problem can induce mania?

Answer 5

Hyperthyroidism

Question 6

____________ is the most common disorder among those who commit suicide.

Answer 6

Major depressive disorder

2% - 12% of people with MDD eventually commit suicide.

Question 7

MDD is more common in which gender?

Answer 7

Women

Question 8

What evidence supports the chemical theory of depression?

Answer 8

Those with depression have been shown to have less 5-HIAA in their CSF.

Question 9

What scales are used to assess depression in the research and clinical settings?

Answer 9

• Research: Hamilton Depression Rating Scale

* Clinic: PHQ-9

Question 10

What are the prognoses for treated and untreated MDD?

Answer 10

• Untreated: people with MDD typically have more frequent depressive episodes with time
• Treated: about 60% of people show a significant response to antidepressants; adding psychotherapy improves the outcome further still

Question 11

SSRI discontinuation can cause rebound _________.

Answer 11

anxiety

Question 12

Venlafaxine and duloxetine go under the trade names _______________.

Answer 12

Effexor and Cymbalta

Question 13

List three cases in which electroconvulsive therapy is indicated.

Answer 13

• Patient doesn’t respond to multiple kinds of antidepressants
• Patient cannot tolerate pharmacotherapy (pregnant women)
• Immediate relief of symptoms is indicated (the patient is imminently suicidal.

Question 14

What are the risks of electroconvulsive therapy?

Answer 14

ECT is actually very safe –the main risk is from anesthesia or paralytics (generally succinylcholine)

Question 15

List five symptoms of atypical depression.

Answer 15

• Mood reactivity (feeling briefly happy at good news)
• Hypersomnia
• Leaden paralysis
• Hyperphagia
• Hypersensitivity to interpersonal rejection

Question 16

What triad of symptoms characterizes seasonal affective disorder?

Answer 16

• Hypersomnia
• Carbohydrate craving
• Irritability

Question 17

What is the lifetime prevalence of manic-depression (aka bipolar I)?

Answer 17

• ~1%

Question 18

What genetic component does bipolar I have?

Answer 18

A strong one: monozygotic twin concordance rates are as high as 70% and first-degree relatives are 10x as likely as the population at large to develop it

Question 19

What percent of people with bipolar I disorder die by suicide?

Answer 19

10% - 15%

Question 20

How successful is lithium in treating those with bipolar disorder?

Answer 20

Very! It reduces mania in 50%-70% of cases and reduces the suicide rate.

Question 21

__________________ are good for treating rapid cycling bipolar disorder.

Answer 21

Valproic acid and carbamazepine

Question 22

_________________ should never be used as monotherapy in those with bipolar I disorder.

Answer 22

Antidepressants

They can, however, be used in combination with mood stabilizers.

Question 23

__________ is the best therapy for pregnant women with mania.

Answer 23

Electroconvulsive therapy

Question 24

What things automatically make some bipolar I?

Answer 24

• Mania: DIGFAST for 7 or more days
• Psychotic symptoms in the presence of manic symptoms
• Hospitalization for mania

Question 25

How is bipolar II disorder treated?

Answer 25

Current practice is the same as for bipolar I disorder: mood stabilizers all the time and supplemental antidepressants during depressive episodes

Question 26

How many mood episodes need to be present in one year for a diagnosis of bipolar disorder with rapid cycling?

Answer 26

Four

Question 27

Wakening early in the morning is suggestive of depression with ________________ features.

Answer 27

melancholic

Question 28

To have dysthymia (aka persistent depressive disorder), you need to have depressive symptoms for more than 2 years and never be asymptomatic for more than _____________ in that time.

Answer 28

two months

Question 29

To have persistent depressive disorder, you need to have at least two of the following symptoms: ______________.

Answer 29

``` ■ Poor concentration or difficulty making decisions ■ Feelings of hopelessness ■ Poor appetite or overeating ■ Insomnia or hypersomnia ■ Low energy or fatigue ■ Low self-esteem ```

Question 30

Cyclothymia is not a common diagnosis because those with it usually remain functional. What two symptoms does it encompass?

Answer 30

* Mild depression | * Hypomania

Question 31

How is premenstrual dysphoria disorder treated?

Answer 31

* Daily SSRI or luteal-phase only SSRI * Oral contraceptives * Rarely, oopherectomy and hysterectomy

Question 32

Describe the diagnostic features of disruptive mood dysregulation disorder.

Answer 32

* Recurrent physical/verbal outbursts at least three times a week * Lasting for at least one year without breaks of three months or more without symptoms * Symptoms in at least two settings * Symptoms must have started before age 10