First Aid - Other Mood Disorders

Question 0

Dysthymic disorder – Criteria?

Answer 0

#Chronic depression for over two years BUT not severe to meet criteria for major depressive disorder
#No psychotic features, new social/occupational dysfunction
#2/6 of SigE CAps, or low self-esteem, hopelessness

Question 1

Dysthymic disorder – lifetime prevalence? Male to female ratio?

Answer 1

6%; 1:2

Question 2

Lifetime prevalence of bipolar disorder? Male to female ratio? Recurrence rate after one manic episode? Suicide rate?

Answer 2

1%; 1:1

90%; 10%

Question 3

Diagnostic criteria for bipolar?

Answer 3

#Elevated, expansive, or irritable mood
#3 (4 if irritable) DIGFAST
#One week (Only one episode is required for diagnosis

Question 4

DIGFAST?

Answer 4

#Distractibility
#Insomnia
#Grandiosity
#Flight of ideas
#Psychomotor agitation
#(pressured) Speech
#Thoughtless (reckless behavior)

Question 5

Bipolar I subtypes?

Answer 5

#Rapid cycling (4 mood episodes in 12 months)
#Bipolar with psychotic features

Question 6

Organic causes of mania?

Answer 6

#Brain tumors, syphilis, encephalitis, multiple sclerosis
#Hyperthyroid
#Metabolic disorders

Question 7

Drug causes of mania?

Answer 7

#Cocaine, amphetamines, steroids
#Captopril
#Antidepressants
#INH

Question 8

Treatment for acute mania?

Answer 8

#Mood stabilizer (lithium, valproic acid, carbamazepine)
#Olanzapine, risperidone, or haloperidol for treatment naïve patients and agitation
#Benzodiazepines for REFRACTORY agitation

Question 9

Treatment of bipolar depression?

Answer 9

#Mood stabilizers
#Antidepressant until mood recovers

Question 10

Bipolar Patient presents with ataxia, tremor, and Nystagmus – suspected diagnosis?

Answer 10

Lithium toxicity

Question 11

Difference in children versus adults with bipolar disorder?

Answer 11

May present with mania and depression in the same day

Question 12

Bipolar II disorder – criteria?

Answer 12

#1 major depressive episode and 1 episode of hypomania
#4 days normally elevated, expensive, or irritable mood and 3 of DIGFAST

Question 13

Lithium – necessary routine labs? Avoid these drugs?

Answer 13

BMP

NSAIDS, ACE inhibitors, diuretics

Question 14

Lithium – side effects? CBC may show? EKG?

Answer 14

Leukocytosis

#Tremor
#Nausea
#Weight gain
#Hypothyroidism
#Nephrogenic DI

Question 15

Lithium – Signs of toxicity?

Answer 15

#Course tremor
#Ataxia
#Diarrhea
#Nystagmus
#Arrhythmias
#Seizures

Question 16

Valproic acid is better than Lithium in?

Answer 16

#Mixed mania
#Substance-abuse
#Rapid cycling

Question 17

Blackbox warning for Valproic acid? Other side effects?

Answer 17

Hepatotoxicity (must check LFTs at regular intervals)

Pancreatitis, thrombocytopenia

Question 18

Second line agent for mania? Side effects? Routine lab work?

Answer 18

Carbamazepine

Stevens-Johnson syndrome, agranulocytosis, aplastic anemia, hepatitis

CBC monthly for first 6 months then every 3 months

Question 19

Carbamazepine toxicity?

Answer 19

Ataxia, confusion, tremors

Question 20

Cyclothymia? Criteria?

Answer 20

Mild bipolar disorder

#Two years of cycling hypomania and dysthymic episodes (without major depressive, manic episodes)
#Must not be symptom-free for over two months at a time