First Aid Psychiatry: Mood Disorders Flashcards
Major depressive episode can be found in what disroder
MDD
dysthymic
bipolar I/II
What are the mood disorders
- MDD
- bipolar I/II
- dysthymic
- cyclothymic
what are the mood episodies
- depression
- mania
- hypomania
criteria for major depressive episode
5 for two weeks
SIGE CAPS
symptoms of maina
DIG FAST: must have at least 3
- Distractibility
- Insomnia
- Grandiosity
- Flight of ideas
- Agitation
- Speech (pressured)
- Thoughtlessness
how is hypomania different from mania
- 4 days
- no hospitalization
- no psychotic features
- no social impairment
how is mania different from hypomania
- least 7 days
- social impairment
- hospitalization
- may have psychosis
Patients with mixed features of mood episodes should have what medicine
not lithium
- valproic acid
Medical causes of manic episode
- hyperthyroid
- temporal lobe seizure, MS
- HIV
Medical causes of depressive episode
- stroke, MI
- Diabetes, cushing, addison
- Parkinson
stroke patients usually develop what mood disorder
- depression
Anhedonia
inability to experience pleasure
sleep problems associated MDD
- initial and terminal insomnia
- REM sleep shifted earlier in the night and for greater duration
- with reduced stages 3 and 4 sleep
first line treatment in patients in MDD with psychotic features
atypical (second-generation) antipsychotics along with antidepressants
what has shown benefits when augmenting antidepressants in treatment of refractory MDD
- T3, T4
2. lithium
what therapy is good for MDD
CBT or interpersonal psychotherapy
when do you use ECT for MDD
- patient is unresponsive to pharmacotherapy
- rapid reduction of symptoms desired ( immediate suicide risk)
Common side effect of ECT
retrograde and anterograde amnesia
Melancholic features of MDD
- anhedonia
- depression worse in the morning
- early morning awakenings
atypical features of MDD
hypersomnia, hyperphagia , reactive mood, leaden paralysis, hypersensitivity to interpersonal rejection
catatonia for MDD
-catalepsy, purposeless moto, mutism, bizarre postures
triad of season affective disorder
- irritability
- carbohydrate craving
- hypersomnia
Onset of MDD symptoms occurs during pregnancy or ?
4 weeks following delivery
Major depression with psychotic features is best treated with
combination antidepressants and antipsychotic
Anxious distress
feeling keyed up/tense, restless, difficulty concentrating
what is required for diagnosis for bipolar I
manic episode
Best treatment for a pregnant women who is having a manic episode.
ECT
Lithium reduced the risk of what
suicide
pharmacotherapy treatments for bipolar I
Anticonvulsants and atypical antipsychotics
Diagnosis bipolar II
history of 1 or more major depressive episode and at least one hypomanic
- if there has been manic episode, even in the past, then the diagnosis is bipolar I
symptoms of dysthymia
2 or more of CHASES
- poor Concentration
- feeling of Hopelessness
- poor Appetite
- inSomnia
- low Energy
- low Self-esteem
rapid cycling
at least 4 mood episodes within 12 months
diagnosis for dythymia
2 years of depression
2 criteria of SIGECAPS
Never asymptomatic for 2 months or more
treatment for for dysthymia
combination of psychotherapy and pharmacotherapy
criteria for cyclothymic disorder
- hypomanic symptoms and depressive symptoms
- do not meet criteria for either
- no past MDD, hypmania or manic episode
firstline treatment for premenstural dysphoric disorder
SSRI
other treatment options for premenstrual dysphoric disorcer
oral contraceptives
GnRH agonists
which category of symptoms tends to respond well to antipsychotics in schizophrenia
positive
which category of symptoms tends to be resistant to antipsychotics in schizophrenia
negative
what are examples of catatonia seen in schizophrenia patients
- stereotyped movement
- bizarre posturing
- muscle rigidity
Echolalila
meaningless repetition of another person’s spoken words
Echopraxia
mimiic behavior
-PRAxia: Practice behavior
what drugs can create schizophrenic like symptoms
cocaine and amphetamines
- both increase dopamine activity
how do you diagnose a patient with mixed features of mood episodes
criteria met for manic or hypomanic episode
- 3 symptoms of major depressive episode
- 1 week present
a patient with depression will cause psychotic themes of
paranoia and worthlessness
a patient with mania have psychotic themes of
grandiosity and invincibility
criteria for major depressive disorder
at one major depressive episode
Among those who complete suicide, what is the most common disorder
Major depressive disorder
what is 5-HIAA
metabolite of serotonin
patients with CSF fluid with decreased 5-HIAA indicates
depressed patients with impulsive and suicidal behavior
what are some hormones that can cause MDD
high cortisol and abnormal thyroid axis
MOA of bupropion
dopamine and NE reuptake inhibitor
MOA of SNRI
Serotonin-NE reuptake inhibitor
MOA of mirtazapine
alpha 2 antagonist
Loss of a parent before age 11 is associated with later development of
major depression
Leaden paralysis
heaving feeling in legs/arms
treatment for MDD with atypical features
First line: SSRI
MOAI
what can be prescribed to patients with resistant/refractory MDD with no psychotic features
second-generation antipsychotic along with antidepressant
Anticonvulstants are good to treat what
rapid cycling bipolar disorder
and mixed features
cyclothymic disorder can coexist with what other disorder
borderline
