MDD, Bipola

Question 1

Mood disorders

Answer 1

Major Depressive
Bipolar
Substance induced
Secondary to Medical condition

Question 2

Dysthymia

Answer 2

Persistent Depressive Disorder
s/s- low energy, drive, self esteem, pleasure in everyday life, avoiding opportunities, withdraw from stressors

Notes- Diff to dx, overlap w/ PD

Tx-Pschoy therapy, medication, combos

Question 3

Major Depressive Disorder

Answer 3

s/s- disabling, affects family, work, sleep, eating, health. low mood w. low self esteem, loss of interest, pleasure. Recurrent, mild-sever, maybe psychotic (H&D)

Dx- self reported, MSE, NO LABS. Last 2 wks. PHQ 9, 2
Basic metabolic- thyroid, testoterone (dec)

Notes- Unipolar Depression- never experience dys, eu, euphoria

Tx- Antidepressants, Electro Convulsive (severe), CBT, Magnets, Deep Brain (if side effect issue)
60% respond 1st RX

Question 4

Disruptive Mood Dysregulation disorder

Answer 4

Children

Question 5

Premenstrual dysphoric disorder (PMDD

Answer 5

s/s severe form of PMS, cyclic, being after ovulation, end after menses starts, 6d, intense day 2-start of menses
Mood dominant, very disruptive. Anxiety, anger, depression.

TX- SSRIs (antidepress), hormonal contraceptives
inability to bounce back/resilient/adapt

Question 6

Spectrum

Answer 6

Euphoric- up or high
Euthymic- in the middle
Dysthymic- down or sad

very sad or sad time to time, despair loss of hope, sleep ranges, ruminative dispair, loss of appetite, illness

Question 7

Prevlanace of Depression

Answer 7

1yr- 7%
Life- 16%
3% men (underdx) (alcoholics high)
5-9% women (overdx
Twins sibling likely to have if one has it
2-3x if family has it

Question 8

Onset of Depression

Answer 8

earlier in life, the more severe

Kindling hypothesis-more episode, worse each new episodes

Question 9

False Postives w. MDD

Answer 9

Pseudo dementia- highly related to depression in elderly vs. true dementia. Pay attn to their answer w/ effort.
Some psychosis
Some thyroid
Bipolar
Screen for bipolar and MDD
Psychiatric 
Family

Question 10

SIG E CAPS

Answer 10

S- sleep in or dec
I- interest dec
G- Guilt inc.
E- energy dec.
C- concentration dec.
A- appetite inc or dec
P- psychomotor dec
S- suicide inc.

Question 11

MDD outcomes w/ TX

Answer 11

Respones <50% bette (still s/s) diff meds
Remission >50% w/no s/s. consider inc. meds
Recovery= >50% better for 6 mo.

Question 12

SSRI

Answer 12

Prozac-fluoxetine
Paxil- paroxetine
Zoloft -sertraline

Question 13

SNRI serotonin norepinephrine reuptake inhibitors

Answer 13

Effexor-venlafaxine
Cymbalta-duloxetine (SE-liver)
Used for MMD pt w/ pain disorder

Question 14

Side effects and Mechanism- SSRI, SNRI

Answer 14

inhibit uptake of serotonin so still floats around
down regulation desensistizes
Not selevtive for receptor= side effects
Sexual, GI
6wks - need prolonged exposure 2 wks s/s dec. notice
Safe in OD
Need po

Question 15

Tricyclic Anitdepressants

Answer 15

Elavil- amitriptyline
Pamelor- nortripyline
Block reuptake of NE, ST, Dopa
SE- d/t block of muscarni, histaminia, alpha1 andrengeric receptors
Pain syndromes
Lethal if OD-suciidal ideation
NOT USED

Question 16

Monoamine Oxidase Inhibitors Anitdepressants

Answer 16

NEVER USED
Selegine, Phenlzine
food restrictions
Serotonin Syndrome if used with SSRI-very sick, confusion, seizures, coma, death

Question 17

Wellbutrin

Answer 17

MDD (bupropion)
Less sexual dys
No serotonin effect

Question 18

Desryel- trazadone, Remeron (mirtazapine)

Answer 18

sleep medicaion
no abuse
no diversion

Question 19

Side Effects MMD RX

Answer 19

Manic switch- see a pt in depress bipolar stage, Rx will cause mania
Serotonin Syndrome
SSRI Discontinuation Syndrome

Question 20

Bipolar I

Answer 20

hx of atleast 1 manic episode
obvious manic or mixed depress and mania
Most under and over recognized

Question 21

Bipolar II

Answer 21

1 or major depressive (50-70% of time) and 1 hypomanic episode (20%)

Question 22

Bipolar Prevalence

Answer 22

2.6% in US
7.5y to accurate dx (some MDD)
EVB- Half Pts do not meet criteria (80% MDD, 24% PD

Question 23

Manic Episode

Answer 23

a discrete period of altered fx w/ elevated or irritable mood, w. changes in energy or behavior, NOT due to drugs or physiological effects. have no idea behavior
D- distracted
I- irresponsibly- involved in high pleasure but lead to harm
G- grandiosity esteem
F- racing thoughts
A- activity, agitation
S- no need for sleep, not tired
T- pressured speech, talkative

Question 24

Hypomania

Answer 24

marked impairment just outside of ideal society fx
4 days
Hospital
Psychotic
?- mover productive, mood was high, energy didnt sleep, felt like on a high, overspending, driving fast, sex partners, special powers
TIME PERIOD important
Sober periods

Question 25

Bordline Personality Disorder

Answer 25

long term pattern
mood swings, anger
Impulsive
Feeling empty
Projection
Last hours or days?
Triggers

TX- ask for Mania episodes. Dont’ stop at mood swings
Find current mood!!!

Question 26

Cyclothymia

Answer 26

rapid cycling bipolar

switching depress, mania over days or weeks or hrs

Question 27

Culture competent

Answer 27

AA- dx w/ schizophrenic

C- Bipolar

Question 28

Bipolar RX

Answer 28

Lithium (preserve gray mater) SE-Kidneys, Thyroid

Valproic Acid (depkote) SE-birth defects, dizzy, hair loss, HA, wt gain

Lamictal- lamotrigine-SE rash, Stevens Johnson Syndrome 3rd degree burns

Start low doses

Question 29

Second Generatoin Antipsychotics-

Answer 29

block dopamine 2A receptors. Dopamine relased in other areas dec mood isssue and movement ok.

1. Quetiapine
2. Olanzapine
3. Aripiprazole

SE- parkinsoism, akthisa tardive dyskinesia, wt, glucose, lipids. Get baselines to monitor