MDD, Bipola Flashcards
Mood disorders
Major Depressive
Bipolar
Substance induced
Secondary to Medical condition
Dysthymia
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
Major Depressive Disorder
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
Disruptive Mood Dysregulation disorder
Children
Premenstrual dysphoric disorder (PMDD
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
Spectrum
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
Prevlanace of Depression
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
Onset of Depression
earlier in life, the more severe
Kindling hypothesis-more episode, worse each new episodes
False Postives w. MDD
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
SIG E CAPS
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.
MDD outcomes w/ TX
Respones <50% bette (still s/s) diff meds
Remission >50% w/no s/s. consider inc. meds
Recovery= >50% better for 6 mo.
SSRI
Prozac-fluoxetine
Paxil- paroxetine
Zoloft -sertraline
SNRI serotonin norepinephrine reuptake inhibitors
Effexor-venlafaxine
Cymbalta-duloxetine (SE-liver)
Used for MMD pt w/ pain disorder
Side effects and Mechanism- SSRI, SNRI
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
Tricyclic Anitdepressants
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
Monoamine Oxidase Inhibitors Anitdepressants
NEVER USED
Selegine, Phenlzine
food restrictions
Serotonin Syndrome if used with SSRI-very sick, confusion, seizures, coma, death
Wellbutrin
MDD (bupropion)
Less sexual dys
No serotonin effect
Desryel- trazadone, Remeron (mirtazapine)
sleep medicaion
no abuse
no diversion
Side Effects MMD RX
Manic switch- see a pt in depress bipolar stage, Rx will cause mania
Serotonin Syndrome
SSRI Discontinuation Syndrome
Bipolar I
hx of atleast 1 manic episode
obvious manic or mixed depress and mania
Most under and over recognized
Bipolar II
1 or major depressive (50-70% of time) and 1 hypomanic episode (20%)
Bipolar Prevalence
2.6% in US
7.5y to accurate dx (some MDD)
EVB- Half Pts do not meet criteria (80% MDD, 24% PD
Manic Episode
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
Hypomania
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
Bordline Personality Disorder
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!!!
Cyclothymia
rapid cycling bipolar
switching depress, mania over days or weeks or hrs
Culture competent
AA- dx w/ schizophrenic
C- Bipolar
Bipolar RX
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
Second Generatoin Antipsychotics-
block dopamine 2A receptors. Dopamine relased in other areas dec mood isssue and movement ok.
- Quetiapine
- Olanzapine
- Aripiprazole
SE- parkinsoism, akthisa tardive dyskinesia, wt, glucose, lipids. Get baselines to monitor
