Mood and Anxiety Disorders Flashcards
Define bipolar I disorder.
1+ manic episode with occasional major depressive episodes.
What is the greatest risk factor for developing bipolar I disorder?
family history
Define mania.
abnormal and persistently elevated, expansive, or irritable mood for 1+ week with impairment in social or occupational function.
Describe the characteristics associated with mania and state how many must be present for a diagnosis.
Must have at least 3 of the following:
Mood: euphoria, irritable, labile, dysphoric
Thinking: racing, disorganized, expansive, grandiose
Behavior: hyperactivity, pressured speech, decreased need for sleep, risk taking/impulsivity, increased goal directed activity.
At what age is screening for bipolar I disorder recommended?
12 - 18
What are the treatment options for bipolar I disorder?
- Mood stabilizer: Li, anti-psychotic, valproate
- Improve sleep hygiene
- CBT, behavioral therapy, interpersonal therapy
List three drugs used for bipolar disorder that have significant associated concerns and state those concerns.
Lithium: requires blood level monitoring
Depakote: requires blood level monitoring
Lamortigine: requires adherent patient - sudden withdrawal can cause Stevens-Johnson Syndrome
Define bipolar II disorder.
Hypomania with major depressive episodes
Define hypomania.
Period of elevated, expansive, or irritable mood 4+ days that is different from the patient’s usual non-depressed mood but with no marked impairment.
Describe the characteristics associated with hypomania and state how many must be present for a diagnosis.
Must have at least 3 of the following:
Mood: euphoria
Thinking: racing, disorganized, expansive, grandiose
Behavior: hyperactivity, pressured speech, decreased sleep need, excessive involvement in pleasure activities
Describe the characteristics associated with hypomania and state how many must be present for a diagnosis.
Must have at least 3 of the following:
Mood: euphoria
Thinking: racing, disorganized, expansive, grandiose
Behavior: hyperactivity, pressured speech, dec sleep need, excessive involvement in pleasure activities
Describe the characteristics associated with hypomania and state how many must be present for a diagnosis.
Must have at least 3 of the following:
Mood: euphoria
Thinking: racing, disorganized, expansive, grandiose
Behavior: hyperactivity, pressured speech, dec sleep need, excessive involvement in pleasure activities
What method is used to screen for bipolar I or II?
Mood disorder questionaire.
What are the treatment options for bipolar I disorder?
- Mood stabilizer: Li, anti-psychotic, valproate - carbamazepine for depressive episode
- Improve sleep hygiene
- CBT, behavioral therapy, interpersonal therapy
What are the treatment options for bipolar I disorder?
- Mood stabilizer: Li, anti-psychotic, valproate - carbamazepine for depressive episode
- Improve sleep hygiene
- CBT, behavioral therapy, interpersonal therapy
What must be present for a diagnosis of major depressive disorder to be made?
Depressed mood most of the day and/or loss of interest/pleasure in most activities nearly every day for at least two weeks
What screening tool for depression is commonly used in primary care?
Beck Depression Inventory for Primary Care
In patients successfully treated for depression, what is the greatest risk factor for recurrence and when is recurrence most likely to occur?
R/F: childhood maltreatment
Risk greatest within first few months after treatment
Describe the SIGE CAPS mnemonic used to illustrate symptoms of depression.
S: Sleep changes I: lack of Interest G: excessive Guilt E: lack of Energy C: decrease in Concentration A: altered Appetite P: Psychomotor dysfunction (agitation) S: Suicidal thoughts
What is the risk of suicide in depression patients treated with psychotherapy alone and what age group is at greatest risk?
15% commit suicide –> Males 25-30 and Females 40-50 are at greatest risk.
What is the risk of suicide in depression patients treated with psychotherapy alone and what age group is at greatest risk?
15% commit suicide –> Males 25-30 and Females 40-50 are at greatest risk.
Describe the SADPERSONS mnemonic that illustrates patients at increased risk of suicide.
S: male Sex A: Age (> 85 highest rate) D: Depression P: Previous attempt E: Excess alcohol or other SUD R: lack of Rational thinking S: lack of Social support O: Organized plan N: No spouse S: Sickness (psych or medical)
What lab value must be evaluate din any patient with overdose and why?
Acetaminophen –> S/S may present long after ingestion
What is the relationship[ between gender and suicide risk?
Women 2x more likely to attempt, but men are 3x more likely to be successful.
What drugs are best to prescribe for depressive patients at risk for suicide and why?
SSRIs –> carry low risk of harm in overdose
What should be included in the management of a patient discovered to have SI?
Risk factor reduction, manage the underlying cause, close monitoring and follow up, determine lethality of current medication regimen.
Describe the diagnostic criteria for dysthymia (dysthymic disorder).
2+ years (1+ in kids) of feeling sad, down, or depressed most of the time on most days with at least 2 of: appetite change, sleep change, fatigue, low self-esteem, impaired concentration, hopelessness.
How is dysthymia managed?
Same as major depression
Define cyclothymic disorder.
Less severe depressive episodes and hypomania over a 2 year period with symptom free periods that last no longer than 2 months.
Describe cyclothymic disorder by comparing it to another mood disorder.
Less severe form of bipolar disorder.
What is the management of cyclothymic disorder?
Same as bipolar I –> Li, anti-psychotic, valproate, improve sleep hygiene, CBT, behavioral therapy, interpersonal therapy.
What is the greatest risk factor for post-partum depression?
Previous PPD
What is used in the management of PPD?
SSRIs first line
Define generalized anxiety disorder.
Excessive anxiety or worry more days than not in 6 month period with at least 3 of: fatigue, restlessness, difficulty concentrating, muscle tension, sleep disturbance, irritability, shakiness, headache.
What treatment options are available for generalized anxiety disorder?
SSRIs (paroxetine/escitalopram), SNRIs (venlafaxine)
Buspirone - no sedation but takes weeks to improve
BZDs and BBs - short term
Psychotherapy
What is the most common psychiatric disorder seen in the elderly?
Generalized anxiety disorder
T/F: Generalized anxiety disorder is more common in women than in men.
True: 2x more likely in women
Describe the diagnostic criteria for panic disorder.
S/S not s/p substance use or other condition
Recurrent (at least 2) attacks not related to a trigger
Episode followed by concern of more attacks
Significant change in behavior related to attacks
Describe what is needed for a diagnosis of panic attack.
Sudden (peak in ~ 10 min) episode of intense fear or discomfort with at least 4 of: palpitations, trembling, sweating, choking sense, dyspnea, chills, dizziness, nausea, hot flashes, paresthesia, fear of dying.
What other disorder is most commonly associated with panic disorder?
Alcohol use disorder
What is used in the management of an acute panic attack?
BZDs
What is used in the long term management of panic disorder?
SSRIs 1st line
Other: TCAs (imipramine), and CBT
What labs should be evaluated before making a diagnosis of panic disorder?
TSH, CMP, CBC
Describe diagnostic criteria for a phobic disorder.
Dx when response to phobic stimuli interferes with daily routine and/or social or occupational function. Response to stimuli must persist for 6+ months.
What comorbidities commonly exist with phobic disorders?
Major depression, SUD, anxiety, personality disorders
Describe agoraphobia.
Fear of places and situations (crowded places for ex) that might cause panic, helplessness, or embarrassment. May cause patient to avoid leaving home.
Name and describe a cognitive factor in agoraphobia.
Informational transmission - ex: phobia results from hearing stories about patient’s cousin
What is used in the management of agoraphobia?
SSRIs (1st line), BZDs, TCAs, BBs,
Insight oriented therapy + graded exposure
What population is most likely to suffer PTSD?
Young patients exposed to combat, violence, rape, assault, etc.
What must be true of the traumatic event experienced by the patient for a PTSD diagnosis to be made?
- Directly experienced event, witnessed event, or learned of event that happened to friend or family.
- Must experience repeated or extreme exposure to the trauma.
- Symptoms must be present for 1+ month after event.
List the categories of symptoms that must be present for PTSD to be diagnosed. State how many in each category must be present.
1+ Intrusive: memories, dreams, flashbacks, physical or psychological response to stimuli related to event.
1+ Avoidance: thoughts, feelings, external reminders
2+ negative alterations in cognition and mood
2+ changes in arousal/reactivity related to event
With regard to PTSD, describe negative alterations in cognition and mood related to the event.
Can't remember pieces of event Persistent negative emotional state Distorted blame of self or others Decreased interest/involvement Detachment/estrangement
With regard to PTSD, describe changes in arousal/reactivity related to event.
Irritability/anger, self-destructive behavior, hypervigilence, increased startle response, difficulty concentrating or sleeping.
T/F: Events seen on TV or read about in the news can cause PTSD.
False
What treatment options are available for PTSD?
SSRIs (first line) TCAs, MAOIs, CBT
Describe the difference between acute stress disorder and PTSD.
Acute stress disorder is essentially PTSD with symptoms present < 1 month after event.
What is the treatment for acute stress disorder?
Counseling, psychotherapy –> treat as PTSD if S/S persist.
