mood (depression, mania)

Question 1

cyclothymic criteria

Answer 1

multiple periods of hypomanic & depressive sxs that do NOT meet criteria for full episodes for over 2y (w/o euthymic for more than consecutive 2m)

Question 2

bipolar depression FDA approved meds

Answer 2

symbyax, seroquel, latuda

Question 3

remission from MDE per APA guidelines

Answer 3

at least 3w absence of dysphoria + anhedonia AND <=3 remaining sxs

Question 4

risk of bipolar with dx in 1st degree relative

Answer 4

10%

Question 5

minimum duration for hypomanic v manic episode

Answer 5

hypomanic = 4d
manic = 1w or ANY if hospitalized

Question 6

basic manic/hypomanic criteria

Answer 6

elevated/irritable mood + 3 of dec need for sleep, inc activity/agitation, out of character risky activities, grandiosity, talkativeness, FoI, distractability

Question 7

neuro finding in late onset mania

Answer 7

R hemispheric & subcortical lesions…. higher relative mortality than pts w mania throughout adulthood

Question 8

suicide rate in bipolar

Answer 8

10-15%

Question 9

bipolar first episode is most often which type

Answer 9

depression

Question 10

are depressive/manic episodes more common in each gender

gender ratios in bipolar 1 vs 2

Answer 10

M: manic >= depression
F: depression > manic

1: F = M
2: F > M

Question 11

when in gestation is VPA teratogenic

Answer 11

3-6 weeks (before aware of pregn)

Question 12

define rapid cycling specifier

more common in M or F?

Answer 12

> =4 major depressive, manic, or hypomanic episodes in past year

F > M

Question 13

effect of Li in PD

Answer 13

may be neuroprotective long term?!

Question 14

% of ppl w CV dz who develop depression?

Answer 14

25+

Question 15

lamictal FDA indication?

Answer 15

bipolar 1 maintenance

Question 16

adjustment prognosis for adults v teens

Answer 16

teens more guarded bc more likely to develop major mental illness

adults prognosis good once stressor terminated

Question 17

kava kava & st johns wort showed benefit for what conditions in RCTs, respectively?

Answer 17

KK = anxiety
SJW = somatoform

Question 18

MC comorbid mental illness in epilepsy?

Answer 18

depression (7.5% prevalence, up to 50% in intractable)

Question 19

incidence of depression on isotretinoin

Answer 19

4-11% although studies are poor… also must be addressed beyond DC med

*ALL prescribers must participate in iPLEDGE (ie even male pts). many risks including dec night vision, corneal opacities,

Question 20

% of suicides that are gero

Answer 20

20% (only make up 13% of whole pop)

Question 21

top 2 causes of death in adolescents

Answer 21

accidental injuries 40%, suicide 19.2%

Question 22

mean age of onset for bipolar disorder (any episode) & % who have recurrent episodes

Answer 22

18yo, >90%

Question 23

features of atypical depression

Answer 23

• inc appetite/wt gain, mood reactivity, interpersonal rejection sensitivity, leaden paralysis
• F>M, more in bipolar 1/2, earlier age, more chronic
• MAOIs best

Question 24

Li effect on birthweight

Answer 24

increase

Question 25

when is Li safe during pregnancy

Answer 25

2nd/3rd T, but stop before birth bc possible fluid shifts from change in glom filtration

Question 26

how to address Li side effects: nausea, diarrhea, hypothyroid, tremor, edema, polydipsia/polyuria

Answer 26

• nausea: w food, SR (to dec peak conc)
• diarrhea: IR (to dec distal absorp/serum conc)
• hypothyroid: T3
• tremor: propranolol or primidone
• edema: spironolactone
• polydipsia/polyuria: amiloride or HCTZ (halve Li dose an follow levels)

Question 27

M:F prevalence of MDD, bipolar 1, SCZ, ADHD, tic

Answer 27

MDD: 1:1.5-3
BPD: 1.1:1
SCZ: 1.4:1
ADHD: 1.6-2:1
tic: 2-4:1

Question 28

sleep changes in MDD

Answer 28

inc latency, dec slow wave (phase 3) bc dec blood flow in orbitofrontal & ant cingulate, dec REM latency, inc REM eye movements, & dec total sleep

Question 29

med for HepC and risk of mental illness

Answer 29

IFNa, up to 40% risk depression in 2-4 months, use ppx antidepr

Question 30

bupropion + TCA interaction?

Answer 30

WB inhib 2D6 > INC TCA lvl&raquo_space; antichol side effects ie blurred vision, urinary ret, constip, dry mouth, etc

Question 31

antidepressants w highest v lowest risk of switch to mania

Answer 31

highest: effexor
lowest: WB

Question 32

% bipolar who attempt suicide at least once, risk of death by suicide compared to gen pop, % of suicides due to bipolar

Answer 32

25-50%, 10-25x gen pop, 25%

Question 33

antidepressant w/o indication for anxiety

Answer 33

WB

Question 34

how many non overlapping sxs for mixed features specifier

Answer 34

3

Question 35

VPA MoA, OD

Answer 35

blocks volt gated Na channels > inc GABA lvls

OD: CNS depr but rarely fatal, can remove w HD

Question 36

days to reach Li steady state, timing to obtain trough

Answer 36

5 days, 12h after dose

Question 37

paxil % protein bound & % excreted in urine

Answer 37

95% protein bound, 66% excr in urine

Question 38

NT w most evidence in OCD

Answer 38

serotonin, low @BG

DA, high @PFC (mesocortical)

Question 39

premenstrual dysphoric do DSM5 criteria ABC categories

Answer 39

A timing
B mood
C associated sxs

Question 40

% of suicide completions with psych disorder

Answer 40

95%

Question 41

risk of suicide anx vs depr

Answer 41

anx more than double depr