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Psychiatry > Mood disorders > Flashcards

Mood disorders Flashcards

1
Q

What is the diagnostic criteria for major depressive disorder?

A
  • Must be going on for at least 2 weeks

- Must have 5 or more symptoms of SIG E CAPS and one of them either has to be depressed mood or anhedonia

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2
Q

What are the sig e caps used for MDD?

A
  • change in sleep
  • loss of interest–> anhedonia
  • guilt- increased feeling
  • energy- change in levels
  • concentration- change
  • appetite- change
  • psychomotor retardation
  • suicidal thoughts/ideation
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3
Q

When do you hospitalize a suicidal patient?

A

Find out if they have an active plan of suicide and if it is a reasonable plan to act on.

Ex–> if a patient says they want to jump out of a helicopter, do they have access to a helicopter?
If a patient says they want to shoot themselves, do they have access to a gun?

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4
Q

If a patient has an idea of suicide but they are not qualified to be hospitalized, what should you do as their psychiatrist?

A

Make a contract that if they should have feelings of wanting to hurt themselves instead of hurting themselves, they will call you instead.

*better way to build rapport with patient instead of immediate hospitalization

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5
Q

A patient with depression who has either psychosis or catatonia should be treated with?

A

ECT

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6
Q

Tx for MDD

A

SSRIs and psychotherapy

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7
Q

Patients may become discouraged with their MDD symptoms do not immediately start to abate when on SSRIs. As the psychiatrist, you should encourage what to the patient?

A

SSRIs take 4-6 weeks to start working and to reach maximum efficacy.

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8
Q

If a patient is on an SSRI for the first time and after 4-6 weeks of being on it, there is either no improvement or there are worsening of symptoms, you as the psychiatrist should?

A

Change the SSRI; follow up with patient 4-6 weeks

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9
Q

Define dysthymia disorder

A

Patient has low mood for at least two years with only some of the SIG E CAPS symptoms but not enough to diagnose MDD. Symptoms cannot be missing for more than 2 months.

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10
Q

patient has hypomania but it does not impair function more than likely has what disorder?

A

cyclothymia

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11
Q

A patient with bipolar II will present how?

A
  • hypomania with episodes of depression
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12
Q

In order to diagnose bipolar I, what must a patient have a hx of?

A

An episode of mania

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13
Q

What are the criteria to diagnose bipolar I?

A

Elevated mood/energy with 3 or more symptoms of DIG FASTER for at least 1 week

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14
Q

What are the DIG FASTER symptoms used in bipolar I criteria?

A
  • distractibility
  • insomnia
  • grandiosity
  • flight of ideas
  • activity level increased or agitation
  • sexual exploitation
  • Talkative
  • Elevated mood
  • Racing thoughts
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15
Q

Always take a careful hx in a patient presenting with depression. Ask if they ever experienced a manic episode. Why is this so important?

A
  • If you prescribe an SSRI to a patient who actual is bipolar I, then you may induce a manic episode by having that patient on the SSRI.
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16
Q

First line treatment for bipolar I disorder

A

lithium

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17
Q

Must monitor what two organs when patients are on lithium?

A

thyroid

kidneys

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18
Q

If a bipolar I patient is in a manic episode while in the ED and cannot be calmed down, what is the medication used to treat immediately?

A
  • B52–> haldol and atovan
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19
Q

What is the treatment line for bipolar I disorder?

A

1st line- lithium
2nd line- valproic acid
3rd line- carbamazepine or lamotrigine

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20
Q

What is the preferred antipsychotic for patients with bipolar I if the mood stabilizers do not work?

A

quetiapine (seroquel)

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21
Q

When a patient presents to the ER in a manic episode, what should you rule out?

A

Drugs via urine tox

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22
Q

What are the five stages of death/dying?

A
  1. denial
  2. depression
  3. bargaining
  4. anger
  5. acceptance
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23
Q

If a loved one dies unexpectantly, which causes a fear or anxiety in the patient, the patient can meet criteria for which two disorders?

A
  • Acute stress disorder or PTSD depending on duration of symptoms
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24
Q

A patient with grief or bereavement cannot be diagnosed with ___ because there is no criteria for bereavement in that disorder.

A
  • Adjustment disorder
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25
Q

Normal grief can last up to?

A

One year

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26
Q

If a patient is experiencing grief from loss of a loved one, what kind of symptoms/behaviors will have they?

A
  • the behaviors will focus on the loved one
  • talking to deceased
  • praying at grave site, visiting grave site
  • mood wanes and waxes
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27
Q

If a patient is experiencing MDD from loss of a loved one, what kind of symptoms will they have?

A
  • SIG E CAPS
  • persistent depressed mood
  • talking with the deceased
  • feeling trapped in their negative emotions
  • goes on longer than 12 months
  • hallucinations–> visual and auditory of the deceased
28
Q

What is the timeline/duration of persistent complex bereavement disorder?

A

lasts more than 6 months but less than one year

29
Q

What do you treat MDD due to loss of loved one?

A
  • SSRI, SNRI
30
Q

Tx for persistent complex bereavement disorder?

A
  • SSRI, SNRI
31
Q

Define baby blues

A
  • depressed mood due to birth of baby
  • lasts up to two weeks
  • no tx necessary–> will resolve on its own
32
Q

Define postpartum depression

A
  • depressed mood due to birth of baby lasting more than 2 weeks
  • will need treatment–> SSRI/SNRI
33
Q

Define postpartum psychosis

A
  • mom fears baby and may try to kill baby without –> due to stressor of birth of baby–> realizing she is hurting baby
  • must treat with antipsychotics
  • must get baby away from mom
34
Q

define catatonia

A
  • patient has 3 or more of the following symptoms:
  • stupor, catalepsy- waxy/waning flexibility- patient can be put in any position easily-, negativism, mutism, stereotypy, agitation/grimace, echolalia, echopraxia
35
Q

define echolalia

A

patient copies your speech

36
Q

define echopraxia

A

patient copies your movements

37
Q

Tx for catatonia

A

lorazepam (BZD)

38
Q

Must follow up with a patient with catatonia because it can lead to ?

A
  • malnutrition
  • DVT
  • rhabdomyolysis
39
Q

Patient has increased HR, BP, and temp but is not on any psychiatric medications. Their physical presentation is a combo of rigidity and problems with the ANS. What is the diagnosis?

A

malignant catatonia

40
Q

Patient has increased temp, BP, and HR due to side effect of their antipsychotic. They present with rigidity like a lead pipe. What is the diagnosis?

A

neuroleptic malignant syndrome

41
Q

Patient is in the OR and begins to experience an elevated temp, HR, and bp once the anesthesia is started. Their body becomes rigid. What is the diagnosis?

A

Malignant hyperthermia

42
Q

Tx for malignant hyperthermia

A

dantrolene

43
Q

What is the theory on how antidepressants work?

A
  • It is thought that the SSRI or SNRI increases neuroplasticity by blocking the reuptake of serotonin or serotonin and norepinephrine. Keeping the neurotransmitters in the synapse longer increases neuroactivity.
44
Q

How long should you treat a patient with depression?

A
  • for at least 6 months once you reach an effective med and dose
45
Q

Certain antidepressants require a washout period before you start another antidepressant. Why?

A
  • Could cause serotonin syndrome
46
Q

Why must you have a washout period when switching out fluoxetine?

A
  • It has a long half-life.
47
Q

Name some SSRIs

A
  • sertraline
  • escitalopram
  • fluoxetine
  • paroxetine
  • citalopram
48
Q

What are the two main ADRs of SSRIs that people want to stop taking them?

A
  • sexual dysfunction

- weight gain

49
Q

Name some SNRIs

A
  • Venlafaxine
  • Desvenlafaxine
  • Duloxetine
50
Q

____ is an atypical antidepressant that can also be used to help a person stop smoking.

A
  • bupropion (Wellbutrin)
51
Q

Mirtazapine is a serotonin modulator but has an ADR of ?

A
  • appetite stimulation–> weight gain

* good for an elderly patient who is depressed and is thin

52
Q
  • ADR of trazodone
A
  • priapism
53
Q
  • Trazodone is used as a ____ even though it is a serotonin modulator.
A
  • sleep aid
54
Q

Imipramine and doxepin are what kind of antidepressant class?

A
  • tricyclic acid antidepressants
55
Q

Trptyline drugs can also be used to treat ___ and ___ plus depression.

A
  • neuropathic pain

- enuresis

56
Q

Selegine and phenylzine are what type of antidepressants?

A
  • monoamine oxidase inhibitors
57
Q

ADR associated with MAOi’s?

A
  • tyramine crisis–> HTN crisis due to eating meats and cheeses while on the medication
58
Q

Lithium is a known teratogen. What can it cause?

A
  • ebstein anomaly in a fetus
59
Q

Valproic acid is a known teratogen. What can it cause?

A
  • spina bifida (neurological impairments to the fetus)
60
Q

Common ADRs of valproic acid?

A
  • pancreatitis
  • agranulocytosis
  • decreased platelets
61
Q

___ can be used as an adjunct in mood stabilizing; is a known antipsychotic

A

quetiapine

62
Q

ADRs of quetiapine

A
  • prolongation of QT complex
  • weight gain
  • drowsiness
63
Q

Carbamazepine is used to treat?

A
  • mood disorders as a second line
  • absence seizures
  • trigeminal neuralgia
64
Q

Treatment for benzodiazepine withdrawals?

A
  • diazepam or chlordiazepoxide
65
Q

ADRs of beta blockers

A
  • decreased heart rate

- decreased mood

Psychiatry (15 decks)

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