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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
Normal grief can last up to?
One year
26
If a patient is experiencing grief from loss of a loved one, what kind of symptoms/behaviors will have they?
- the behaviors will focus on the loved one - talking to deceased - praying at grave site, visiting grave site - mood wanes and waxes
27
If a patient is experiencing MDD from loss of a loved one, what kind of symptoms will they have?
- 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
What is the timeline/duration of persistent complex bereavement disorder?
lasts more than 6 months but less than one year
29
What do you treat MDD due to loss of loved one?
- SSRI, SNRI
30
Tx for persistent complex bereavement disorder?
- SSRI, SNRI
31
Define baby blues
- depressed mood due to birth of baby - lasts up to two weeks - no tx necessary--> will resolve on its own
32
Define postpartum depression
- depressed mood due to birth of baby lasting more than 2 weeks - will need treatment--> SSRI/SNRI
33
Define postpartum psychosis
- 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
define catatonia
- 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
define echolalia
patient copies your speech
36
define echopraxia
patient copies your movements
37
Tx for catatonia
lorazepam (BZD)
38
Must follow up with a patient with catatonia because it can lead to ?
- malnutrition - DVT - rhabdomyolysis
39
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?
malignant catatonia
40
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?
neuroleptic malignant syndrome
41
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?
Malignant hyperthermia
42
Tx for malignant hyperthermia
dantrolene
43
What is the theory on how antidepressants work?
- 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
How long should you treat a patient with depression?
- for at least 6 months once you reach an effective med and dose
45
Certain antidepressants require a washout period before you start another antidepressant. Why?
- Could cause serotonin syndrome
46
Why must you have a washout period when switching out fluoxetine?
- It has a long half-life.
47
Name some SSRIs
- sertraline - escitalopram - fluoxetine - paroxetine - citalopram
48
What are the two main ADRs of SSRIs that people want to stop taking them?
- sexual dysfunction | - weight gain
49
Name some SNRIs
- Venlafaxine - Desvenlafaxine - Duloxetine
50
____ is an atypical antidepressant that can also be used to help a person stop smoking.
- bupropion (Wellbutrin)
51
Mirtazapine is a serotonin modulator but has an ADR of ?
- appetite stimulation--> weight gain | * good for an elderly patient who is depressed and is thin
52
- ADR of trazodone
- priapism
53
- Trazodone is used as a ____ even though it is a serotonin modulator.
- sleep aid
54
Imipramine and doxepin are what kind of antidepressant class?
- tricyclic acid antidepressants
55
Trptyline drugs can also be used to treat ___ and ___ plus depression.
- neuropathic pain | - enuresis
56
Selegine and phenylzine are what type of antidepressants?
- monoamine oxidase inhibitors
57
ADR associated with MAOi's?
- tyramine crisis--> HTN crisis due to eating meats and cheeses while on the medication
58
Lithium is a known teratogen. What can it cause?
- ebstein anomaly in a fetus
59
Valproic acid is a known teratogen. What can it cause?
- spina bifida (neurological impairments to the fetus)
60
Common ADRs of valproic acid?
- pancreatitis - agranulocytosis - decreased platelets
61
___ can be used as an adjunct in mood stabilizing; is a known antipsychotic
quetiapine
62
ADRs of quetiapine
- prolongation of QT complex - weight gain - drowsiness
63
Carbamazepine is used to treat?
- mood disorders as a second line - absence seizures - trigeminal neuralgia
64
Treatment for benzodiazepine withdrawals?
- diazepam or chlordiazepoxide
65
ADRs of beta blockers
- decreased heart rate | - decreased mood

Psychiatry (15 decks)

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