Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Board Certification > Mood disorders > Flashcards

Mood disorders Flashcards

1
Q

MDD prevalence

A
  • Lifetime prevalence is 12%

- 3 times higher for young adults than people over 60

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Bipolar prevalence

A

BP I and II are both around 1% to 1.5%

BP I is equal in men and women

BP II is greater in women

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

MDD onset

A

Mean age at 40 years

50% have onset between ages 20 to 50 years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Bipolar age of onset

A

Can start at 5 years old and all the way to 50+

Mean onset is 30

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

MDD risk factors

A

conduct disorder

low education

and other obvious stuff

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Bipolar risk factors

A

Very strong genetic effects

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

MDD prognosis

A

Untreated episodes last 6 months to a year

50% will recover in 1st year after hospitalization

5 to 10% will have a manic episode after a while

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Bipolar prognosis

A

50% will have a 2nd manic episode within 2 years.

50 to 60% of patients achieve significant control on lithium

15% suicide rate

Example of a poor prognostic indicator is male gender

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Criteria for Dysthymic Disorder (persistent depressive disorder)

A

2 or more of the MMD symptoms for at least 2 years (1 year for children)

Has never been without symptoms for more than 2 months

Impaired functioning

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

MADRS

A

Montgomery-Asberg Depression Rating Scale

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

EPDS

A

Edinburgh Postnatal Depression Scale

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Adjustment disorder with depressed mood

A

Psychological symptoms present within 3 months of the stressor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

PMDD

A

depressed prior to menses and end at the start of menses

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Mania criteria

A

Mood change +
Increased goal directed activity or increased energy +
3 or more other symptoms (4 or more if mood is irritable) +
Present for a week

Not due to substances/antidepressants

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Hypomania criteria

A

Same except only lasts 4 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Mixed episode criteria (mania and depression)

A

Meets both mania and depressive criteria nearly everyday for a week

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

MDQ

A

Mood disorder questionnaire

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

YMRS

A

young mania rating scale

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

BSDS

A

bipolar spectrum disorder scale

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Treatment guidelines for MDD

A

Medication
Psychotherapy

Possibly medication +psychotherapy
Possible ECT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Treatment guidelines for Severe MDD without psychotic features

A

Medication
Medication + psychotherapy
ECT

Not psychotherapy alone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Some indicators of severe MDD

A

PHQ 9 over 20

Duration over 2 years

3 or more episodes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Treatment guidelines for Severe MDD with psychotic features

A

Medication (antidepressant + antipsychotic)
Medication + psychotherapy
ECT

Not psychotherapy alone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Examples of situations that support the use of psychotherapy

A

Pregnancy

comorbid personality disorder

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Pregnancy and psychotropics
There is limited data
26
FDA pregnancy risk categories
B - There may or may not be harm in animals, but no evidence of harm in people C - Harm to animals, but THERE ARE NO studies in humans D - There is evidence of risk to humans, but occasionally you may still want to use it X - do not use it
27
Lactation Risk categories
L2 - limited number of studies without significant risk L3 - minimal/non-life-threatening risk L4 - Hazardous, may be used if the mother's condition is life-threatening
28
Are you required to notify a patient about off label use?
It's not legally required, but recommended
29
Citalopram
Limit to 40 mg (20 mg for people over 60) due to prolonged QT effect
30
Serotonin syndrome can be associated with giving SSRIs plus
MAOIs
31
SSRI pregnancy categories
Most are C Paroxetine is D (cardiac effects) The baby can have SSRI withdrawal
32
SSRI lactation category
Sertraline paroxetine are L2
33
3 pearls about SNRIs
Before starting an SNRI and periodically after starting, measure blood pressure Avoid them in alcoholism/liver disease due to rare liver toxicity Contraindicated within 2 weeks of having an MAOI
34
SNRI pregnancy and lactation categories
C L3
35
Bupropion pearls
Watch out for seizure history C L3
36
TCA neurotransmitters
serotonin and NE Clomipramine is more serotonin Desipramine is more NE
37
4 TCA pearls
The 2 types of prominent side effects: Anticholinergic and Cardiac Can be used for chronic pain Monitor drug level Do an ECG for kids
38
TCA pregnancy and lactation
C or D L2
39
Mirtazapine neurotransmitters
Serotonin and norepinephrine
40
Mirtazapine pregnancy and lactation
C and 3
41
Vilazodone (Viibryd) mechanism of action
SSRI and serotonin 1A partial agonist
42
Vilazodone is good for sexual functioning and good for
not gaining weight
43
Vortioxetine (Trintellix) mechanism of action
serotonin modulator and stimulator. It works on more than one serotonin receptor site: partial agonism at some and antagonism at others.
44
MAOI examples
Phenelzine Selegiline Tranylcypromine Isocarboxazid
45
MAOI adverse effects
combining them with anything that increases norepinephrine can raise blood pressure. Also, combining it with anything that increases serotonin can cause serotonin syndrome
46
MAOI pregnancy and lactation
Pregnancy is C and lactation is unknown
47
Paroxetine half life
21
48
Sertraline half life
26
49
Lexapro half life
27 to 32
50
Citalopram half life
33
51
Fluoxetine half life
84 hours (3.5 days), metabolite is 1 to 2 weeks
52
Antidepressant discontinuation syndrome can be remembered with the mnemonic Finish
``` Flu like Insomnia Nausea Imbalance Sensory disturbances Hyperarousal (agitated) and Headache ```
53
Best psychotherapy for MDD
EBP: ``` CBT IPT Problem solving ACT (acceptance and commitment therapy) Mindfulness based cognitive therapy ``` Not EBP but is an option: Psychodynamic Group, marital, or family style as needed
54
How long until you can fairly evaluate your treatment for MDD
4 to 8 weeks
55
Has the MDD has improved 100% in a month?
If "yes," move to continuation phase of treatment If "no," reassess the diagnosis, adverse effects, comorbid conditions, psychosocial factors, quality of therapeutic alliance, treatment adherence Modify treatment Reassess in 4 to 8 weeks. If there's still not enough improvement, repeat the steps above or maybe get a consultation
56
If the MDD treatment is inadequate, you can maximize the initial treatment approach by
Raising the dose Consider going above the FDA approved dose Extend the trial time Adjust the frequency or type of therapy
57
If the MDD treatment is inadequate, you can try changing to other treatments by
Switching from therapy to an antidepressant Switching from one antidepressant to another, including to an MAOI
58
If the MDD treatment is inadequate, you can trying augmenting and combining treatments, such as
Adding another antidepressant (not MAOI because of the d-d interaction) Adding lithium, thyroid hormone, or SGA Less supporting evidence for adding anticonvulsant, omega 3, folate, vitamin D, psychostimulant, benzo, buspar
59
Treatment resistant depression
ECT is the most effective treatment for treatment resistant depression Other options are TMS, vagus nerve stimulation, deep brain stimulation, and ketamine
60
Continuation phase of MDD
Goal is to reduce the risk of relapse Continue antidepressants for 4 to 9 months Continue psychotherapy For ECT responders, provide antidepressants and/or continuation ECT Involve family and patient to identify early warning signs
61
Maintenance phase of MDD
Comes after continuation phase Acknowledge that 20% of patients relapse in 6 months, and 50 to 85% will have at least one relapse over the lifetime It's indicated for patients with 3 or more episodes, patients with recurrence risk factors, comorbid psych and medical issues
62
Risk factors for MDD relapse
``` persistent mild symptoms history of MDD episodes severe episodes early onset comorbid disorders medical disorders family history psychosocial stressors negative coping style sleep disturbance ```
63
Discontinuing MDD treatment
Stopping psychotherapy has less risk than stopping meds Advise against stopping before a stressful event Schedule a follow up in 2 months after stopping treatment
64
Psychiatric management of bipolar disorder: Besides the obvious stuff, other interventions can include
Limiting access to bank accounts during mania Tell them that 50% of people who go off lithium will relapse in 5 months
65
Are SGAs off label for the treatment of mania?
No, they are FDA approved
66
Besides SGAs, what are good adjuncts for manic agitation, insomnia, bipolar dysphoria, and bipolar panic
High potency benzos like ativan and klonopin
67
What kinds of meds would we give for Severe mania or mixed episodes
Mood stabilizer plus SGA, and benzos can help too
68
what would be the medication for not so severe mania
monotherapy with lithium, valproate, or an SGA (just monotherapy)
69
What should you know about the comparison between lithium and valproate in treating mixed episodes of bipolar
Valproate is better than lithium for mixed episodes
70
In addition to medications, what's another important intervention for mania
psychosocial therapy
71
What do you do if there is a break through episode of mania
Check serum levels Restart the 2nd generation antipsychotic Use a benzo on a short term basis
72
If mania is not controlled after 10 to 14 days, what do you do
Add another first-line medication, such as carbamazepine, add a SGA, or switch to another SGA
73
What are some options for severely refractory mania
ECT or clozapine
74
What are the first line options for acute bipolar depression
Lithium, lamotrigine, or if severe started lithium plus an antidepressant (though there is little data to support this)
75
What is an antidepressant and antipsychotic combination that could be used for acute bipolar depression
fluoxetine and olanzapine
76
When should you consider ECT for acute bipolar depression
life-threatening suicidality psychosis pregnancy Very severe cases
77
What are 2 good therapies for acute bipolar depression
IPT and CBT
78
What do you do for breakthrough bipolar depression
Check serum levels add lamotrigine, bupropion, or paroxetine
79
What do you do if psychotic features arise with bipolar depression
add SGA
80
What are the 2 first line meds for rapid cycling, and what is the alternative
Lithium and valproate, and lamotrigine
81
Which medications have the best evidence for maintenance treatment of bipolar disorder, and what are alternative meds
Lithium and valproate Lamotrigine, carbamazepine, oxcarbazepine
82
What about antipsychotics in the maintenance treatment of bipolar?
Usually discontinue adjunctive antipsychotics unless psychosis is/could be a concern. Sometimes you will continue the SGA even without psychosis, but there's not as much evidence to support it as there is for Li and valproate
83
Which SSRI interacts with warfarin and how?
Fluoxetine effects the metabolism of warfarin
84
A patient drinks a lot of alcohol daily. Which antidepressant should you avoid
duloxetine, it can cause liver toxicity
85
``` Which is an EARLY warning sign of Li toxicity? A) Nausea B) Convulsions C) Coarse hand tremor D) Thirst ```
Coarse hand tremor is an early sign. Convulsions is a LATE sign, Nausea and thirst are expected side effects.
86
SSRIs can combined oral contraceptives and sumatriptan (for migraines)
Ok with COCs | Contraindicated with sumatriptan (too much serotonin)

Board Certification (12 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions