Mood disorders Flashcards
Diagnostic Criteria for Depression?
“SIG E CAPS”
Sleep disturbances
Interest loss
Guilt or worthlessness
Energy decreased
Concentration deficit
Appetite disturbances
Psychomotor retardation
Suicidal thoughts
Diagnostic criteria for manic episodes?
“DIG FAST”
Distractibility
Irresponsibility
Grandiosity (grandmaster)
Fast ideas (thinking)
Agitation
Sleep isn’t needed
Talkative
What medical conditions related to depression?
Stroke, MI
DM, Cushing syndrome
Parkinson’s, Cancer
What substances induce depression?
Alcohol, anticonvulsants, anti-psychotics, stimulants withdrawal (cocaine).
What medical conditions related to manic episodes?
What substances induce mania?
Hyperthyroidism, temporal lobe seizure, HIV, MS.
- Substances: anti-depressants, sympathomimetics, stimulants (cocaine).
What is the prevalence of depression?
12% of the population
Regarding criteria, what is the duration, severity and function impairment thats required for MDD Dx?
- Duration: episodes for at least two weeks
- Severity: 5/9 of the criteria must include depressive mood and loss of interest
- Impairment: negatively affect daily life
Characteristics of depression with atypical features?
Hyperphagia
Hypersomnia
Leaden paralysis (heavy limbs)
Subtypes of depression?
- Postpartum (onset is peripartum)
- MDD with psychotic features (hallucinations or delusions)
- MDD with seasonal pattern (related to decreased exposure to sun in winter season)
- Depression with atypical features
SSRI ADRs?
- Insomnia (use daylight)
- GI upset (use after food)
- Withdrawal symptoms and relapse (no addiction)
- Transient anxiety
- Headaches
- Transient sexual dysfunction
- Anorexia and weight loss
What are the non-pharmacological treatment for depression?
- Lifestyle modifications (physical activity + deep breathing test)
- Psychotherapy (CBT, interpersonal therapy, talk therapy)
What are the first line of antidepressants for depression?
SSRI (Cipralex)
What are the antidepressants options for depression?
- SSRI
- SNRIs (venlafaxine)
- TCA
- MAOI
What are the ADRs of TCA?
Arrhythmia
Prolonged QT
Weight gain
What are the ADRs of MAOIs?
Orthostatic hypotension
HTN crisis
When to do Electroconvulsive therapy in depressed patient?
- Unresponsive to medications
- Can’t tolerate medications
- Extremely safe procedures (ADRs caused by anesthesia)
When to avoid Electroconvulsive therapy?
- Severe CV disease
- Recent MI/Stroke
- Space occupying lesion
- Unstable aneurysms
What are the diagnostic criteria for Persistent depressive disorder?
- Depressed mood >/- 2 years
- Never without symptoms for 2 months during the two years
+ 2 or more of these symptoms: - Poor concentration
- Hopelessness
- Insomnia or hypersomnia
- Low energy or fatigue
- Low self esteem
What are the sleep disturbances in MDD?
- Difficulty initiating sleep
- Multiple awakening
- Early morning awaking
What is the difference between mania and hypomania?
Mania:
- Last 7 days followed by hypomania or depressed mood
- Severe social / occupational impairment
- MUST hospitalize patient
- +/- psychotic symptoms
Hypomania:
- 4-6 days
- no the other things
What is the prevalence of bipolar disorder among population?
1-2%
*Bipolar has the strongest genetic link among other diseases
What is the management of bipolar disorder?
- Mood stabilizer (Lithium, valproic acid)
- CBT
- ECT if medication failed
What is the investigation needed before starting Lithium?
- CBC
- LFT, RFT, TFT
- ECG, electrolytes
- Pregnancy test**
What is the complication of lithium in pregnant woman, how to avoid?
Ebstein anomaly (congenital heart defect)
- Stop the medication 1 month before planning pregnancy
What is the normal, toxic and lethal levels of lithium in blood?
Normal: 0.6 - 1.2
Toxic: >1.5
Lethal: >2
* Lithium blood level must be checked 5 days after taking it.
What are the ADRs of lithium?
- GI disturbances (take it after food)
- Sedation (taken before sleep)
- Metallic taste & dry mouth
- Tremor
- Hypothyroidism
- Weight gain (increases appetite)
- Diabetes insipidus (polyuria/dipsia)
- ECG changes
