Mood Disorders

Question 1

Norepinephrine, dopamine
 Enhances:

Answer 1

▪ Concentration
▪ Ambition
▪ Productivity

Question 2

most common psych disorder

Answer 2

depression

Question 3

why do life events precipitate depression

Answer 3

stress reduces neurotransmitters

Question 4

Sensitivity:

Answer 4

SNOUT
sensitivityrules out

Question 5

Specificity:

Answer 5

Specific positive
rule IN disease
SPIN

Question 6

indications for labs with depression

Answer 6

 First episode of depression
 Precipitant unclear
 Severe depression
 Older age

Question 7

Depression- labs to check

Answer 7

CBC, CMP, TSH, B12/folate, pregnancy test, UDS

Question 8

Major Depressive Disorder

Answer 8

> 5 symptoms present, most of the day, nearly every day, >2 weeks
One symptom must be depressed mood or loss of interest/pleasure

Question 9

Bipolar Disorder: 15 Symptoms

Answer 9

• Depression
• Hyperactivity
• Insomnia!!!
• Mood swings
• Anxiety
• Irritability
• Impulse control problems
• Delusions
• Paranoia
• Low energy
• Inability to focus
• Substance abuse
• Alcohol abuse
• Legal problems
• Relationship issues

Question 10

1st line depression meds

Answer 10

SSRIs

Question 11

SSRI highest risk pregnancy

Answer 11

prozac, paxil

Question 12

lowest SSRI risk pregnancy

Answer 12

escitalopram

Question 13

SSRI side effects

Answer 13

diarrhea, N/v, sexual dysfunction, somnolence, weight gain

Question 14

Prescribing antidepressants in older adults

Answer 14

SSRI- first choice- citalopram, escitalopram, sertraline

Question 15

antidepressant on BEERS list

Answer 15

TCAs
Avoid paroxetine, fluoxetinea

Question 16

Discontinuing SSRIs

Answer 16

taper slowly over 1-2 months

Question 17

serotonin syndrome

Answer 17

Symptoms: rapid heart rate, changes in blood pressure and temperature, confusion, restlessness, agitation,
headache, nausea, vomiting, tremors, shivering
* Severe symptoms: Call 911; refer to emergency department
 Seizures, high fever, syncope, irregular heart rate
* Management: stop the SSRI, SNRI, other meds
* Consider: cyproheptadine (Periactin) to block serotonin production

Question 18

SNRI that does not raise BP

Answer 18

duloxetine

Question 19

SNRI indications

Answer 19

 Depression unresponsive to SSRIs
 Anxiety disorders
 Chronic pain, especially neuropathic pain
 Menopausal VMS (hot flashe

Question 20

NDRI

Answer 20

buproprion
Indications:
 Depression, ADHD (Why?)
 Cigarette smoking cessation, weight loss
 No sexual side effects, no weight gain

Question 21

NDRI contra

Answer 21

seizures
hypertension

Question 22

highest suicide rates among

Answer 22

older men

Question 23

Suicidal Risk Factors

Answer 23

1. Presence of psych disorders
2. Hopelessness
3. Impulsivity
4. History of attempts
5. Marital status: highest to lowest risk shown below
    Never married > Widowed > Separated > Divorced > Married without children > Married with children

Question 24

if positive depression screening, next should be

Answer 24

labs