Mood Disorders

Question 1

Lyme Disease

Answer 1

can cause problems with cog. fxn and mood changes might be the first sx
- give 2-3 weeks of Doxy

Question 2

Bio changes in Depression

Answer 2

Dec metabolism of anterior frontal lobe
elevated HPA
Dec lymphocytic prolif
INCR REM sleep and core body temp

Question 3

Lithium Side Effects

Answer 3

Weight gain
Acne/skin changes
hypothyroid
polyuria
metallic taste

Question 4

Tx of Choice - Dysthymia

Answer 4

Venlafaxine or Bupropion

MAOI

Question 5

Post partum blues frequency/timeline

Answer 5

30-75% get it (avg 50%)

• starts in 3-5 days PP
• lasts days to weeks, resolves on its own
• NO ANHEDONIA ==> this is Post-partum DEPRESSION

Question 6

depression post stroke

Answer 6

higher risk of depression in post-stroke for up to 2 years, 8x INCR risk of mortality

Question 7

Sleep Deprivation in Depression vs Mania

Answer 7

can help in depression

can trigger mania - college student who gets acutely manic during finals –> give long acting BZD (clonazapem)

Question 8

Seasonal Affective d/o

Answer 8

similar to atypical depression in that INCR sleep and INCR weight gain, remits by sprint time

• carb craving
• lasts about 5-6months
• trigger is the shortened daylight
• Tx w/ light therapy and SSRI

Question 9

Acute Depressive Episode in stable Bipolar

Answer 9

on top of Lithium start a antidepressant

• anti-dep triggered mania seen in about 30% so start low, and taper off once the depression is gone
• some anti-dep may cause rapid cycling
• start w/ bupropion

Question 10

Cyclothymia

Answer 10

recurrent mild depression + hypomania

• persists for 2 years (AT LEAST)
• 1 year for children/teens
• sx-free intervals are NEVER longer than 2months
• starts in teenage years/early adult and is chronic
• ddx includes borderline or substance abuse

Question 11

PMDD

Answer 11

starts 1 week before menses
HA, irritability, emo lability
other sx include edema, breast pain, weight gain
- tx include short course of SSRI +/- analgeis or diuretics

Question 12

most common complaints after ECT

Answer 12

HA
muscle soreness
nausea

Question 13

Lithium Monitoring Timeline

Answer 13

initially check plasma Li level every 1-2months
Thyroid fxn
creatinine
UA
if patient is OVER 50y --> ECG (cardiac)

Question 14

bereavement vs MDD

Answer 14

marked functional impairment
thoughts of death OTHER than id be better of dead without loved one
hallucinations OTHER than hearing loved one calling them

Question 15

childhood depression

Answer 15

SSRI works, TCA doesnt
sx diff from adult (socially withdrawn, irritable, worsening grades, no interest in friends etc)
1/3 –> will develop bipolar
auditory hallucinations common (mood congruent)

Question 16

MDD/Refractory MDD augmentation strategies

Answer 16

ADD LITHIUM

or add thyroid hormone, stimulant, estrogen , light therapy

Question 17

ECT CONTRA-indications

Answer 17

MI in past 4 weeks
space occupying lesions
INCR ICP
Aneurysms
Bleeding D/o
any condition that disrupts BBB (meningitis?)

Question 18

melancholic depression

Answer 18

Anhendonia of ALL activities
nothing makes them feel better
weight loss
intense guilt
early morning awakening
psychomotor retardation
- Tx of Choice --> TCA's

Question 19

Double depression

Answer 19

is MDD on top of dysthymia

• INCR risk of suicide
• more severe depressive sx
• more psychosoc impairment
• more tx resistance

Question 20

Atypical depresson

Answer 20

feel better in morning (reverse of MDD)
self-pity
improved mood with some pleasurable events
excess sensitivity to rejection
MAOI's = more effective