Mood Disorders Flashcards
Which of the following is necessary for a diagnosis of major depressive disorder with seasonal pattern?
A. At least four episodes of depressive disturbance in the previous 2 years
B. Full remission must occur at a characteristic time of year
C. Seasonal episodes must be at least equal to nonseasonal episodes
D. Seasonal-related psychosocial stressors must be present
Full remission must occur at a characteristic time of year (i.e. Spring time)
A 27-year-old woman presents to the clinic reporting a depressed mood for the past 2 weeks. She states she has had significant weight gain, has been sleeping more than usual, has decreased interest in normally pleasurable activities, feels guilty, and has had decreased concentration. She states she had a hypomanic episode in the past while she was using amphetamines. What is the most likely diagnosis?
MDD (Unipolar Depression)
A 65-year-old man who does not have housing and has a history of diabetes mellitus and post-traumatic stress disorder is admitted to inpatient psychiatry approximately 24 hours after presenting to the emergency department with tremulousness and a report of “two voices laughing at me.” Upon initial psychiatric assessment, the patient states, “the voices are terrifying…they sound like demons” and then clarifies “but they aren’t bothering me anymore.” His ethanol level on admission was 300 mg/dL. Nursing notes that the patient slept 3.25 hours and appeared agitated at 02:00. Today, his morning vital signs are temperature 99.0°F, HR 98, BP 165/88, and RR 20. Based on his presentation, what is the primary diagnosis for this patient?
What is the best medical management for this patient?
Alcohol Hallucinations
Benzo’s (Lorazapam or chlordiazepoxide)
Antipsychotics may be given to reduce emergent agitation during alcohol hallucinosis but should be used sparingly. Antipsychotics may induce extrapyramidal symptoms or neuroleptic malignant syndrome and are not indicated for long-term use in patients with secondary psychoses.
A patient with symptoms of major depression is seeking help to stop smoking. Which medication would be most suitable to treat both conditions simultaneously?
What is the MOA of the most suitable medication?
Buproprion
Blocks reuptake NE and dopamine
What is the strongest risk factor associated with Bipolar I Disorder?
Are men or women affected more?
Family History
Men = Females
In patients with Bipolar is lithium associated with a decreased suicide rate?
Yes, why it is considered first-line for treatment
What is the difference between Bipolar and Schizophrenia?
Although they have similarities, bipolar disorder primarily causes extreme mood shifts, whereas schizophrenia causes delusions and hallucinations.
What is the definition of sucide gesture?
Suicide gesture is self-injurious behavior that is intended to lead others to think that one wants to die despite no intention of dying
What risk factor is the most associated with sucide?
Previous sucide attempt
Does asking patients about suicide increase the incidence of suicide?
What psych medication is contraindicated with suicide ideation?
No
monoamine oxidase inhibitors (MOI’s)
Contraindicated because they are lethal at high doses. In contrast, SSRI’s should be used in patients with sucidial ideations because they are safer if taken as an overdose.
What are some protective factors of suicide?
Marriage and Pregnancy
What dissociative anesthetic can be used to treat severe depression?
Ketamine
What is the MOA of Bupropion?
What adverse effect are you most worried about with Bupropion?
Bupropion is an aminoketone antidepressant
Mechanism by which depression is relieved is unclear but may be related to blockade of dopamine or NE reuptake
Seizures
Most common adverse effects are agitation, headache, dry mouth, constipation, weight loss, GI upset, dizziness, tremor, insomnia, blurred vision, and tachycardia
What is the mechanism of action of mirtazapine?
Mirtazapine is in a group of tetracyclic antidepressants (TeCA). Mirtazapine inhibits the central presynaptic alpha-2-adrenergic receptors, which causes an increased release of serotonin and norepinephrine.
When do most Seratonin Syndrome cases present?
Most cases present within 24 hours (usually within 6 hours) of initiating a new serotonergic medication, such as sertraline, or changing the dosage.
What can be given as serotonin antagonist in the treatment of seratonin syndrome?
What is the role of benzodiazepines?
Cyproheptadine
Given for agitation, to reduce hyperthermia, and to high HR and BP
What are the 5 stages of grief?
- Denial
- Anger
- Bargaining
- Depression
- Acceptance
What medications should not be given/taken with serotonergic drugs due to the increased risk of seratonin syndrome?
- St. John’s wort
- MDMA (ecstacy)
- Cocaine
- Amphetamines
What criteria is used to diagnose seratonin syndrome?
Hunter Criteria
hypertonia, agitation, tremor, hyperreflexia, temperature and clonus
*Clonus is the most important criteria
In addition to women, which other demographic of the population should take a lower dose of zolpidem?
Older patients, regardless of gender should take the lowest dose (5mg) of zolpidem for sleep distrubance or insomnia
A 25-year-old man presents to the emergency department after being arrested for stealing from a department store. He states that he is the president of the United States. He also says that he has not slept for three days and does not feel like he needs to sleep. During the interview, he speaks rapidly and is easily distracted. He does not use substances, and the toxicology screen is negative. What is the most likely diagnosis?
Bipolar I Disorder
What does SIGECAPS stand for?
*Sadness
*Lack of interest/anedonia
*Guilt
*Lack of energy
*Lack of concentration
*Appettite loss
*Psychomotor activity
*Suicide ideation
