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Psychiatry > Mood disorders > Flashcards

Mood disorders Flashcards

1
Q

DSM diagnostic criteria (duration of sx) of MDE

A 
5/9 sx of Mr. SIGECAPS for >2 weeks
Mood (depressed)
Sleep
Interest
Guilt
Energy
Concentration
Appetite
Psychomotor activity 
Suicidal Ideation
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2
Q

DSM diagnostic criteria (duration of sx) of manic episode

A 
3/7 sx of DIGFAST for >1 week
Distractibility
Insomnia/Inpulsivity
Grandiosity/Goal directed activity
Flight of ideas
Activity/Agitation
Speech (pressured)
Thoughtlessness

+ severe impairment in social/occupational functioning
+ psychotic features

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3
Q

DSM diagnostic criteria (duration of sx) of mixed episode

A

criteria met for both manic and MDE for >1 week

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4
Q

DSM diagnostic criteria (duration of sx) of hypomanic episode?

A 
3/7 sx of DIGFAST for 4 days
Distractibility
Insomnia/Inpulsivity
Grandiosity/Goal directed activity
Flight of ideas
Activity/Agitation
Speech (pressured)
Thoughtlessness

no severe impairment in social/occupational functioning
no psychotic features

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5
Q

What two medical disorders are at very high risk of developing depression

A

pancreatic cancer

stroke

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6
Q

DSM diagnostic criteria (duration of sx) of MDD

A

at least 1 episode of MDE with no hx of mania/hypomania

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7
Q

What should you suspect in a patient with weight gain and increased appetite?

A

Major depression with atypical features

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8
Q

What should you suspect in a patient with weight gain without appetite?

A

metabolic disorder (ie hypothyroidism)

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9
Q

How do you differentiate between MDD vs dementia in terms of effort during cognitive testing, insight to intellectual difficulties, cortical/neurological signs?

A

MDD: very little effort during cognitive testing, increased insight to intellectual difficulties, ø cortical/neurological signs
dementia: lots of effort during cognitive testing, decreased insight to intellectual difficulties, + cortical/neurological signs

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10
Q

How do adults with MDD often present? children?

A

Adults: sad, depressed
Children: angry, mad, irritable/short-tempered

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11
Q

What are the sleep problems associated with MDD?

A

multiple awakenings throughout the night
ntial and terminal insomnia (difficulty falling asleep, early morning awakenings)
hypersomnia (excessive sleepiness)
decreased REM sleep

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12
Q

4 pathophysiological findings of depression

A

decreased serotonin
abnormal upregulation of ß-receptors
high cortisol (due to hyperactivity of HPA)
abnormal thyroid axis

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13
Q

T/F if untreated, MDE will last for 6-13 months

A

True. MDE are self-limiting, but will generally occur more frequently as the disease progresses

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14
Q

black box warning for antidepressants use in pediatric patients?

A

increases risk of suicidality

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15
Q

SSRIs are notorious for these ADRs

A

sexual dysfunction, GI disturbance, HA

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16
Q

MAOi are notorious for this ADR

A

serotonin syndrome, esp. when used in combination with SSRI or when tyramine-rich foods are consumed

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17
Q

TCAs are notorious for this ADR

A

QT prolongation

Others: anticholinergic effects (dry-mouth, constipation), sedation, weight gain, orthostatic hypotension

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18
Q

Non-responders to antidepressants can be converted to responders using which medications? (ie augmentation therapies)

A

Thyroid hormone
Lithium
L-tryptophan

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19
Q

What are MAOi’s generally indicated for?

A

Atypical depression

20
Q

When is ECT indicated?

A

when a patient is refractory to or can’t tolerate pharmacotherapy, or if a rapid reduction of symptoms is desired (imminent suicide risk)

21
Q

common ADRs of ECT

A

retrograde/anterograde amnesia
HA
Nausea
muscle soreness

22
Q

what is the melancholic subtype of MDD

A

anhedonia, early AM awakenings, psychomotor disturbance, excessive guilt, anorexia

23
Q

what is the atypical subtype of MDD

A 
hypersomnia
hyperphagia -> weight gain
reactive mood
leaden paralysis
hypersensitivity to interpersonal rejection
24
Q

what is the catatonic subtype of MDD

A

immobility, purposeless motor activity, extreme negativism or mutism, bizarre postures, echolalia

25
Q

what is the psychotic subtype of MDD

A

presence of mood-congruent delusions or auditory hallucinations

(mood congruent delusions reflect MDD - delusions of being defective, deficient, diseased, guilty, or deserving of punishment)

26
Q

∆ btwn normal grief and depression in terms of:
time
suicidal thoughts
perceptual disturbances present

A

normal grief
time: 2 mo
suicidal thoughts: yes
perceptual disturbances present: hallucinations and delusions

27
Q

DSM diagnostic criteria (duration of sx) of bipolar I disorder

A

one manic (or mixed) episode

28
Q

definition of rapid cycling in bipolar

A

occurrence of >4 mood episodes in one year

29
Q

typical onset for bipolar

A

< 30 yo

30
Q

3 main Ddx for manic sx

A

bipolar
ADHD (if patient is <7 yo)
oppositional defiant disorder

31
Q

what must you rule out before a diagnosis of bipolar is made

A

Rx or OH use

32
Q

of all the major psychiatric disorders, which one has the highest genetic link?

A

bipolar I disorder - 1st degree relatives of patients with bipolar disorder are 8-18x more likely to develop the illness

33
Q

How long do untreated manic episodes generally last?

A

3 mo

34
Q

Why is it that antidepressant monotherapy discouraged in treatment of bipolar patients?

A

can precipitate mania

35
Q

treatment for children 12?

A

12: lithium

36
Q

which of the mood stabilizers cause increased risk of suicide? decreased risk of suicide?

A

increased: valproate, carbamazepine
decreased: lithium

37
Q

best treatment for a manic woman in pregnancy

A

ECT

38
Q

difference btwn bipolar I and bipolar II

A

bipolar I: mania lasts >7 days with marked impairment in social/occupational functioning; may have psychotic features

bipolar II: mania lasts >4 days with no impairment in social/occupational functioning; no psychotic features

39
Q

DSM diagnostic criteria (duration of sx) of bipolar II disorder

A

one MDE + one hypomanic episode

40
Q

how do you differentiate between hypomania and ADHD?

A

both have sx of distractibility, impulsivity, and hyperactivity

Hypomania - rarely occurs in preschool children
ADHD - diagnosed before age 7

41
Q

ADHD kids frequently develop which two disorders

A

oppositional defiant disorder (ODD)

conduct disorder

42
Q

∆ btwn episodic and dysthymic disorder

A

MDD: episodic
dysthymia: persistent

43
Q

DSM diagnostic criteria (duration of sx) of dysthymic disorder

A

depressed mood for 2 years, with at least 2 of the listed criteria, and never asymptomatic for >2 months

  • poor conc.
  • hopeless
  • altered appetite
  • altered sleeping
  • low energy/fatigue
  • low self-esteem

NO MDE!

44
Q

DSM diagnostic criteria (duration of sx) of cyclothymic disorder

A

numerous periods with hypomanic sx + depressive sx for 2 years, and never asymptomatic for >2 months

NO MDE!

45
Q

cyclothymic disorder may coexist with this other psychiatric disorder

A

borderline personality d/o

46
Q

Triad of SAD

A

irritability
carbohydrate craving
hypersomnia

47
Q

DSM diagnostic criteria (duration of sx) of adjustment d/o

A

development of emotional/behavioral sx within 3 months of a stressful event that causes severe distress or significant impairment in daily functioning
must resolve within 6 mo after stressor has terminated

Psychiatry (12 decks)

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