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mood disorders Flashcards

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1
Q

major depressive episode-contingent on two conditions

A

cannot be due to substance use or meds

must cause social or job impairment

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2
Q

manic epidosde criteria

A

period of abrnomally and persistently elevated, expansive or irritable modd lasting at least 1 wk (or any duration if hospitalization is needed) and including at least 3 of following (4 is mood is irritable)

distractibility
inflated self esteem
increase in goal directed activity
decreased need for sleep
flight of ideas or racing thoughts
more talkative or pressure speech 
excessive involvement in pleasurable activtiies that have high risk of neg consequences

can’t be due to substance use or med conditions and must cause social or job impairment

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3
Q

what percentage of manic pts have psychotic symptoms

A

75

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4
Q

mixed episode

A

criteria met for both manic and major depressive episode

these criteria must be present nearly everyday for at least 1 week

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5
Q

hypomanic episode

A

distinct period of elevated, expansive, or irritable mood that includes at least 3 of symptoms listed for manic episode criteria (4 if modd is irritable)

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6
Q

differences btwn hypomania and mania

A

see pg 37

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7
Q

what is the predominant mood state in mixed episodes

A

irritability

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8
Q

mixed episodes-tx?

A

poorrer response to lithium

anticonvulsants may help

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9
Q

diagnosis of major depressive disorder

A

at least 1 major depressive episode

no hx of manic or hypomanic episode

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10
Q

main pathogenesis in MDD

A

decreased serotonin and 5-HIAA

abnormal regulation of beta adrenergic receptors

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11
Q

drugs that increase levels of what alleviate depression

A

serotonin
NE
dopamine

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12
Q

loss of a parent before age what is associated with the later development of major depression

A

11

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13
Q

what percentage of pts respond to SSRIs for depression?

A

50-60

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14
Q

side effects of SSRIs

A

headache
GI disturbance
sexual dyxfxn
rebound anxiety

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15
Q

side effects of TCAs

A 
lethal in overdose
sedation
weight gain
orthostatic hypotension
anticholinergic effects
can aggravate prlonged QTC
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16
Q

most common side effect of MAOIs

A

orthostatic hypotension

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17
Q

what meds can be added for tx of depression to convert nonresponders to responders

A

liothyronin T3
T4
lithium
L tryptophan

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18
Q

ECT is performed by doing what

A

premedication w atropine
then general anesthesia and muscle relaxant
then induced generalized seizure under 1 min

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19
Q

compare effectiveness of diff antidepressant meds

A

equally effective but differ in side effects

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20
Q

serotonin syndrome

A

autonomic instability
hyperthermia
seizures
coma or death

21
Q

features of atypical depression

A 
hypersomnia
hyperphagia
reactive mood
leaden paralysis
hypersensitivity to interpersonal rejection
22
Q

catatonic depression

A 
catalepsy(immobility)
purposeless motor activity
extreme negativism or mutism
bizarre postures
echolalia
23
Q

types of depressive disorders

A

melancholic
atypica
catatonic
psychotic

24
Q

cortisol is increased in MDD-true or false?

A

true

25
Q

with mania or depressive symptoms, what is it important to assess first?

A

is it med induced or medical condition induced?

26
Q

normal grief usually lasts

A

under 2 months

27
Q

bipolar I diagnosis

A

one manic or mixed episode

28
Q

Kubler Ross model of grief has what stages?

A

denial, anger, bargaining, depression, acceptance

29
Q

always remember to include what in your differential of a psychotic patient?

A

bipolar disease

30
Q

rapid cycling

A

occurrence of four or more mood episodes in 1 year (major depressive, manic, mixed. etc)

31
Q

what has the highest genetic link of all major psychiatric disorders

A

bipolar I disorder

32
Q

what btwn episodes helps decrease risk of relapse in bipolar I?

A

lithium prophylaxis

33
Q

tx for bipolar I

A

mood stabilizers:

lithium

anticonvulsants (carbamazepine, valproic acid)

atypical antipsychotics (olanzapine, quetiapine, ziprasidone)-both as monotherapy and adjunct therapy

psychotherapy (prolongs remission once acute episode controlled)

ECT

34
Q

what is the disadvantage of anticonvulsants for tx of bipolar I?

A

increased risk of suicide (as opposide to long term lithium use which reduces suicide risk)

35
Q

side effects of lithium

A 
weight gain
tremor
GI disturbances
fatigue
cardiac arrhythmias
seizures
goiter/hypothyroidism
leukocytosis
coma
polyuria (nephrogenic diabetes insipidus)
polydipsia
alopecia
metallic taste
36
Q

what is best tx for manic woman in pregnancy

A

ECT

37
Q

anticonvulsants are especially useful in what case for bipolar I?

A

rapid cycling bipolar disorder and mixed episodes

38
Q

diagnosis of bipolar II

A

hx of one or more major depressive episodes and at least one hypomanic episode

39
Q

tx for bipolar II

A

same as for bipolar I disorder

40
Q

dysthymic disorder

A

chronic, mild depression with no discrete episodes

41
Q

diagnosis for dysthymic disorder

A

depressed modd for majority of time most days for at least 2 years (in children or adolescents at least 1 year)

at least two of the following:
poor concentration or difficulty making decisions
feelings of hopelessness
poor appetite or overeating
insomnia or hypersominia
low energy or fatigue
low self esteem

CHASES mnemonic

during the two year period:

  • the person has not been w/o above symptoms for more than 2 months at a time
  • no major depressive episode
  • never had manic or hypomanic episode
42
Q

mnemonic for dysthymic disorder

A

2 Ds
2 years of depression
2 listed criteria
never asymptomatic for more than 2 months

43
Q

tx for dysthymic disorder

A

cognitive therapy, insight oriented psychottherapy most effective

antidepressant meds (SSRIs, TCAs, MAOIs) useful when used concurrently w psychotherapy

44
Q

cyclothymic disorder diagnosis

A

numerous periods with hypomanic symptoms and periods with depressive symptoms for at least 2 years

must never have ben symptom free for more than 2 months

no hx of major depressive episode or manic episode

45
Q

cyclothymic disorder may coexist with

A

borderline personality disorder

46
Q

seasonal affective disorder

A

at least 2 consecutive yrs of 2 major depressive episodes during same season

47
Q

triad for seasonal affective disorder

A

irritability
carb craving
hypersomnia

48
Q

adjustment disorders criteria

A

emotional or behavioral symptoms within 3 months after stressful life event. symptoms produce either:

  • severe distress in excess of what wuld be expected after event
  • significant impairment in daily functioning

symptoms are not those of bereavement

symptoms resolve within 6 months after stressor has ended

Psych (20 decks)

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