Mood Disorders Flashcards
which mood disorder carries a 70 percent rate of comorbid substance abuse (ETOH)?
bipolra
how is rapid cycling bipolar disorder characterized?
at least four episodes per year
how do we characterize bipolar disorder type 2?
hypomania (less than 4 days duration) alternating with depression
they have NEVER had a TRUE manic episode
how do we characterized mixed mania subtype of bipolar disorder?
simultaneous mania and depression
what is the strongest risk factor for bipolar disorder?
genetics!
- -risk of illness in 1st degree relative is 10x the general population
- -30 percent chance if one parent has BPD
- -50-75 percent if 2 parents
- -risk in identical twins 63 percent
what are the three theories for the pathophysiology behind bipolar disorder?
1) abnormality of synapses, circuits, and regulation of plasticity cascades
2) impaired mitochondrial function leading to impaired energy metabolism
3) HPA axis dysregulation: significant elevation of cortisol (abnormal response to stressors)
when is bipolar disorder usually diagnosed?
13-18 years old
which part of the brain will be significantly increased in size in a patient with bipolar disorder?
amydala
when does the average person with bipolar disease receive a proper diagnosis?
not until 10 years after first episode!
for which population is there a very poor prognosis with bipolar disorder?
childhood onset BPD!
kids diagnosed under 12 might not get DX and TX for 20 years
what mnemonic can we use for describing a manic episode?
DIGFAST
D: distractable (move between projects, conversation topics)
I: insomnia; decreased need for sleep
G: grandiosity
F: flight of ideas (start many projects)
A: agitated (bouncing off the walls)
S: sexual exploits (many partners in one week)
T: talkative
what is the difference between hypomania and mania?
in hypomania you are FUNCTIONAL and often productive; just hyper and extra alert
what are the main differences between bipolar I depression and unipolar depression?
in bipolar I depression: sleep a LOT, eat a lot, gain weight, psychotic features
in unipolar depression: reduced sleep, low appetite, weight loss
which mood stabilizer should you use for acute mania in bipolar disorder?
valproate! has a much more rapid onset (1-4 days) than lithium (14 days)
which mood sequence (between euthymia, depression, mania) does best with mood stabilizers?
mania/depression/euthymia do better than depression/mania/euthymia
which is the DOC in older patients with bipolar disorder?
valproate (less cognitive impairment than lithium)
which two drugs used for bipolar disorder carry a black box warning for SJS and TEN syndrome?
lamotrigine** and carbamazepine
which antipsychotic is most associated with weight gain?
olanzapine
which antipsychotic has a big effect on prolactin (galactorrhea, gynecomastia, infertility) and weight gain?
risperidone
which is often our antipsychotic DOC due to not carrying much risk of QT prolongation, DM, or prolactin changes?
quetiapine (seroquel)
why might someone be interested in ziprasidone (geodon) to treat their psychosis? what are the benefits?
no effect on diabetes, lipids, weight gain
what are the benefits of using an antipsychotic such as aripiprazole (abilify)?
no effect on diabetes, weight gain, prolactin, EPS, sedation
what is our only therapy that is superior to pharmacotherapy in treating bipolar disorder?
bilateral ECT
is ECT safe in pregnancy?
yes!
what should you do if you believe there is a seasonal component to your patients bipolar disorder?
phototherapy!
any treatment for depression (phototherapy, ECT, SSRI, etc) carries the risk of what?
inducing mania in a bipolar patient
what interesting technique regarding sleep-wake cycles has shown 40-60 percent improvement in bipolar patients’ propensity to have a manic episode?
sleep deprivation
what is the difference between cyclothymia and bipolar disorder type 2?
cyclothymia is more chronic (over 2 years) – it is mild depression followed by hypomania
bipolar type 2 is SEVERE depression followed by hypomania
what is the mnemonic we use to remember the symptoms of major depressive disorder? what does each letter mean?
SIGECAPS
S: sleep – typical (sleep less); atypical (sleep more)
I: interest – diminished
G: guilt – enhanced
E: energy – diminished
C: concentration – decreased
A: appetite/weight – typical (weight loss); atypical (weight gain)
P: psychomotor retardation – don’t want to move
S: suicidality
what are the criteria for diagnosing major depressive disorder?
- 5/8 of SIGECAPS (exception; suicide is a definite DX)
- loss of function
- sx must include loss of interest, depressed mood
- depressed mood most of the day nearly every day present over a 2 week period
what percentage of people who have an episode of MDD have a second episode?
60 percent
in which population is major depressive disorder most common, what is the lifetime risk for these patients?
MC in women between onset of menstruation and menopause and those using hormone therapy
21 percent lifetime prevalence
patients with disease in which body system are more likely to experience depression?
cardiovascular disease
4x more likely to experience post MI
what are the contraindications for ECT?
recent MI, barry aneurysm, brain mass, increased intracranial pressure
why may a patient be resistant to try ECT?
stigma, short term confusion/memory loss/delerium
the PHQ-9 and QIDS are helpful in making a diagnosis for what disorder?
depression
about what percentage of patients have adequate treatment for their depression?
less than half :(
how long should you continue treatment in a patient with one lifetime episode of MDD?
6-12 months
how long should you continue treatment in a patient with 2 lifetime episodes of MDD?
15 months-3 years
how long should you continue treatment in a patient with 3+ episodes of MDD?
lifelong
biggest downside to SSRIS in treating anxiety, depression?
decreased sex drive
biggest downside of using tricyclics to treat depression?
drying of mucosal membranes, reduction of lubrication, inhibits erection and ejaculation
