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Elaina: Psych > Mood Disorders > Flashcards

Mood Disorders Flashcards

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1
Q

which mood disorder carries a 70 percent rate of comorbid substance abuse (ETOH)?

A

bipolra

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2
Q

how is rapid cycling bipolar disorder characterized?

A

at least four episodes per year

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3
Q

how do we characterize bipolar disorder type 2?

A

hypomania (less than 4 days duration) alternating with depression

they have NEVER had a TRUE manic episode

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4
Q

how do we characterized mixed mania subtype of bipolar disorder?

A

simultaneous mania and depression

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5
Q

what is the strongest risk factor for bipolar disorder?

A

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
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6
Q

what are the three theories for the pathophysiology behind bipolar disorder?

A

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)

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7
Q

when is bipolar disorder usually diagnosed?

A

13-18 years old

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8
Q

which part of the brain will be significantly increased in size in a patient with bipolar disorder?

A

amydala

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9
Q

when does the average person with bipolar disease receive a proper diagnosis?

A

not until 10 years after first episode!

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10
Q

for which population is there a very poor prognosis with bipolar disorder?

A

childhood onset BPD!

kids diagnosed under 12 might not get DX and TX for 20 years

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11
Q

what mnemonic can we use for describing a manic episode?

A

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

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12
Q

what is the difference between hypomania and mania?

A

in hypomania you are FUNCTIONAL and often productive; just hyper and extra alert

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13
Q

what are the main differences between bipolar I depression and unipolar depression?

A

in bipolar I depression: sleep a LOT, eat a lot, gain weight, psychotic features

in unipolar depression: reduced sleep, low appetite, weight loss

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14
Q

which mood stabilizer should you use for acute mania in bipolar disorder?

A

valproate! has a much more rapid onset (1-4 days) than lithium (14 days)

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15
Q

which mood sequence (between euthymia, depression, mania) does best with mood stabilizers?

A

mania/depression/euthymia do better than depression/mania/euthymia

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16
Q

which is the DOC in older patients with bipolar disorder?

A

valproate (less cognitive impairment than lithium)

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17
Q

which two drugs used for bipolar disorder carry a black box warning for SJS and TEN syndrome?

A

lamotrigine** and carbamazepine

18
Q

which antipsychotic is most associated with weight gain?

A

olanzapine

19
Q

which antipsychotic has a big effect on prolactin (galactorrhea, gynecomastia, infertility) and weight gain?

A

risperidone

20
Q

which is often our antipsychotic DOC due to not carrying much risk of QT prolongation, DM, or prolactin changes?

A

quetiapine (seroquel)

21
Q

why might someone be interested in ziprasidone (geodon) to treat their psychosis? what are the benefits?

A

no effect on diabetes, lipids, weight gain

22
Q

what are the benefits of using an antipsychotic such as aripiprazole (abilify)?

A

no effect on diabetes, weight gain, prolactin, EPS, sedation

23
Q

what is our only therapy that is superior to pharmacotherapy in treating bipolar disorder?

A

bilateral ECT

24
Q

is ECT safe in pregnancy?

A

yes!

25
Q

what should you do if you believe there is a seasonal component to your patients bipolar disorder?

A

phototherapy!

26
Q

any treatment for depression (phototherapy, ECT, SSRI, etc) carries the risk of what?

A

inducing mania in a bipolar patient

27
Q

what interesting technique regarding sleep-wake cycles has shown 40-60 percent improvement in bipolar patients’ propensity to have a manic episode?

A

sleep deprivation

28
Q

what is the difference between cyclothymia and bipolar disorder type 2?

A

cyclothymia is more chronic (over 2 years) – it is mild depression followed by hypomania

bipolar type 2 is SEVERE depression followed by hypomania

29
Q

what is the mnemonic we use to remember the symptoms of major depressive disorder? what does each letter mean?

A

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

30
Q

what are the criteria for diagnosing major depressive disorder?

A
  • 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
31
Q

what percentage of people who have an episode of MDD have a second episode?

A

60 percent

32
Q

in which population is major depressive disorder most common, what is the lifetime risk for these patients?

A

MC in women between onset of menstruation and menopause and those using hormone therapy

21 percent lifetime prevalence

33
Q

patients with disease in which body system are more likely to experience depression?

A

cardiovascular disease

4x more likely to experience post MI

34
Q

what are the contraindications for ECT?

A

recent MI, barry aneurysm, brain mass, increased intracranial pressure

35
Q

why may a patient be resistant to try ECT?

A

stigma, short term confusion/memory loss/delerium

36
Q

the PHQ-9 and QIDS are helpful in making a diagnosis for what disorder?

A

depression

37
Q

about what percentage of patients have adequate treatment for their depression?

A

less than half :(

38
Q

how long should you continue treatment in a patient with one lifetime episode of MDD?

A

6-12 months

39
Q

how long should you continue treatment in a patient with 2 lifetime episodes of MDD?

A

15 months-3 years

40
Q

how long should you continue treatment in a patient with 3+ episodes of MDD?

A

lifelong

41
Q

biggest downside to SSRIS in treating anxiety, depression?

A

decreased sex drive

42
Q

biggest downside of using tricyclics to treat depression?

A

drying of mucosal membranes, reduction of lubrication, inhibits erection and ejaculation

Elaina: Psych (7 decks)

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