mood disorders

Question 1

which mood disorder has worse prognosis, higher suicide rates than MDD, and usually requires hosptialization

Answer 1

bipolar I

Question 2

One more MANIC episodes

Episodes of depression are common but are not necessary for diagnosis.

Answer 2

bipolar I

Question 3

One or more major DEPRESSIVE episodes + at least one hypomanic episode

Answer 3

bipolar II

Question 4

similar to bipolar I but less severe and cause less social impairment

Answer 4

bipolar II

Question 5

what may trigger a manic episode; medications wise

Answer 5

antidepressants without mood stabilizers

Question 6

• can go days without sleep, very talkactive and loud, socially outgoing, overly self confident, hypersexual, disinhibited
• difficult to follow thought process, judgement impaired

Answer 6

bipolar I

Question 7

bipolar I tx

• effective
• acute mania
• agitation or psychotic
• acute depression
• secondary tx

Answer 7

bipolar I tx

• effective: mood stabilizers
• acute mania: 2nd gen antipsychotics
• agitation or psychotic: haldol or benzos
• acute depression: SSRI or quetiapine; use olanzapine concurrently for depression
• secondary tx: ECT, MAO-I, TCA

Question 8

bipolar II does not have what

Answer 8

no manic or mixed episodes

Question 9

tx for bipolar II when pt mainly has depression

Answer 9

lithium

Question 10

which d/o does MDD develop in 10-20% of pts

Answer 10

dysthymic d/o

Question 11

what is dysthymic d/o?

-no what

Answer 11

Less severe but longer lasting depression
“bad state of the mind”
- no psychotic, MDE, or manic/hypomanic features

Question 12

how to dx dysthymic d/o

Answer 12

during 2 year period- depressive sx never absent more than 2 months

Question 13

dysthymic d/o tx
1st line
3 other tx

Answer 13

• *1st line SSRI, 2nd line SNRI, TCA

- psychotherapy

Question 14

similar to bipolar II but less severe

- 15-20% risk of BPD

Answer 14

cyclothymic d/o

Question 15

pessimism, brooding, loss of interest, decreased productivity, inadequacy feelings, social withdrawal

Answer 15

dysthymic d/o

Question 16

moody, erratic, impulsive, somewhat volatile

Answer 16

cyclothymic d/o

Question 17

cyclothymic d/o tx

Answer 17

1st line is mood stabilizers and antimanic drugs

- tx similar to BPD

Question 18

maladaptive behavior or emotional symptoms that develop in 3 months after a stressful life event and end within 6 months of event

Answer 18

adjustment d/o

Question 19

adolescents: precipitants are parental rejection and divorce, school problems, leaving home
adults: stressors are marital discord, financial difficulties, loss of job, marriage, parenthood, natural disasters, racial/religious persecution

Answer 19

adjustment d/o

Question 20

tearfulness, depressed mood, vandalism, reckless driving, truancy, fighting, anxiety

Answer 20

adjustment d/o

Question 21

adjustment d/o tx

Answer 21

supportive psychotherapy or group therapy

- short term meds for assoc insomnia, anxiety, and depression (not 1st line)

Question 22

For an adjustment disorder to be diagnosed, the following criteria must be met:

Answer 22

Having emotional or behavioral symptoms within three months of a specific stressor occurring in life
Experiencing more stress than would normally be expected in response to the stressor
An improvement of symptoms within six months after the stressful event ends
The symptoms are not the result of another diagnosis

Question 23

Loss of pleasure in most or all activities
Failure of reactivity to pleasurable stimuli
Quality of depressed mood more pronounced than that of grief or loss
Worsening of symptoms in the morning hours
Early-morning waking
Psychomotor retardation
Excessive weight loss
Excessive guilt
maybe suicide ideation

Answer 23

Melancholic depression

Question 24

Mood reactivity
Significant weight gain or increased appetite – comfort eating
Hypersomnia – excessive sleep or sleepiness
Leaden Paralysis – sensation of heaviness in limbs
Significant social impairment as a consequence of hypersensitivity to perceived interpersonal rejection

Answer 24

Atypical depression

Question 25

Disturbances of motor behavior and other symptoms Mute and almost stuporous Either remains immobile or exhibits purposeless or even bizarre movements – posturing and waxy flexibility – move as if made by wax. Seen in catatonic schizophrenia as well.

Answer 25

Catatonic depression – rare but severe

Question 26

``` ____ depression Includes delusions / hallucinations ___ depression Incidence Rate: 10–15% among new mothers Occurs within one month of delivery ```

Answer 26

``` Psychotic depression Includes delusions / hallucinations Postpartum depression Incidence Rate: 10–15% among new mothers Occurs within one month of delivery ```

Question 27

50% of hospitalized pts with major depression have this MDD subtype

Answer 27

melancholia

Question 28

seasonal affective tx [3]

Answer 28

light therapy, buprion, SSRI

Question 29

melancholia tx [2]

Answer 29

antidepressants, ECT

Question 30

atypical depression tx [3]

Answer 30

MAOI, SSRI, atypicals

Question 31

catatonic depression tx [2/2]

Answer 31

both antidepressants and antipsychotics simultaneously | - maybe ECT, benzos

Question 32

psychotic depression tx - agitation - maintenance

Answer 32

agitation: benzos plus antidep maintenance: antidep, 2nd gen antipsychotics

Question 33

Waxy flexibility should make you think of what two possible diagnosis?

Answer 33

Catatonic depression and catatonic schizophrenia

Question 34

Is a major depressive episode necessary for the the diagnosis of bipolar?

Answer 34

Not for bipolar I

Question 35

In order to diagnose dysthymic disorder symptoms must occur over what period of time?

Answer 35

2 years.

Question 36

Can ECT be used during pregnancy? | elderly?

Answer 36

Yes | yes

Question 37

MDD suicide risk and course

Answer 37

15%; chronic course with relapses

Question 38

ECT side effects

Answer 38

postictal confustion, somatic complaints(HA, nausea, mm soreness, **memory loss(returns to baseline)

Question 39

MDD tx

Answer 39

** SSRI 4-6 wks maintenance: over 6 months ECT effective, psychotherapy combo

Question 40

MDE dx

Answer 40

5 or more depressive signs; 2 week period; changes from previous function 1 symptom of depressed mood or anhedonia no manic s/s; no result of bereavement

Question 41

manic episode dx

Answer 41

abnormal and persistant increased expansive and irritable mood at least 1 week -3 manic sx(4 if mood is irritable)

Question 42

when to hospitalize manic episode

Answer 42

psychotic features; acute mania need to initiate tx

Question 43

what results in severe social and/or occupational dysfunction

Answer 43

manic and hypomanic episodes

Question 44

hypomanic episode dx

Answer 44

at least 4 days of manic mood; -3 manic sx(4 if mood is irritable) no psychotic features

Question 45

mixed episode dx and describe severe sx

Answer 45

rapidly alternating moods; symptoms of both manic and depressive at least 1 week sx severe: marked impairment in occupational or social functioning

Question 46

SSRI first line in what [5]

Answer 46

GAD, panic, dysthmic, OCPD, MDD, PTSD