Mood Disorders Flashcards
Is depression and bipolar disorder order more common in men or women?
Women
Which has the earliest onset?
A. Depression
B. Persistent Depressive Disorder
C. Bipolar
C. Bipolar (25 y.o.)
Depression (32 y.o.)
PDD (31 y.o.)
When working up a patient for a suspected mood disorder is it useful to use the SIGECAPS and PHQ-9 questionnaires?
Yes
For a patient to be diagnosed with major depressive disorder (MDD)….
They must have 5 symptoms of depression for at least how long?
What needs to be excluded?
These symptoms need to have a significance impact on what?
5 Sx over 2 WEEKS
Exclude…..
Underlying Illness
Substance Abuse
The Sx must have a significant impact on the patient’s ADLs
For a patient to be diagnosed with persistent depressive disorder (PDD)….
They must have 2 or more symptoms of depression for at least how long?
2 Years
Are patients with MDD likely to verbalize depressive symptoms?
No
T/F: The elderly with MDD will often manifest new somatic complaints
True
What is most likely the biggest complaint in a patient with MDD?
Loss of interest
_______ (initial/middle/terminal) insomnia is described as difficulty falling asleep as well as tossing and turning
Initial Insomnia
_______ (initial/middle/terminal) insomnia is described as awakening in the middle of the night, being up for a few hours, and falling back to sleep
Middle Insomnia
_______ (initial/middle/terminal) insomnia is described as early morning awakening with the inability to fall back asleep.
Terminal Insomnia
What medication classes are first line for MDD treatment?
SSRIs…..
fluoxetine (PROZAC), 20-80 mg/d citalopram (CELEXA), 20-40 mg/d escitalopram (LEXAPRO), 10-20 mg/d sertraline (ZOLOFT), 50-200 mg/d paroxetine (PAXIL), 20-50 mg/d
SNRIs……
venlafaxine XR (EFFEXOR XR), 37.5-225 mg/d duloxetine (CYMBALTA), 30-120 mg/d
TCAs…..
amitriptyline
nortriptyline
imipramine
desipramine
If a patient is started on a SSRI, SNRI, or TCA for MDD…..
How long may it take for the medication to take effect?
How long should you continue the medication prior to titrating the dose?
May show improvement in 1-2 weeks
Need to wait 4-8 weeks before adjusting the dose
T/F: Electroconvulsive therapy is used in MDD treatment
True
It does have a higher remission and relapse rate
About __% of patients with MDD will develop chronic depression
20%
About __-___% of patients hospitalized for depression will successfully take their own life
10-15%
What is the recommended treatment of light-to-moderate MDD?
Psychotherapy
+/- medication depending on patient preference
What is the recommended treatment of moderate-to-severe MDD?
Medication +/-psychotherapy
ECT can be considered
What is the GOLD STANDARD treatment for depression WITH psychotic features?
ECT
When working up a patient with suspected mania, what questionnaire should you use in combination with the PHQ-9 and SIGECAPS?
DIGFAST
______ is described as abnormal persistent elevated, expansive or irritable mood lasting at least 4 days (< 7 days).
Hypomania
Would you expect to see delusions or hallucinations in patients with hypomanis?
No
Are hypomanic patients often hospitalized?
No
How is Bipolar 1 defined?
How long are the intervals between episodes?
At least 1 manic episode and usually recurrent depression and mania
Intervals between episodes can be anywhere from months to years
How is Bipolar 2 described?
Do these patient have a history of manic episodes in the past?
One or more major depressive episodes and at least one episode of hypomania
These patients have NO prior episodes of mania
___% of patients with a single manic episode will have recurrent mood episodes
90%
__-__% of Bipolar 1 patients have a family history of MDD
60-65%
T/F: Bipolar Disorder is more common in women than in men
False
There is an equal prevalence in both men and women
What is Bipolar 2 often diagnosed as first?
What may lead to a diagnosis of Bipolar 2
MDD
Depressed state followed by and episode of hypomania
(*remember bipolar 2 patients have no history of manic episodes)
Bipolar 2 patients may have 4 or more mood changes….
What is this concerned as?
Rapid Cycling
If a patient diagnosed with Bipolar 2 does have a manic episode what happens to their diagnosis?
Changes to Bipolar 1
What are pharmacological management options for acute mania?
Lithium Divalproex Olanzaprine Risperidone Quetiapine Aripiprazole Ziprasidone
What are pharmacological management options for an acute major depressive episode?
Lithium
Lamotrigine
Quetiapine
What are pharmacological management options for bipolar disorder maintenance?
Lithium Lamotrigine Divalproex Olanzaprine Risperidone Quetiapine Aripiprazole
Why is important to follow a manic bipolar patient closely?
Depression may follow closely when the mania breaks
T/F: Routine and good sleep habits are important for preventing relapse in a patient diagnosed as bipolar
True
Is psychotherapy beneficial for bipolar patients in a manic state?
No
But this should be used when they’re in a depressive state
Cyclothymic disorder is the mildest form of bipolar disorder……
Do these patients often have impairment in their ADLs?
Do these patients exhibit psychotic symptoms?
Are these patients asymptomatic for longer than 2 months?
No to all three
Is persistent depressive disorder (Dysthymia) more common in men or women?
Women
For a patient to be diagnosed with persistent depressive disorder (Dysthymia)…..
They must have at least two of what six symptoms?
Poor appetite or overeating Insomnia or hypersomnia Low energy or fatigue Low self-esteem Poor concentration/difficulty making decisions Feelings of hopelessness
How is persistent depressive disorder (Dysthymia) managed?
Antidepressants
Psychotherapy
