Mood Disorders

Question 1

Up to 1/3 of stroke PTx have major depression. T or F

Answer 1

T

Question 2

65% of PTx post MI have depressive symptoms. T or F

Answer 2

T

Question 3

Which area of the brain has a decreased volume in depression?

Answer 3

hippocampus

Question 4

Typical depression has a _____ variation, and it worse in the _____

Answer 4

diurnal

morning

Question 5

Is memory effected in depression?

Answer 5

yes it can be

Question 6

What psychotic symptoms can depression cause?

Answer 6

2nd person auditory hallucinations

delusions (eg. hypochondriasis, poverty, guilt, nihilism)

Question 7

How would someones mood be in depression in a MSE?

Answer 7

flat, unhappy, empty

Question 8

How would someones affect be in depression in a MSE?

Answer 8

depressed, decreased range, decreased reactivity

Question 9

Depression can cause ____ retardation, ____ weight, and patients ____ have insight

Answer 9

Depression can cause psychomotor retardation, decreased weight, and patients do have insight

Question 10

How long must depression be present for a dx?

Answer 10

most of the time, every day for 2 weeks

Question 11

What conditions should you be careful to exclude when diagnosing depression?

Answer 11

bipolar, thyroid disorder

Question 12

Many of the side effects from antidepressants are transient. T or F

Answer 12

true

Question 13

In the Mx of depression, if a drug is not providing adequate response, what are the possible explanations?

Answer 13

wrong Dx
wrong dose
wrong drug
compliancy

Question 14

What is the 1st line Mx in depression if a patient isn’t eating or drinking

Answer 14

ECT

Question 15

What is the 1st line Mx in depression if a patient has a very high suicide risk?

Answer 15

ECT

Question 16

What area of the brain does ECT stimulate?

Answer 16

hippocampus

Question 17

ECT induces a _____ lasting _____

Answer 17

seizure

15-20 seconds

Question 18

What are the side effects of ECT?

Answer 18

tension HA
short term cognitive dysfunction / amnesia
myalgia
tooth damage

Question 19

What are the contraindications to ECT?

Answer 19

phaeochromocytoma
MI last 3mth
recent CVA
brain SOL

Question 20

What type of depression causes anhedonia, decreased reactivity, wake 2hr early, worse morning wakening, psychomotor disturbance, <5% wt and a loss of libido?

Answer 20

Somatic depression

Question 21

Atypical depression causes a mood thats ____ following a positive event, _____ sleeping, _____ paralysis and _____ weight

Answer 21

Atypical depression causes a mood thats better following a positive event, increased sleeping, leaden paralysis and increased weight

Question 22

_____ syndrome is a form of psychotic depression that occurs in the ____ age group. an example would be “I can’t eat because my bowel’s have turned to dust”

Answer 22

Cotard syndrome

elderly

Question 23

Postnatal depression affects ____ women

Answer 23

1 in 10

Question 24

How long postpartum does postnatal depression occur?

Answer 24

1-4wks postpartum

Question 25

What type of psychotherapy stems around changing your behaviour & you’ll change your thoughts, to combat 'thinking errors'?

Answer 25

CBT cognitive behavioural therapy

Question 26

What type of psychotherapy focuses on lifestyle changes, the importance of having therapy etc.? It should be a part of every consultation

Answer 26

psychoeducation

Question 27

What is bipolar disorder with mixed features?

Answer 27

patients exhibit symptoms of mania/ hypomania at the same time as depressive symptoms

Question 28

What is cyclothymia?

Answer 28

milder form of bipolar disorder where patients have alternating periods of elevated and low moods

Question 29

What is rapid cycling bipolar disorder?

Answer 29

patients rapidly switch between episodes of mania and depression (i think - double check this)

Question 30

What is the peak age range for diagnosis of bipolar disorder?

Answer 30

17-25 years

Question 31

How long does hypomania last in bipolar disorder? (without Tx)

Answer 31

4+ days

Question 32

How long does mania last in bipolar disorder? (without Tx)

Answer 32

>1 week

Question 33

What is the difference in presentation between mania and hypomania?

Answer 33

hypomania has no psychotic symptoms and patients will likely still be functioing

Question 34

Is insight present in mania and hypomania?

Answer 34

no

Question 35

What psychiatry term describes speech in mania?

Answer 35

pressure of speech

Question 36

Describe someone's mood in mania

Answer 36

expansive elevated irritable

Question 37

What drug class should you try and avoid in the management of bipolar disorder?

Answer 37

antidepressants

Question 38

In the management of acute mania in bipolar disorder, should you stop their maintenance antipsychotic?

Answer 38

no, increase dose

Question 39

Which antipsychotics are 1st line in the management of acute mania in bipolar disorder?

Answer 39

PO olanzapine, quetiapine, risperidone

Question 40

Which drugs are 2nd line in the management of acute mania in bipolar disorder?

Answer 40

lithium, valproate, carbamazepine

Question 41

What is the management of agitation in acute mania in bipolar disorder?

Answer 41

benzo

Question 42

What is the 1st line Mx of depressive symptoms in bipolar disorder? And what is the adjunct therapy?

Answer 42

antipsychotic quetiapine or olanzapine +- fluoxetine SSRI also lamotrigine

Question 43

What are the advantages and disadvantage of lamotrigine in the Mx of depressive symptoms in bipolar disorder?

Answer 43

slow to produce effect | less transient SEs

Question 44

What is the 1st choice of maintenance medication in the Mx of bipolar disorder?

Answer 44

atypical (2nd gen) antipsychotic OR lithium

Question 45

What must you monitor in prescribing Lithium?

Answer 45

U+Es, TFTs, Ca

Question 46

What drugs that aren't antipsychotics can be tried as maintenance medication in the management of Tx resistant bipolar disorder?

Answer 46

lamotrigine and valproate (both AEDs)