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Psychiatry > Mood disorders > Flashcards

Mood disorders Flashcards

1
Q

What percentage of patients with MDD attempt suicide?

A

15%

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2
Q

Which systems are most noticeably affect by MDD?

A
  • HPA axis

- immune system

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3
Q

What worsens the outcome of MDD?

A
  • unRx MDD

- with comorbid conditions

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4
Q

What is the criteria for MDD

A
  • 5 or more sx
  • in same 2 wks
  • change from prev functioning
  • no hx of manic / hypomanic episodes
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5
Q

What are the sx of depression?

A

M SIGE CAPS

  • mood - depressed/low
  • sleep - incr/decr
  • interest / pleasure decr
  • guilt, worthlessness
  • energy - decr
  • concentration - decr
  • appetite - incr/decr
  • psychomotor - incr/decr
  • suicidal ideation
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6
Q

What is meant by Melancholic features? When are they most prominent?

A
  • despondent, despiar
  • excessive guilt
  • lack of reactivity
  • worse in morning
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7
Q

What is meant by atypical features?

A
  • weight gain
  • hypersomnia
  • leaden paralysis
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8
Q

What is meant by peripartum onset?

A
  • within 4wks after child birth
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9
Q

What are the core affective sx of MDD in adults?

A
  • low mood

- anhedonia

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10
Q

What are the core affective sx of MDD in children?

A
  • irritability

- behavioral problems

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11
Q

What are the 3 areas of depressive sx?

A
  • neurovegetative
  • cognitive
  • behavioral
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12
Q

List the Neuro-vegetative sx (PALES)

A
  • Pain
  • Appetite loss
  • Libido loss
  • Energy decr
  • Sleep disturbed
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13
Q

List the Cognitive sx (GASH)

A
  • Guilt
  • Attention + concentration impaired
  • Self esteem loss
  • Hopelessness
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14
Q

List the Behavioral sx (PASS)

A
  • Psychomotor slowing
  • Agitation
  • Social withdrawal
  • Self neglect
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15
Q

Describe Grief (bereavement)

A
  • significant stressor present
  • predominant feeling of loss + emptiness
  • occurs in waves with reminders
  • decr in intensity with time
  • thoughts/memories of loss
  • thoughts of death focused on deceased
  • preserved self esteem
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16
Q

How does MDD differ from Grief?

A
  • depressed mood + anhedonia
  • persistent
  • not tied to specific thoughts
  • self critical + self loathing
  • pessimistic
  • worthlessness
  • suicidal / undeserving of life
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17
Q

What is the Primary Rx Goal of MDD?

A

Complete remission

- but only achieved in about 40%

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18
Q

What Pharmacotherapy will you give for MDD?

A
  • 1st line = SSRI
  • 2nd line = TCA
  • BZD for sx rx (eg. insomnia)
  • psychosis - 2nd gen AP (Olanzapine) or augment with Lithium
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19
Q

How long after initiating Rx do you expect a response?

A
  • 4-6 wks newer drugs

- 6-8 wks older drugs

20
Q

At what stage in the cycle do mood sx in PMDD occur? When do they resolve?

A
  • occur shortly after ovulation (week before menses)
  • remit within days of menses
  • minimal/absent week after menses
21
Q

How many sx present? How many cycles must sx occur in for PMDD?

A
  • at least 5 sx

- more than 2 cycles

22
Q

Which pharmacotherapeutic agents are effective in the mx of PMDD?

A
  • SSRI
  • BZD
  • Ovulation suppressor (OCP, GnRHa)
23
Q

What is the criteria for Persistent Depressive Disorder (PDD)?

A
  • persistent depressed mood
  • > 2 yrs adults
  • > 1 yr children
  • never without sx for > 2 mo
  • NO suicidal thoughts + psychomotor changes
24
Q

How do you manage PDD?

A
  • mild = psychotherapy
  • mod to severe = meds + psychotherapy (out pt)
  • cx / severe / resistant = refer + admit
25
Q

What was Persistent Depressive Disorder previously known as?

A

Dysthymia

26
Q

How many episodes typically occur in BPD?

A
  • 4 or less per year

- >4 per year = rapid cycling

27
Q

What is Mania?

A
  • distinct period
  • abnormally + persistently
  • elevated, expansive or irritable mood
  • for 1 wk or longer
  • or any duration requiring hospitalization
28
Q

What is Hypomania?

A
  • distinct period
  • abnormally + persistently
  • elevated, expansive, irritable mood
  • for 4 or more days
  • no psychotic sx
  • no hospitalization required
29
Q

What are the sx of a manic episode? DIGFAST

A
  • Distractibility
  • Impulsivity (sexual, risky behav)
  • Grandiosity (inflated self esteem)
  • Flight of ideas
  • Activity incr (PMA)
  • Sleep need decr
  • Talkative (pressure of speech)
30
Q

Define a mixed episode

A
  • Manic + major depressive sx

- for at least 1 week

31
Q

When would you dx Bipolar 1?

A
  • at least 1 prev manic episode

- or any duration with psychosis

32
Q

When would you dx Bipolar 2?

A
  • predominantly MDE + hypomanic
  • less than 4 days
  • no psychosis
  • no hx of manic episodes
33
Q

What is a cyclothymic disorder?

A
  • hypomanic + depressive sx

- that dont meet criteria for hypomanic / MDE

34
Q

What are the specifiers or BPD?

A
  1. Current/latest episode
    - Severity (mild/mod/severe)
    - Associated sx
  2. Lifetime pattern
    - rapid cycling (>4/yr)
    - seasonal pattern (winter)
    - partial remission (sx improve but not all / not long enough)
    - full remission (sx free > 2months)
35
Q

What are clues that a depressive may be Bipolar and not Unipolar? (5,4,5)

A
  • early age sx onset
  • psychotic depression <25yo
  • pospartum depression esp with psychotic fts
  • short episodes with rapid onset + offset
  • recurrent, multiple episodes
  • seasonal pattern
  • atypical fts
  • fam hx of bipolar
  • episodes with marked psychomotor abnormalities
  • hyperthymic temperament
  • severe anxiety
  • hypomania ass w Antidepressant Rx
  • rapid improvement on Antidepressant Rx
  • Antidepressant poop out
36
Q

When will you admit a pt with BPD for Rx?

A
  • suicide / homicide risk
  • rapidly progressive sx
  • psychosis
  • manic, MDE, mixed episodes
  • relapse + no access to food/shelter/support
  • can be voluntary / involuntary
37
Q

When will you treat BPD as an out pt?

A
  • maintenance

- hypomanic + mild-mod depressive episodes with frequent evaluation

38
Q

What are the Contra-indications to psychotherapy in BPD?

A
  • manic
  • MDE
  • mixed
  • psychotic
39
Q

Most common causes of relapse?

A
  • stressful life events
  • substances
  • non adherence
40
Q

What is the correct way to use antidepressants in the Rx of bipolar depression?

A
  • avoid as far as possible -> hypomania + rapid cycling
  • if necessary to use them
  • always use in combo with at least 1 (preferably 2) mood stabilizers
41
Q

Which mood stabilizer is effective in treating depression?

A

Lamotrigine

  • start low go slow
  • SJS
42
Q

How would you Rx psychotic depression?

A

atypical AP

  • Olanzapine, Quetiapine
  • avoid Haloperidol -> dysphoria
43
Q

Which mood stabilizers would you use in Rx manic and hypomanic episodes?

A
  • Valproate (up titrate fast)

- Lithium (start low go slow)

44
Q

Which AP is preferred in manic and hypomanic episodes?

A

Haloperidol

45
Q

What additional measures must be taken in rx

A
  • emergency sedation

- stop AD if using one

46
Q

What is the rx of choice for mixed fts and rapid cycling?

A

Valproate

47
Q

If a patient shows poor response to treatment, what should you then consider?

A
  • previous response
  • comorbid conditions
  • side effect profile
  • compliance
  • substance use
  • dx

Psychiatry (6 decks)

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