Mood Disorders and Suicide Flashcards
when is the typical onset of Major depressive disorder
around 32 years old
when is the typical onset of bipolar disorder
around 25 years old
when is the typical onset of Dysthymia
around 30 years old
what are the biologic etiologies of Mood disorders
Neurotransmitters, Genetics, Hormonal
What are psychosocial etiologies of mood disorders
stressful life events, trauma or ACEs can trigger
can also be ‘familial’
Learned helplessness
Pessimism
Insult with genetic susceptibility
what primary areas of the brain are involved in depression
Amygdala (can enlarge)
Hippocampus (may be smaller)
what are other names for Major depression
unipolar depression or clinical depression
what is the presentation of MD
patient may be able to tell you they feel depressed
may present with variety of ‘negative symptoms’- SIG E CAPS
how is MD screened?
PHQ-9 (Patient health questionnaire-9)
or
MDI (major depression inventory)
a patient has a PHQ-9 of 12, what level of MD is this associated with
moderate depression - likely does not require treatment
a patient has a PHQ-9 of 25, what level of MD is this associated with
Severe MD and requires treatment
what is the scoring system for MDI
<20: no depression
20-24= mild depression
25-29 = moderate depression
30+ = severe depression
what is the prognosis of Major depressive episode
depressive episodes may last months to years
most abate within 6 months
most resolve spontaneously
20% will develop chronic depression
What diseases are associated with MD
hypothyroidism
Anemia
chronic obstructive airways disease
chronic pain
chronic kidney disease
cancer
cardiovascular diseases
neurologic disease (Parkinsons, stroke, dementia)
what medications are associated with MD
hormonal agents
antivirals
immunologic agents
antimigraine
retinoic acid derivatives
opioids
beta blockers
what is the first line treatment of MD
SSRI’s
should try for atleast 4-8 weeks before changing agents or increasing dose
continue for 4-6 months once symptoms resolve
what is an adjunctive treatment of MD
cognitive behavioral therapy (CBT)
what are side effects of SSRI
Sexual dysfunction, headache, GI upset, increased anxiety/ SI (early), insomnia
Metabolized by liver CYP450 (drug-drug interactions)
not considered safe in pregnancies
Risk for serotonin syndrome
what is a risk of MD treatment
Discontinuation syndrome
- flu-like symptoms, insomnia, Nausea, headache, irritability, vivid dreams
- few days after stopping and lasts about 2 weeks
- slow taper off to avoid this
what is the presentation of Serotonin syndrome
AMS, fever, abnormal vitals, agitation, diaphoresis, hyerreflexia, etc
how do you treat serotonin syndrome
stop the med!
can use benzos and typically resolves in 24 hours
what is another name for Persistent Depressive Disorder
Dysthymia
what is Dysthymia
chronic, persistent low mood (not episodic)
lows aren’t as low as MDD
what are the DSM-5 criteria for Dysthymia
mostly same symptoms as MDD
Only requires 2 of the 6 symptoms but must be present for 2 or more years and must be present pretty much continuously
what is the treatment of dysthymia
SSRI - first line
any of the other anti-depressants medications
CBT
What is Bipolar disorders
significant ‘mood swings’
Highs and lows (depression and mania or hypomania)
what is the DSM-5 criteria for mania
increased mood, overly expressive, irritability, increased energy/activity
lasting 1 or more weeks, present a majority of the time
change from baseline behavior
causes significant impairment
isn’t due to a medical condition of a substance
What are the types of Bipolar disorders
Bipolar 1 and Bipolar two
what is Bipolar 1 disorder
mania + depression
may have psychotic symptoms
what is bipolar 2 disorder
Hypomania + depression
Usually no psychotic symptoms
what is rapid cycling bipolar
if 4+ episodes in a 12-month period
what is the treatment of bipolar disorders
Mood stabilizers or second-generation antipsychotics for mania
+/- SSRI, or other antidepressants
Electroconvulsive therapy (ECT) if meds ineffective
psychotherapy or CBT as an adjunct
what are SGA’s
Risperidone (risperdal)
Olanzapine (zyprexa)
Quetiapine (seroquel)
Ziprasidone (Geodon)
Ariprprazole (abilify)
Clazapine (clozaril)
Lurasidone (Latuda)
What are different types of Mood stabilizers
first line treatment for bipolar disorders
Lithium
valproate
carbamazepine (Tegretol)
what is Lithium
first line mood stabilizers for bipolar disorders
requires regular monitoring of serum levels
what is Valproate
primarily for mixed or irritability predominant BPD
for lithium non-responders
what is cabamazepine
primarily for rapid cycling or lithium non-responders
can be used in combination with anti-psychotics
what SGAs are used for maintenance treatment
Apriprazole (abilify)
Olanzapine (zyprexa)
Lurasidone(latuda) - also used for MDD
Quetiapine (seroquel) - also used for MDD
when is ECT used
in patients who have failed pharmacologic treatment and are at high risk for suicide who need urgent treatment
can be used in combination with medications
what is the course of treatment for ECT
2-3 times per week for a total of 6-12 treatments or regular maintenance treatment (1x per month or week)
what are the Side effects of ECT
hypotension, arrhythmias
what are post-procedure effects of ECT
HA, Nausea, fatigue, confusion, muscle pain, antero- and/or retrograde amnesia (temporary or permanent)
what conditions are ECT used for
MDD, BPD, schizophrenia, catatonia
what is TMS
Transmagnetic stimulation
noninvasive brain stimulation using magnetic impulses = treatment for resistant depression
does not require anesthesia or cause seizures
What is Cyclothymia
milder form of bipolar disorder
Hypomania + subclinical depression
symptoms lasting 2+ years
what is the treatment of cyclothymia
depends on predominant mood disturbance
mood stabilizers and/or antidepressants predominate
what is PMDD
premenstrual dysphoric disorder
what are the treatment options for PMDD
first line is SSRI
Exercise
Diet Modification: low salt, avoid caffeine and alcohol
OCP, Hormonal treatment - second line
CBT
Surgical menopause (infrequent)
What are the stages of grief
shock and denial
anger
depression and detachment
dialogue and bargaining
acceptance
how is grief treated
encourage patients to ‘feel the feelings’
validate the feelings
enlist help of therapist if willing
enlist family/friends for support
suggest ‘healing’ activities - exercise, journaling, massage (self-care)
used medications sparingly
what is the 5th leading cause of death in the US
suicide
who is at greater risk of suicide
3.7x greater for M> F
ages: 85+, 75-84 and 25-34 (In that order)
what are risk factors of suicide
history of psychiatric disorder
veterans
certain professions
serious medical diagnosis
+FH
male
divorce, widowed, or single
Hx of prior suicide attempts
recent loss
feeling of helplessness
recent hospital discharge
LGBTQ youth
what are protective factors of suicide
religion/spirituality
support system
life satisfaction
healthy coping mechanisms
marriage
children
female gender
How do you assess for suicide risk?
Keep a high ‘index of suspicion’
ASK and RE-ASK
Solicit their plan
Safety plan, safety contract or hospitalization
