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ClinMed2: Psych > Mood Disorders and Suicide > Flashcards

Mood Disorders and Suicide Flashcards

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1
Q

when is the typical onset of Major depressive disorder

A

around 32 years old

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2
Q

when is the typical onset of bipolar disorder

A

around 25 years old

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3
Q

when is the typical onset of Dysthymia

A

around 30 years old

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4
Q

what are the biologic etiologies of Mood disorders

A

Neurotransmitters, Genetics, Hormonal

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5
Q

What are psychosocial etiologies of mood disorders

A

stressful life events, trauma or ACEs can trigger

can also be ‘familial’

Learned helplessness

Pessimism

Insult with genetic susceptibility

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6
Q

what primary areas of the brain are involved in depression

A

Amygdala (can enlarge)
Hippocampus (may be smaller)

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7
Q

what are other names for Major depression

A

unipolar depression or clinical depression

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8
Q

what is the presentation of MD

A

patient may be able to tell you they feel depressed
may present with variety of ‘negative symptoms’- SIG E CAPS

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9
Q

how is MD screened?

A

PHQ-9 (Patient health questionnaire-9)
or
MDI (major depression inventory)

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10
Q

a patient has a PHQ-9 of 12, what level of MD is this associated with

A

moderate depression - likely does not require treatment

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11
Q

a patient has a PHQ-9 of 25, what level of MD is this associated with

A

Severe MD and requires treatment

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12
Q

what is the scoring system for MDI

A

<20: no depression
20-24= mild depression
25-29 = moderate depression
30+ = severe depression

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13
Q

what is the prognosis of Major depressive episode

A

depressive episodes may last months to years
most abate within 6 months
most resolve spontaneously
20% will develop chronic depression

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14
Q

What diseases are associated with MD

A

hypothyroidism
Anemia
chronic obstructive airways disease
chronic pain
chronic kidney disease
cancer
cardiovascular diseases
neurologic disease (Parkinsons, stroke, dementia)

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15
Q

what medications are associated with MD

A

hormonal agents
antivirals
immunologic agents
antimigraine
retinoic acid derivatives
opioids
beta blockers

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16
Q

what is the first line treatment of MD

A

SSRI’s
should try for atleast 4-8 weeks before changing agents or increasing dose
continue for 4-6 months once symptoms resolve

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17
Q

what is an adjunctive treatment of MD

A

cognitive behavioral therapy (CBT)

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18
Q

what are side effects of SSRI

A

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

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19
Q

what is a risk of MD treatment

A

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

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20
Q

what is the presentation of Serotonin syndrome

A

AMS, fever, abnormal vitals, agitation, diaphoresis, hyerreflexia, etc

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21
Q

how do you treat serotonin syndrome

A

stop the med!
can use benzos and typically resolves in 24 hours

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22
Q

what is another name for Persistent Depressive Disorder

A

Dysthymia

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23
Q

what is Dysthymia

A

chronic, persistent low mood (not episodic)
lows aren’t as low as MDD

24
Q

what are the DSM-5 criteria for Dysthymia

A

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

25
Q

what is the treatment of dysthymia

A

SSRI - first line
any of the other anti-depressants medications
CBT

26
Q

What is Bipolar disorders

A

significant ‘mood swings’
Highs and lows (depression and mania or hypomania)

27
Q

what is the DSM-5 criteria for mania

A

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

28
Q

What are the types of Bipolar disorders

A

Bipolar 1 and Bipolar two

29
Q

what is Bipolar 1 disorder

A

mania + depression
may have psychotic symptoms

30
Q

what is bipolar 2 disorder

A

Hypomania + depression
Usually no psychotic symptoms

31
Q

what is rapid cycling bipolar

A

if 4+ episodes in a 12-month period

32
Q

what is the treatment of bipolar disorders

A

Mood stabilizers or second-generation antipsychotics for mania
+/- SSRI, or other antidepressants
Electroconvulsive therapy (ECT) if meds ineffective
psychotherapy or CBT as an adjunct

33
Q

what are SGA’s

A

Risperidone (risperdal)
Olanzapine (zyprexa)
Quetiapine (seroquel)
Ziprasidone (Geodon)
Ariprprazole (abilify)
Clazapine (clozaril)
Lurasidone (Latuda)

34
Q

What are different types of Mood stabilizers

A

first line treatment for bipolar disorders
Lithium
valproate
carbamazepine (Tegretol)

35
Q

what is Lithium

A

first line mood stabilizers for bipolar disorders
requires regular monitoring of serum levels

36
Q

what is Valproate

A

primarily for mixed or irritability predominant BPD
for lithium non-responders

37
Q

what is cabamazepine

A

primarily for rapid cycling or lithium non-responders
can be used in combination with anti-psychotics

38
Q

what SGAs are used for maintenance treatment

A

Apriprazole (abilify)
Olanzapine (zyprexa)
Lurasidone(latuda) - also used for MDD
Quetiapine (seroquel) - also used for MDD

39
Q

when is ECT used

A

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

40
Q

what is the course of treatment for ECT

A

2-3 times per week for a total of 6-12 treatments or regular maintenance treatment (1x per month or week)

41
Q

what are the Side effects of ECT

A

hypotension, arrhythmias

42
Q

what are post-procedure effects of ECT

A

HA, Nausea, fatigue, confusion, muscle pain, antero- and/or retrograde amnesia (temporary or permanent)

43
Q

what conditions are ECT used for

A

MDD, BPD, schizophrenia, catatonia

44
Q

what is TMS

A

Transmagnetic stimulation
noninvasive brain stimulation using magnetic impulses = treatment for resistant depression
does not require anesthesia or cause seizures

45
Q

What is Cyclothymia

A

milder form of bipolar disorder
Hypomania + subclinical depression
symptoms lasting 2+ years

46
Q

what is the treatment of cyclothymia

A

depends on predominant mood disturbance
mood stabilizers and/or antidepressants predominate

47
Q

what is PMDD

A

premenstrual dysphoric disorder

48
Q

what are the treatment options for PMDD

A

first line is SSRI
Exercise
Diet Modification: low salt, avoid caffeine and alcohol
OCP, Hormonal treatment - second line
CBT
Surgical menopause (infrequent)

49
Q

What are the stages of grief

A

shock and denial
anger
depression and detachment
dialogue and bargaining
acceptance

50
Q

how is grief treated

A

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

51
Q

what is the 5th leading cause of death in the US

A

suicide

52
Q

who is at greater risk of suicide

A

3.7x greater for M> F
ages: 85+, 75-84 and 25-34 (In that order)

53
Q

what are risk factors of suicide

A

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

54
Q

what are protective factors of suicide

A

religion/spirituality
support system
life satisfaction
healthy coping mechanisms
marriage
children
female gender

55
Q

How do you assess for suicide risk?

A

Keep a high ‘index of suspicion’
ASK and RE-ASK
Solicit their plan
Safety plan, safety contract or hospitalization

ClinMed2: Psych (10 decks)

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