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Behavioral Dynamics > Mood disorders- Part 2 > Flashcards

Mood disorders- Part 2 Flashcards

1
Q

____ is persistent depressive disorder. What are the DSM criteria?

A

Dysthymia

Patients with ongoing depressive symptoms for two years or longer
Do not have to be in full major depressive episode for all of the two-year span PLUS 2 more of the following:

Appetite changes (poor appetite or overeating)

Sleep changes (insomnia or hypersomnia)

Fatigue or loss of energy

Diminished ability - thinking, concentration or decision-making

Low self-esteem

Feelings of hopelessness

aka more times than not in a depressed mood

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1
Q

T/F: Dysthymia patients sometimes will have manic episodes.

A

FALSE! Cannot have manic symptoms or secondary cause

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2
Q

What is the treatment for Dysthymia?

A

1st: SSRIs with therapy

2nd: TCAs and MAOIs have shown success in studies

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3
Q

____ is a depressed mood in response to an identifiable psychosocial stressor

A

Adjustment Disorder with Depressed Mood

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4
Q

T/F: Adjustment Disorder with Depressed Mood is classified as a true depressive disorder. Why or why not?

A

FALSE! NOT classified as a true depressive disorder

Significant depressive symptoms, in response to a stressor, that do not meet criteria for a more specific depressive disorder

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5
Q

What is the DSM for Adjustment Disorder with Depressed Mood?

A

Low mood, tearfulness, or feelings of hopelessness in response to a stressor within 3 months of onset

Symptoms are significant, as evidenced by one or both of the following:
Significant distress exceeding what would be expected given the nature of the stressor
Impaired functioning (social or occupational)

Syndrome is not bereavement¹

Syndrome resolves within 6 months after stressor and its consequences have ended

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6
Q

Recurrent major depressive symptoms occurring consistently at particular times of year is _____. Is it considered a separate mood disorder?

A

Seasonal Affective Disorder

NO, In conjunction with MDD or Bipolar I/II

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7
Q

For seasonal affective disorder ____ onset is considered a “winter depression”. _____ is considered a “Summer depression”

A

Begins late fall-early winter; remits in summer

Begins in late spring; remits in winter

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8
Q

Seasonal affective disorder is believed to be linked to ??? What types of areas is it worse?

A

abnormal serotonergic activity

more prevalent in higher latitudes

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9
Q

**What are some s/s of fall onset seasonal affective disorder?

A

Increased sleep
Increased appetite
Carbohydrate craving
Increased weight
Irritability
Interpersonal difficulties
Rejection sensitivity
Leaden paralysis (extreme heaviness in the arms and legs)

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10
Q

**What are some s/s of spring onset seasonal affective disorder?

A

Decreased sleep
Decreased appetite
Decreased weight
Dysphoria

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11
Q

What is the treatment for SAD? When will you see a response?

A

light therapy for non-psychotic, non-suicidal patients

4-6 weeks to see a response

SSRIs, psychotherapy

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12
Q

What are some SE of phototherapy?

A

Photophobia, HA, fatigue, irritability, insomnia, hypomania

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13
Q

What is the basic bipolar requirments?

A

major depressive episode with manic episode

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14
Q

What is the criteria for a major depressive episode?

A

2+ weeks with five or more of the following symptoms nearly all the time/nearly every day:

Depressed mood
Anhedonia

Significant change in weight or appetite
Sleep changes (insomnia or hypersomnia)
Activity changes (psychomotor agitation or retardation)
Fatigue or loss of energy
Feelings of worthlessness or guilt (excessive, inappropriate)
Diminished ability - thinking, concentration, or decision making
Recurrent thoughts about death or suicide

and must cause distress or functional impairment and must NOT be due to other cause (substances or medication)

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15
Q

What is the criteria for a manic episode? **What is the big key here that is underlined and starred in the PP?

A

1+ week (7+ days) of abnormally expansive, elevated, or irritable mood and abnormally increased activity or energy

Along with disturbed mood and energy/activity, 3+ of the following are present (4+ if the mood is only irritable):
Inflated self-esteem or grandiosity
Decreased need for sleep
More talkative than usual / pressured speech
Racing thoughts or flight of ideas
Distractibility
Increase in goal-directed activity or psychomotor agitation
Excessive involvement in activities with high potential for bad consequences / “risky” behavior

and must cause distress or functional impairment and must NOT be due to other causes

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16
Q

What is the criteria for a hypomanic epidose?

A

4+ days of abnormally expansive, elevated, or irritable mood and abnormally increased activity or energy

Along with disturbed mood and energy/activity, 3+ of the following are present (4+ if the mood is only irritable):

Inflated self-esteem or grandiosity (less delusional than mania)
Decreased need for sleep
More talkative than usual / pressured speech
Racing thoughts or flight of ideas
Distractibility
Increase in goal-directed activity or psychomotor agitation
Excessive involvement in activities with high potential for bad consequences
Spending sprees, sexual indiscretions, foolish business investments

Must be a change from baseline mood/behavior that is observable by others

Must not cause functional impairment or require hospitalization

Must not be due to other causes (substances, medication)

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17
Q

What is the difference between hypomania and mania?

A

Hypomania: is 4+ days and generally not as severe as mania

mania is 7+ days and more severe

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18
Q

Bipolar ____ is more extreme than bipolar ____

A

Bipolar I is MORE severe than Bipolar II

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19
Q

What is the criteria for bipolar I? Bipolar II?

A

Bipolar I:
1 or more manic episodes
Nearly always also have hypomanic and major depressive episodes

Bipolar II:
1 or more hypomanic episodes
1 or more major depressive episodes
No manic episodes

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20
Q

What is cyclothymia? What is the criteria?

A

s/s of both mania and depression but not enough criteria for a dx of either

Periods of hypomanic symptoms - fall short of criteria for a hypomanic episode with

Periods of depressive symptoms - fall short of criteria for a major depressive episode

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21
Q

Bipolar disorder has a higher incidence in those with ____ socioeconomic status

A

higher

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22
Q

What some risk factors for bipolar?

A

-Expression and sensitivity to neurotransmitters

Response to psych drugs

(+) Family history of BPD in ⅔ of patients

Increased paternal age

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23
Q

What are some bipolar disorder subtypes?

A

anxiety
catatonic
mixed
psychotic
atypical
melancholic
peripartum
seasonal

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24
Q

How does the atypical subtype present?

A

reactivity to pleasurable stimuli, hyperphagia (always hungry, can never be satisfied)
hypersomnia

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25
Q

Manic and hypomanic episodes develop over a ____
→ Manic - resolves over _____
→ Hypomanic - resolves over _____

A

few days

15-20 weeks

4-8 weeks

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26
Q

Depressive episodes develop ????
→ Major depressive episode - resolves over ____. When is the highest risk of recurrent depressive episodes?

A

more slowly, days to weeks

20 weeks

months following the resolution

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27
Q

What is the criteria for rapid-cycling BPD? The majority of these patients are ____. How would you describe their bipolar?

A

4+ mood episodes a year

women: 80-95%

Longer and more refractory course of illness

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28
Q

_____ : especially common in women with rapid-cycling BPD

A

Hypothyroidism

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29
Q

MDQ screens for symptoms of _____ or ____

A

mania or hypomania

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30
Q

What does the PHQ-2 test for?

A

quick initial screening for a depressive episode

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31
Q

What does the PHQ-9 test for?

A

Further evaluates presence and severity of depression
Can be used for initial screening or follow-up evaluation

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32
Q

**What is the Zung self-rated scale used for?

A

Depression, more in-depth rating of current depressive episodes

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33
Q

Treatment of Bipolar I/II varies depending on if the patient is in an _____ or ______

A

acute mood episode

needing maintenance therapy

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34
Q

What are the goals of bipolar treatment?

A

Control acute mood symptoms

Induce remission of mood symptoms

Reduce or prevent recurrence of mood episodes

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35
Q

What are the criteria for severe mania that they would need to be treated inpatient?

A

Suicidal/homicidal ideation or behavior with specific plan or intent

Psychosis

Catatonia

Impaired judgement that puts patient/others at risk for harm

Grossly impaired functioning affecting ability to care for self

36
Q

Which drug classes are considered antimanic?

A

lithium

anticonvulsants:
carbamazepine (Tegretol), valproate/valproic acid (Depakene), divalproex sodium (Depakote)
Lamotrigine (Lamictal)

Antipsychotics:
quetiapine (Seroquel), lurasidone (Latuda)

37
Q

**______ prevents mania, but does not treat an acute manic episode?

A

Lamotrigine

38
Q

What do you do for a severe acute manic/hypomanic episode?

A

antipsychotic + lithium or valproate

39
Q

What do you do for a mild/moderate acute manic/hypomanic episode?

A

Antipsychotics - risperidone (Risperdal), olanzapine (Zyprexa), others

Lithium (5-10 day latency)

Anticonvulsants:
carbamazepine (Tegretol)
valproate (Depakene)
divalproex (Depakote)

40
Q

What things would you want to consider to “add on” for an acute manic/hypomanic episode?

A

benzodiazepines (for acute agitation), psychotherapy (adjunct)
ECT (refractory)

41
Q

**In a bipolar patient, what do you want to avoid for their acute depressive symptoms? Why?

A

Recommended to avoid antidepressant monotherapy (especially TCAs) because they have a risk of triggering manic symptoms

42
Q

What are the medication options for an acute depressive symptom in a bipolar patient?

A

Anticonvulsants - carbamazepine (Tegretol), valproate (Depakene), lamotrigine (Lamictal)

Lithium (few weeks latency)

Antipsychotics - lurasidone (Latuda), quetiapine (Seroquel), olanzapine (Zyprexa), others

43
Q

What are first line meds for bipolar maintenance therapy? 2nd line?

A

Lithium, valproate (Depakene), quetiapine (Seroquel)

Lithium (if not already tried), or quetiapine (Seroquel), valproate (Depakene), lamotrigine (Lamictal)

44
Q

What bipolar medications are anticonvulsants used as mood stabilizers?

A

Valproate (Depakene) / Divalproex (Depakote)
Lamotrigine (Lamictal)
Carbamazepine (Tegretol)

45
Q

_____ mainly for acute mania/hypomania, or maintenance. How long does it take the antidepressant take effect? Has an (increased/decreased) risk of suicide?

A

Lithium

several weeks to onset

decreased risk of suicide

46
Q

**When do you need to check levels on a pt taking lithium?

A

Check levels 5 days after dose change, 12 hrs after last dose (trough)¹

47
Q

What are the pt education points for lithium?

A

Taken on a daily basis with food, not PRN

48
Q

What are the CI for lithium?

A

Severe CKD, dehydration, sodium depletion, Severe cardiovascular disease - can cause dysrhythmias
Pregnancy

49
Q

**What are the DDI with lithium?

A

Diuretics, NSAIDs, ACEIs, tetracyclines, metronidazole, theophylline

50
Q

What are some side effects of lithium? What lab do you want to check?

A

L - leukocytosis
I - insipidus (nephrogenic diabetes insipidus)
T - tremor / teratogenesis
H - hypothyroidism
P - parathyroid
A - arrhythmia (dysrhythmia)

thyroid panels

51
Q

What is Ebstein’s anomaly? What drug is it associated with?

A

congenital heart defect resulting in an abnormal, leaking tricuspid valve and ASD (atrial septal defect)

Lithium

52
Q

What baselines labs do you need to get before starting a patient on lithium?

A

Labs - Renal function (BUN/Cr), Calcium, Urinalysis (UA), Thyroid function

Pregnancy test - if female of childbearing age

ECG - if at risk for cardiac disease

53
Q

What is the serum lithium levels testing schedule?

A

5 days after start and after each dose change
Periodically once stabilized on a given dose
q. 1-2 weeks until serum at desired level
q. 2-3 months for first 6 months

54
Q

Lithium has a very (narrow/wide) therapeutic index. What is the target range? What is toxic? Is lithium toxicity dangerous?

A

narrow therapeutic index

Target - 0.6-1.2 mEq/L
Toxicity - 1.5 mEq/L

toxicity can be fatal if not recongized and treated

55
Q

Early - GI upset (N/V/D)
Late - tremor, ataxia, confusion, encephalopathy, seizures

What am I?
What is the treatment?

A

Lithium toxicity

supportive care: ABC, IV hydration, benzos for seizures
Hemodialysis if severe

56
Q

What are the CI to valproic acid?

A

Allergy to drug; liver disease; mitochondrial disease; pregnancy

Need to get pregnancy test!

57
Q

______ is an anticonvulsant that increases GABA levels and effectiveness. What is the target serum level?

A

Valproic acid

50-125mg/dL

58
Q

What are the common SE of valproic acid? What labs do you need to monitor?

A

N/V, HA, hair loss, bruising, weight gain, tremor, dizziness

serum drug levels, liver function tests (LFTs)

59
Q

_____ anticonvulsant; inhibits release of glutamate

A

Lamotrigine

60
Q

**What is the titration schedule for lamotrigine?

A

25 mg QD initially, titrated up every 2 weeks

61
Q

_____ is safer in pregnancy than lithium or other anticonvulsants

A

lamotrigine

62
Q

Nausea, rash, pruritus, drowsiness, dizziness
Rare - multiorgan hypersensitivity reaction, derm reaction
Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis

These are CI to _____

A

Lamotrigine

63
Q

______ anticonvulsant; anticholinergic; antimanic; antidepressant; antidiuretic; antineuralgic and is chemicall related to TCAs

A

Carbamazepine

64
Q

allergy to drug or TCAs; bone marrow suppression; use within 14 days of MAOI. Not recommended in pregnancy. These are the CI to _____

A

Carbamazepine

65
Q

**Which psych med has numerous DDI?

A

Carbamazepine

66
Q

N/V/D, HA, rash, pruritus, hyponatremia, fluid retention, leukopenia
Rare - bone marrow suppression, aplastic anemia, agranulocytosis
Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis

These are SE of _____

A

Carbamazepine

67
Q

If you miss 2-3 days of _____ you need to start over at 25mg

A

Lamotrigine

68
Q

________ were initially developed for psychotic d/o, schizophrenia
Used as adjunct therapy for other psych d/o, such as depression
May be used as initial or add-on therapy for bipolar disorder

A

Antipsychotics

69
Q

____ MOA works on serotonin and dopamine antagonists. List them

A

Antipsychotics

quetiapine (Seroquel), lurasidone (Latuda)

70
Q

tardive dyskinesia, GI, dyslipidemia, hyperglycemia, headache, sedation

These are the SE of _____

A

Antipsychotics

71
Q

** What is the specific SE of Quetiapine? Lurasidone?

A

HTN

Akathisia (no feelings or emotions)

72
Q

**Patients taking an antipsychotic (typical or atypical) are at risk of developing _____. If a patient is taking an antipsychotic, you should be assessing their ______ score regularly.

A

tardive dyskinesia

AIMS (Abnormal Involuntary Movement Scale)

73
Q

Persistently fluctuating mood beyond the normal range of mood symptoms is _____

A

cyclothymia

74
Q

What is the presentation of Cyclothymia?

A

2+ years with numerous periods of hypomanic symptoms and numerous periods of depressive symptoms

Symptoms are present at least half of the time

No more than 2 consecutive months free of symptoms

Patient does not meet full criteria for a mood episode
_______
Symptoms cause distress or functional impairment
Symptoms are not due to substance use
Symptoms are not better accounted for by another psych disorder

75
Q

What is the treatment for cyclothymia?

A

meds and therapy

may try mood stabilizer such as lithium

If frequent or refractory depressive s/s, may use low-dose antidepressant in conjunction

76
Q

What is Disruptive Mood Dsyregulation Disorder? What will they go on to develop as adults?

A

Persistently abnormal mood (irritable, sad or angry) with severe, frequent temper tantrums that interfere with ability to function at school or at home

depression

77
Q

What is the Disruptive Mood Dsyregulation Disorder presentation? What is the important point?

A

1+ year of abnormal mood-related symptoms, including:

3+ severe temper outbursts per week
Reaction is out-of-proportion for the stressor
Reaction is not consistent with developmental level
Sad, irritable, or angry mood nearly every day

Child must be at least 6 years old at time of diagnosis AND
Symptoms must have manifested before age 10

must happen in more than 1 place

not another psych dz

78
Q

Suicide is the ___ cause of death in the US for all ages

A

12

79
Q

____ are more likely to have suicidal thoughts
Attempt suicide 3x as often
Preferred method - poisoning/overdose

A

Females

80
Q

____ 4x as likely to successfully commit suicide
Preferred method - firearms

A

Males

81
Q

What ethnicities commit suicide most often?

A

American Indian, Alaska Native, White

82
Q

What are suicide risk factors?

A

Elderly white men (young pts more likely to attempt)
family hx
present or anticipated poor health
access to firearms
inability to accept help
living alone: never married, widowed, divorced or separated
lack of support
psych illness

83
Q

What are to major red flags for suicide?

A

if they have specific detailed plan

lack of protective factors

84
Q

_____ scale is given to patients who have a plan to harm themselves to determine in pt vs out pt

A

Columbia suicide severity rating scale

85
Q

When do you want to hospitalize a pt for suicide?

A

Patients who have actually made a suicide attempt

Patients with moderate-severe suicidal ideation: Stated intent, specific plan

86
Q

What is the protocol to ensure a suicidal patient’s safety?

A

Have staff member present

Limit access to objects that could cause harm

Transport to inpatient facility via ambulance

87
Q

____ and ____ are often used as an inpatient treatment of comorbid disorders

A

lithium and ECT

88
Q
A

Behavioral Dynamics (16 decks)

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