Psych 4 Flashcards
What classifies as mixed features of bipolar disorder
Depressive sx present during the majority of days during mania/hypomania: dysphoria, depressed modd, anhedonia, psychomotor retardation, fatigue, worthlessness, guilt, SI
What classifies as rapid cycling of bipolar
At least 4 mood episodes (manic, hypomanic, depressed) within 12 months
Diagnostic criteria of Persistent depressive disorder (dysthumia)
- Depressed mood for the majority of time most days for at least 2 years (vs. MDD which is episodic)
- At least 2 of the following: poor concentration, hopelessness, poor appetite or overeating, insomnia or hypersomnia, low energy or fatigure, low self-esteem)
- During the 2 year period, pt has not been without the above sx for > 2 months at a time
- May also have MDD
- Must never have had a manic or hypomanic episode (this would make diagnosis bipolar or cyclothymic disorder)
THINK: Persistent Depressive Disorder (DD) = 2 Ds
- 2 yrs depression
- 2 listed criteria
- Never asymptomatic for > 2 months
Tx of dysthymia
Combo with psychotherapy and pharmacotherapy (SSRI, TCA, MAOI) is preferred
Diagnostic criteria for cyclothymic disorder
- Numerous periods with hypomanic sx (but not a full hypomanic episode) and periods with depressive sx (but not full MDE) for at least 2 years
- Pt must have never been sx free for > 2 months during those 2 years
- No history of MDE, hypomania, or manic episode
Tx of cyclothymic disorder
Anti-manic agents (mood stabilizers and SGA) as used to treat bipolar
Progression of cyclothymic disorder
Approx 1/3 of patients eventually develop bipolar I/II
Describe in basic language Disruptive Mood Dysregulation Disorder (DMDD)
Chronic, severe, persistent irritability occurring in childhood and adolescence
Diagnostic criteria of Disruptive Mood Dysregulation Disorder (DMDD)
- Severe recurrent verbal and/or physical outbursts out of proportion to the situation
- Outbursts >3 per week ad inconsistent with developmental level
- Mood between outbursts is persistently angry/irritable most of the day nearly every day
- Sx last for at least 1 year and no more than 3 months without sx
- Symptoms in at least 2 settigs
- Sx must have started before age 10
- No episodes meeting full criteria for manic/hypomanic episode lasting longer than 1 day
Tx of Disruptive Mood Dysregulation disorder (DMDD)
- Unsure because new diagnosis
- Psychotherapy (parent management training = first line)
- Stimulants, SSRIs, mood stabilizers, and SGA can treat sx
Time frame of adjustment disorder
- Sx develop within 3 months in response to stressor
- Distress in excess of what would be expected
- Sx resolve within 6 months after stressor is terminated
Time frame required for diagnosis of major depressive episode
2 weeks with 5+ depressive sx
What type of drug is Abilify
Aripiprazole
Time frame for mania
7 days minimum
Or manic sx + psychosis
Or manic sx + hospitalization
Time frame for hypomania
4 days minimum (can last more than 7 days)
Time frame for dysthymia
2 years for adults
1 year in kids
How many SIG E CAPS are needed for dysthymia vs. MDD
MDD = 5 or more Dysthymia = 3 or more
Time frame and definition of cyclothymia
2 years
Hypomania + dysthymia
What is delusional disorder
1-2 fixed delusions, but functioning well in rest of life
How do you distinguish between delusional disorder and paranoid personality disorder
Paranoid personality applies to more than just a few things - have delusions about everything in their life, not just one or two things
What must MDD be if there are psychotic features
MUST be severe (psychosis bumps mild or moderate up to severe)
Can Bipolar II disorder have psychotic features
Yes, only if psychotic features ONLY present during depressed state of Bipolar II
If psychotic features present during hypomanic state, that hypomania is bumped up to mania, which means BPII becomes BPI
How do you define schizoaffectve disorders in the context of mood vs. psychotic disorders
When people have both psychosis and mood sx but the sx occur independent of each other
What type of drug is Zyprexa
Olanzapine (SGA)
What is dystonia (side effect of FGA)
Involuntary muscle spasm, contraction
Tx of dystonia
Botox
Can also give Benztropine or Benadryl
What are Parkinsonian sx
Slowed movements, resting tremor (symmetric, high frequency, low amplitude), shuffling gait, cogwheel rigidity (when extremities “catch” during movement)
What is akathisia
Subjective feeling of need to move
Urge does not improve with movement (vs. restless leg syndrome where urge does improve with movement)
What lab finding is often seen in suspected MDD and restless leg syndrome
Iron deficiency
Common side effect of Risperidone
Breast formation (increases prolactin via blocking dopamine)
Common side effect of Ziprasidone
QTc prolongation
Common side effect of Olanzapine
Highest weight gain; sedating
Common side effect of Quetiapine
Highest weight gain (along with Olanzapine); sedating
How does Aripiprazole affect weight
Averages of weight change are “weight neutral” (individuals can gain or lose weight)
What is Thorazine
Chlorpromazine (FGA)
What is Invega
Paliperidone (SGA)
What is Prolixin
Fluphenazine (FGA)
What is Clozaril
Clozapine (SGA)
What is Zyprexa
Olanzapine (SGA)
What is Seroquel
Quetiapine (SGA)
What is Trilafon
Perphenazine (FGA)
What is Geodon
Ziprasidone (SGA)
What SGA causes the least weight gain
Ziprasidone
What are the 3 main side effects to know for Clozapine
(1) Agranulocytosis (suppression of WBC in >1% of population)
(2) Myocarditis (>1% of population)
(3) Metabolic effects (weight gain, risk of DM, increased appetite)
What antipsychotic is the most associated with decreased risk of suicide in Bipolar disorder
Clozapine (decreases by 70%)
But is so infrequently prescribed because of ridiculous amount of monitoring necessary
