Psych EOR 1 - Depression/BP Flashcards
Manic Episode
→ elevated, expansive, irritable mood PLUS increased energy/activity >/= 1 WEEK
→ 3+ Symptoms: DIGFAST
D- Distractibility
I- Impulsivity (poor judgment, spending sprees, sexual indiscretion)
G- Grandiosity (increased self-esteem)
F- Flight of Ideas (racing thoughts)
A- Activity/Agitation (increased goal-directed activity, psychomotor agitation)
S- Sleep (decreased need)
T- Talkativeness (pressured speech)
→ ** + Significant Impairment OR Hospitalization OR psychosis (hallucinations, paranoia, delusions) **
Hypomanic Episode
→ elevated, expansive, irritable mood PLUS increased energy/activity >/= 4 DAYS
→ 3+ Symptoms: DIGFAST
D- Distractibility
I- Impulsivity (poor judgment, spending sprees, sexual indiscretion)
G- Grandiosity (increased self-esteem)
F- Flight of Ideas (racing thoughts)
A- Activity/Agitation (increased goal-directed activity, psychomotor agitation)
S- Sleep (decreased need)
T- Talkativeness (pressured speech)
→ ** NO PSYCHOSIS, NOT significantly impaired, NOT Hospitalization (hallucinations, paranoia, delusions) **
Major Depressive Episode
→ 5+: SIGECAPS for >/= 2 WEEKS
S- Sleep
I- Interest
G- Guilt
E- Energy
C- Concentration
A- Appetite
P- Psychomotor agitation/Retardation
S- Suicide
→ ** AT LEAST 1: Depressed Mood or Loss of Interest/Pleasure **
Patient will present as → a 27-year-old man accompanied by his girlfriend. In the office, he seems to be running from topic to topic without a clear message. His speech is pressured. The patient’s girlfriend reports that he took steroids recently for a bad sinus infection and since he started them, his behavior has been abnormal. After discontinuing the medication, he has still been having symptoms. He has not had a normal night of sleep for the past ten days, and he just bought a new sports car though he has no need for one or the money to afford it. She also reports that she has caught him with multiple other women in the past few days, though they were in a committed relationship. The physical exam is benign and the patient’s vital signs are within normal limits.
Bipolar I
Bipolar I
→ Disease Presentation:
Manic Episodes with or without Major Depressive Episodes (Manic is the ONLY requirement)
→ MANIC: elevated, expansive, irritable mood PLUS increased energy/activity >/= 1 WEEK
Days without sleeping
Excessive talkative/loud
Socially outgoing, Over-confident, Hypersexual, Flamboyant
Racing thoughts, flight of ideas, easily distracted, Impaired judgment
Spending sprees
Promiscuity
→ DSM-5:
AT LEAST 1 MANIC EPISODE
Manic/MDD not better explained by other disorders
→ Treatment: (Acute Mania)
LITHIUM = 1st Line
MUST CHECK TSH ANNUALLY
Haloperidol
1st LINE IN PREGNANCY!!!!
1st line in ACUTE MANIA with severe symptoms
Narrow Therapeutic Window → Check Plasma Levels 4-8 weeks (Toxic >1.5)
Mood Stabilizers: Lithium, Valproic Acid
Antipsychotics: Risperidone or Olanzapine)
Acute Psychosis TX = Antipsychotics or Benzos
Pregnant with Manic or Refractory/Life-Threatening Cases = Electroconvulsive therapy
→ Additional Information:
- 1st Degree Relative = Strongest Risk Factor
Patient will present as → a 19-year-old male who has had bouts of sadness for a course of 1 year in which he says that often times cannot even get out of bed so he tells his parents he is ill. Jim states that he recently felt so energized that he could not keep his thoughts straight and jumped from one idea to another. During this energized state, he did become irritable and others stated that he was louder than usual and wondered if he took something that increased his energy. During the week of high energy, he maxed out two of his credit cards and is not sure how he will pay them off before he goes to school in the fall. It was only a week later that he became so depressed that he did not find any pleasure in anything he did, was so tired he did not want to get out of bed which has continued to be a struggle today.
Bipolar II
Bipolar II
- (What cannot be given?)
→ Disease Presentation/DSM5:
More depressive than manic
AT LEAST 1 HYPOMANIC + AT LEAST 1 MAJOR DEPRESSIVE EPISODE
Hypomanic: 4 DAYS of DIGFAST + NO hospitalizations/impairments
Manic: >/= 1 week
NEVER BEEN MANIC
→ Treatment:
Lithium: 1st Line (~ 1 week to work)
Check Creatinine and TSH before
Increased toxicity risk: renal failure, hyponatremia, dehydration
Decreased Suicide Risk
Benzodiazepine: Acute Sedation
Antiepileptics: VALPROATE or CARBAMAZEPINE
Renal Dysfunction
Second Line Mood Stabilizer
Risperidone (atypical antipsychotic)
Lamotrigine (can be 1st line)
ECG Therapy = 1st line in acute mania with pregnancy
Haloperidol
1st LINE IN PREGNANCY!!!!
1st line in ACUTE MANIA with severe symptoms
** SSRI’s = CAN INDUCE MANIA IF MISDIAGNOSED WITH DEPRESSION! **
Patient will present as → a 28-year-old female presents to the clinic with concerns about her mood swings, which have been ongoing for more than two years. She describes periods of several days to weeks where she feels overly energetic, creative, and has a decreased need for sleep, followed by periods of low mood, fatigue, and disinterest in activities. These mood swings are not severe enough to cause significant impairment in her social or occupational functioning but are noticeable and distressing to her. She denies any history of major depressive or manic episodes. On examination, she appears well-groomed and is in no acute distress. She is diagnosed with ? Disorder based on her chronic pattern of fluctuating moods. Psychoeducation is provided about the nature of the disorder, and regular follow-up appointments are scheduled. The importance of monitoring her mood and behavior is emphasized, and the option of starting psychotherapy, such as cognitive-behavioral therapy (CBT), to help manage her symptoms is discussed. The patient is also informed about the potential future risk of developing bipolar disorder and the importance of early intervention if her symptoms intensify.
Cyclothymic Disorder
Cyclothymic Disorder
→ Disease Presentation/DSM-5:
CHRONIC (>2 YEARS) of depressive symptoms and hypomania symptoms
High and low moods without MAIN or Major Depression
LESS intense + LONGER lasting
Never meets criteria for MDD, Manic or Hypomania
→ Treatment:
Lithium (1st Line): especially with mood swings
Anticonvulsants: VALPROATE or CARBAMAZEPINE
Psychotherapy
Patient will present as → a 33-year-old woman complaining of fatigue and decreased interest in “the things that used to make me happy.” She is sleeping less and eating less, and she says that she is forcing herself to eat “because I know I have to eat something.” She finds herself spending less time with her kids and husband as she retreats to her room. She feels guilty that she lacks the energy and enthusiasm she used to have.
Major Depressive Disorder
Major Depressive Disorder
→ Pathophysiology: (3 Hypothesis)
Monoamine, Neurotrophic, Neuroendocrine
Decreased Serotonin, Norepinephrine, and Dopamine
→ Disease Presentation:
5 or more SIGECAPS for >= 2 WEEKS nearly DAILY:
Sad
Decreased interest
Guilt
Decreased Energy
Decreased Concentration
Appetite (weight changes)
Psychomotor (agitation)
Suicide
Symptoms cause distress/impairment to everyday life but NEVER MANIC
Feeling depressed, decreased interest in things must be present
MC in Females
** High Risk of suicide - ESPECIALLY RIGHT AFTER TREATMENT (the treatment gives them the energy they need to go through with it) **
→ Screening: Patient Health Questionnaire (PHQ-2)
→ Treatment:
Therapy
1st Line: SSRIs
Increase dose for 3-4 weeks until the symptoms are gone
Full effect usually within 4-6 weeks
See pt every 2-4 weeks and every 2 weeks until improvement
2nd Line: SNRIs (Duloxetine, Venlafaxine)
TCAs
Electrotherapy: rapid response in patients who are not responsive to medical therapy
→ Psychotic Major Depression:
→ Psychotic Major Depression:
Paranoia + delusions (may have high suspicions or hallucinations)
Pt >50
→ Major Depression with atypical features:
→ Major Depression with atypical features:
Fatigue, Hypersomnia, EXCESSIVE EATING and REACTIVE MOOD
Tx: MAO inhibitors
→ Melancholic Major Depression:
→ Melancholic Major Depression:
Lack of interest and Vegetative symptoms
→ Major Depression with Seasonal Onset:
→ Major Depression with Seasonal Onset:
Seasonally (FALL and WINTER)
Lethargy, excessive carb craving, hypersomnia, excessive eating
TX: SSRI, light therapy, Bupropion
