Psychiatry/Behavioral Medicine (5%) Flashcards
What are some risk factors for developing major depressive disorder?
More common in males or females?
What is the age range that this dx is most commonly seen in?
FHx
female (2:1)
20-40 y/o with highest incidence
How to make the dx of MDD?
Depressed mood or anhedonia (loss of pleasure) or loss of interest in activities with >=5 associated sx almost every day for most of the days for at least 2 weeks:
Fatigue almost all day, insomnia or hypersomnia, feelings of guilt or worthlessness, recurring thoughts of death or suicide, psychomotor agitation, significant weight change (gain or loss), decreased or increased appetite, decreased concentration/indecisiveness
The sx are <strong>not</strong> due to substance use, bereavement or medical conditions
Somatic: constipation, HA, skin changes, CP, abd pain, cough, dyspnea
To make the dx of major depressive d/o, which two sx must be ABSENT?
Mania and hypomania
What is seasonal affective d/o?
Atypical depression?
Melancholia?
Catatonic depression?
- Seasonal affective d/o: the presence of depressive sx at the same time each year (MC in winter due to reduction of sunlight & cold weather)
Management: SSRls, light therapy, Bupropion
- Atypical depression: shares many of the typical sx of major depression but pts experience mood reactivity (improved mood in response to positive events)
Management: MAO inhibitors
- Melancholia: characterized by anhedonia, lack of mood reactivity, depression, severe weight loss/loss of appetite, excessive guilt, psychomotor agitation or retardation & sleep disturbance (increased REM time & reduced sleep)
- Catatonic depression: motor immobility, stupor & extreme withdrawal
Major depressive d/o may be due to an alteration in _______ or a _______ dysregulation
neurotransmitters
neuroendocrine
What is the principle therapy for mild-moderate depression?
Psychotherapy
What medications are often first line in patients with mild-moderate depression?
How long should antidepressants be continued for to determine if they are efficacious?
SSRIs
Should be continued for a minimum of 3- 6 weeks to determine efficacy
What should be attempted for tx in pts who fail to respond to medical therapy?
Electroconvulsive therapy (ECT)
What is the difference between bipolar I and bipolar II disorder?
What is 1st line tx for each?
Bipolar I: >=1 manic or mixed episode, which often cycles w/ occasional depressive episodes, but major depressive episodes are not required for dx
Bipolar II: >=1 hypomanic episode + >=1 major depressive episode (mania or mixed episodes are absent)
Tx: LITHIUM
What is mania?
MANIA: abnormal & persistently elevated, expansive, or irritable mood at least 1 week (or less if hospitalization is required) with marked impairment of social/occupational function, >=3:
- MOOD: euphoria, irritable, labile or dysphoric
- THINKING: racing, flight of ideas, disorganized, easily distracted, expansive or grandiose thoughts, judgment is impaired
- BEHAVIOR: physical hyperactivity, pressured speech, decreased need for sleep, increased impulsivity and excessive involvement in pleasurable activities including risk-taking and hypersexuality, disinhibition, increased goal directed activity –> Psychotic sx (paranoia, delusions, hallucinations) may be seen in these pts
What is hypomania?
Sx similar to manic sx: period of elevated, expansive or irritably mood @ least 4 days that is clearly different from the usual nondepressed mood but does NOT cause MARKED impairment
No psychotic features and usually does not require hospitalization
Does not include racing thoughts or excessive psychomotor agitation
Persistent depressive d/o, or dysthymia, is defined as a chronic depressed mood for how long in children/adolescents?
>1 year
What is 1st line tx for dysthymia (persistent depressive disorder)?
SSRIs
Cyclothymic disorder is similar to what other condition, but less severe?
Bipolar II d/o
What are some examples of panic attack sx?
Dizziness, trembling, choking feeling, parasthesias, sweating, SOB, CP, chills, hot flashes, fear of losing control, fear of dying, palpitations, nausea, abd pain, depersonalization
What is the recommended management for an acute panic attack?
Benzodiazepines
Panic d/o is more common in men or women?
Women (2-3x)
What is the diagnostic criteria for panic disorder?
Recurrent, unexpected panic attacks (at least 2)
Panic attacks often followed by concern about future attacks
Worry about the implication of the attacks
Significant change in behavior related to the attacks
What is agoraphobia?
anxiety about being in places or situations from which escape may be difficult
What is 1st line medical treatment for long term management of panic disorder?
SSRIs 1st line
Cognitive behavioral therapy
What is the diagnostic criteria for generalized anxiety?
Excessive anxiety or worry a majority of days >6 month period about various aspects of life
<em>not episodic, situational, or focal</em>
Generalized anxiety d/o is associated with how many of the following sx?
fatigue, restlessness, difficulty concentrating, muscle tension, sleep disturbance, irritability, shakiness, HA
greater than or equal to 3
Is generalized anxiety d/o more common in males or females?
When is the age range of anticipated onset of GAD?
Females
Early 20s
What medications are used in the management of generalized anxiety d/o?
Antidepressants (SSRIs)
Buspirone (does not cause drowsiness)
BZDs for short term use only, BBs, TCAs
Psychotherapy (CBT)
Which d/o is described below?
Persistent (> 6 months), INTENSE FEAR OF SOCIAL OR PERFORMANCE SITUATIONS in which the person is exposed to the scrutiny of others for fear of embarrassment
Social anxiety d/o
What medications and otherwise can be used in the management of social anxiety d/o?
Antidepressants (SSRIs)
Beta Blockers (for performance anxiety)
BZDs (short term)
Psychotherapy (CBT)
What condition is described below?
Persistent (> 6 months}, intense fear/anxiety of a specific situation (ex. heights, flying), object (ex. pigeons, snakes, blood) or place (ex. hospital)
Specific phobias
T/F: In a pt with a specific phobia, the fear is in proportion to any real danger
FALSE, it is out of proportion!
_____ _____ must be impaired by distress or avoidance of the situation or object, for a pt’s phobia to be diagnosed
Everyday activities
Childhood phobias may ______ with age
lessen
What are options for the management of a pt’s phobia?
Exposure/desensitization therapy (tx of choice)
Short term BZDs and BBs can be used in some pts
