PSYCHIATRY-MOOD DISORDERS Flashcards
Depression DSM criteria
A: down depressed mood for most of the day nearly every day (or irritability in children)
OR lack of interest in most to all activities
B: sleep, appetite, concentration, psychomotor slowing/agitation, energy, worthlessness/guilt, suicidality
C: not due substances/med conditions
D: not better explained by another psych condition
What are the three domains to classify depressive symptoms
- Affective: decreased mood, lack of interest
- Cognitive: worthlessness, suicidal ideation
- Neurovegetative symptoms: sleep changes, appetite, energy, concentration, psychomotor slowing
what are medical conditions that may mimic depression
hypothyroidism, anemia, B12 def, folate deficiency, stroke, HIV, MS, parkinsons, MI, cancer, autoimmune`
what is a differential diagnosis for depression
- Bipolar
- Substance induced depression
- Sadness
- Schizoaffective disorder
- Grief
- Persistent depressive disorder
- Adjustment disorder
What are the DSM criteria for Bipolar disorder
What are indications for lithium
1 therapy for acute mania, bipolar depression (1st line - antisuicidal), maintenance (1st line), antidepressant augmentation, behaviour issues in BPD
What are side effects of lithium
- VERY toxic in OD
- Ebstein’s anomaly in pregnancy - ECG changes (check > 40)
- Fine tremor
- Hypothyroidism
- Polyuria/polydipsia
- Nausea, loose stools
- Renal toxicity
- Skin disorders/hair loss
- Acne
- Weight gain
When is divalproex used in BD
Acute mania (1st line), bipolar depression (2nd line - not antisuicidal), maintenance (1st line)
What are side effects of Divalproex
- Avoid in pregnancy!! (Major malformations including Neural Tube Defects)
- Fine tremor
- Liver dysfunction
- Menstrual disturbances/PCOS - Nausea
- Osteoporosis
- Hair loss
- Thrombocytopenia - Weight gain
DSM-5 Criteria for Hypomanic Episode
What is the distinction between BDI and BDII
BDI: manic episode (may have depressive episodes with, but not required for diagnosis)
BDII: hypomanic and depressive
What is the distinction between manic and hypomanic
Severe enough to necessitate hospitalization, impairment of function, or psychotic features. Mania also lasts 7 days (or hospitalization) whereas hypomania is 4 days
What meds should we use in acute mania
What meds in bipolar depression
FIRST LINE
Select mood stabilizers (lithium, lamotrigine)
Select antipsychotics (quetiapine, lurasidone)
Combination therapy with these agents is also first-line indicated.
SECOND LINE
Can use antidepressant with above, just not alone
ECT
BD maintenance meds
o Select mood stabilizers (lithium, valproate, lamotrigine)
o Select antipsychotics (quetiapine, asenapine, aripiprazole)
o Combination therapy with mood stabilizers and antipsychotics
