Putinta- Affective Disorders Flashcards
___ out of 9 symptoms for 2 weeks or more for MDD
5/9
symptoms to diagnose MDD
SIGECAPS
(sleep, interest, guilt, energy, concentration, appetite, psychomotor, suicide)
to be MDD (major depressive disorder)
“functional depression” most common type
atypical
Retained emotional reactivity!!! (actually enjoy hanging out with their friends)
Leaden paralysis (feel heavy all the time)
Atypical depression
typical depression from the 40s-50s
reduced appetite, weight loss, insomnia, guilt, poor memory, loss of emotional reactivity (responds well to ECT)
melancholic depression
Alzheimer’s vs depressive pseudodementia
lack of effort w/ depressive
1 thing contributing to the amount of years of quality of life lost to disability
major depressive disorder
gold standard for MDD treatment
cognitive behavioral therapy
first line medicine for MDD
SSRIs (sertraline, fluoxetine, paroxetine)
what is effective in MDD treatment, but w/ risk of increasing BP due to NE
SNRIs
not first line but good meds but require serum levels b/c have very narrow therapeutic windows
TCAs (Amitriptyline)
rule of 2’s
persistent depressive disorder
always depressed but not as depressed as someone with MDD
persistent depressive disorder
_____ and ____ are criteria for MDD but NOT for persistent depressive disorder
anhedonia (loss of interest in activities)
suicidal thoughts
Without extreme symptoms of MDD (suicidality and anhedonia)
The “rule of twos” – At least TWO symptoms of depression for TWO years with no less than TWO months consecutively without symptoms
Without psychosis
persistent depressive disorder
this is a cyclical pattern and have sx’s of bloating and breast tenderness or weight gain, irritable, depressed, anxious, pick fights with partner, increased pain sensations during the week leading up to menstrual cycle
absence of suicidal ideation
(5 sx’s week prior to menses)
premenstrual dysphoric disorder
A period of elevated, expansive, or irritable mood lasting at least ONE week
manic episode
DIGFAST sx’s of manic episode (need 3/7 to diagnose)
distractibility
increased goal-directed activity (that doesnt make sense with their daily life)
grandiosity
flight of ideas
agitation
sleep (decreased need)
talkativeness
to help diagnose manic episode
psychotic symptoms
single episode of mania defines illness, may have a major depressive episode, but not required
bipolar 1 disorder
very highly heritable disorders (2)
bipolar 1 disorder
schizophrenia
pt has inflated self-esteem (grandiose), decreased need for sleep, but will sleep for 2-3 hrs a night, talkative but not pressured, more appropriate goal directed activity (staying up all night cleaning the room or studying), may spend more money than they need to, but they aren’t putting themselves in bankruptcy like in bipolar 1
hypomanic episode
A distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased activity or energy, lasting at least 4 consecutive days and present most of the day, nearly every day
no psychosis
hypomanic episode
The episode is not severe enough to cause marked impairment in social or occupational functioning or to necessitate hospitalization
hypomanic episode
being more productive than normal (definite change from baseline, but usually positive)
hypomania
Criteria have been met for at least one hypomanic and at least one major depressive episode
bipolar 2 disorder
Major depressive episode is REQUIRED in bipolar ___ disorder, but is not required in bipolar ____disorder
required in bipolar 2, but not in bipolar 1
hyperthyroidism
malignancy affecting R orbital frontal cortex
levothyroxine
steroids
stimulants opiates
DDx of bipolar disorder
2 or 3 sxs of depression instead of 5 for MDD
2 or 3 sxs of hypomania instead of 4
cyclothymic disorder
For at least a two year period, there have been episodes of hypomanic and depressive experiences which do not meet the full DSM-5 diagnostic criteria for hypomania or major depressive disorder
cyclothymic disorder
Same rule of 2’s – Two years of symptoms, at least Two symptoms of either hypomania or depression for more than half the time, no more than TWO months of absence of symptoms
Never associated with psychosis
2-3 sxs of depression
2-3 sx’s of hypomania
cyclothymic disorder
to treat bipolar disorder
mood stabilizers (valproate, lithium)
top 5 risk factors for suicide
hx of previous attempt
older adults
substance abuse
violent behavior
male
caucasian, native americans
chronic illness
healthcare professionals
risk factors for suicide
The physician’s good clinical judgment is the most important variable in identify the patient at risk for _____
suicide
Psychiatric diagnosis with highest suicide rate is _____
anorexia nervosa
if patient is suicidal, what to recommend
hospitalization
Big stressful life event that happens and it temporarily disrupts your normal functioning (have sx’s w/in 3 months of stressor that lasts no longer than 6 months)
Adjustment disorder
how to treat adjustment disorder if you decide to
cognitive behavioral therapy
Characterized by physiologic and psychological symptoms of fear without external cause or threat.
sx’s persistent (often 6 months)
interferes w/ functioning and/or cause distress
Anxiety disorders
time frame for depression in adults vs children diagnosis
2 yrs for adults
1 yr for children
time frame for anxiety in adults vs children diagnosis
6 months for adults
3 months for children
hypothesis of the cause of this includes decreases serotonin and GABA and increased NE and glutamate
anxiety
caffeine
stimulants
hyperthyroidism
anemia
hypo/hyperglycemia
DDx for anxiety
Excessive anxiety and worry (apprehensive expectation), occurring more days than not for at least 6 months, about a number of events or activities (such as work or school performance)
generalized anxiety disorder
generalized anxiety disorder
May occur with panic attacks. If fear of subsequent panic attacks is absent, and constant worry is present, correct diagnosis is ____
generalized anxiety disorder w/ panic
attack is an abrupt surge of intense fear or intense discomfort that reaches a peak within minutes, and during which time four (or more) of the following symptoms occur
panic attack
4 or more of these sx’s
panic disorder
panic disorder
fear of having panic attack in a place and not able to get out of there in a timely manner
agoraphobia
If social anxiety situations is what triggers panic, than it is not _______
panic disorder
Marked fear or anxiety about a specific object or situation (e.g., flying, heights, animals, receiving an injection, seeing blood) lasting for 6 months or more
specific phobia
Clowns, crossing bridges, public transportation, blood draw, spiders
specific phobia
Feel comfortable in smaller groups of people and get increasingly uncomfortable the larger the group gets
Very common anxiety disorder
social anxiety disorder
mean age of onset is 13 yrs for this anxiety disorder
social anxiety disorder
first line therapy for anxiety disorders
CBT
first line meds for anxiety disorder
SSRIs
second-line pharmacotherapy and may be quite effective, though increased norepinephrine may cause worsening anxiety in some patients (venlafaxine and duloxetine)
SNRIs
is highly effective in social anxiety disorder and in helping with somatic symptoms of various anxiety disorders
Crosses the blood-brain barrier and has some calming effect, as well
beta blocker
propranolol
Exposure to actual or threatened death, serious injury, or sexual violence in one (or more) of the following ways (experiencing it, witnessing it, hearing about it)
PTSD
meet criteria for ONE month; sx’s last >1 month
PTSD
symptoms last >2 day to <4 weeks
(re-experiencing, hyperarousal, numbing, avoidance)
Acute Stress Disorder
gold standard for PTSD treatment
CBT
Recurrent and persistent thoughts, urges or images that are experienced, at some time during the disturbance, as intrusive, unwanted, and that in most individuals cause marked anxiety or distress.
The individual attempts to ignore or suppress such thoughts, urges, or images, or to neutralize them with some thought or action (i.e., by performing a compulsion)
obsessions (OCD)
repetitive behaviors that are always numbered
compulsions (OCD)
The obsessions or compulsions are time consuming (e.g., take more than 1 hour per day) or cause clinically significant distress or impairment in social, occupational, or other important areas of functioning
OCD
no time criteria for ___
OCD
Anxiety relieved to some extent by compulsions – escalating sense of tension released by compulsions
Insight usually present – almost have startling degrees of insight, but cannot avoid engaging in compulsions
OCD
main management in OCD
CBT (exposure response prevention therapy)
Lack of capacity to control aggressive impulses
Presents as verbal aggression, on average 2 times per week for three months, OR three behavioral outbursts destroying property within 12 months
intermittent explosive disorder
Recurrent failure to refrain from impulsive fire setting
Heightened tension before firesetting and relief on fire setting
Fire setting is not in context of anger, vengeance, or attempting to improve living conditions (intentionally setting fire for insurance money)
pyromania
Recurrent urges to steal objects with no monetary value
Heightened tension before committing theft with relief after committing theft
kleptomania
no FDA approved treatment for these disorders
impulse control disorders
