Quiz Flashcards
What are the starting doses of SSRIs?
Fluoxestine 20mg Paxil 20mg Zoloft 50mg Fluvox 50mg Celexa 20mg Lexapro 10mg
What are the starting doses of SNRIs?
Effexor 37.5-75mg
Cymbalta 30-60mg
What is the starting dose of mirtazapine?
15mg
What is the starting dose of wellbutrin?
100-150mg
What is the duration of MDD therapy?
4-8 weeks
What is the diagnostic criteria for MDD?
2+ weeks
5+ sx
What are the sx of MDD?
Sleep (insomnia/hypersomnia) Interest (loss of interest/pleasure) Guilt (feeling of worthlessness; excessive/inappropriate guilt) Energy (Fatigue/loss of energy) Concentration Appetite (change in appetite/wt) Psychomotor Suicidal thoughts Low mood
What is the diagnostic criteria for mania?
3+ sx
1+ week
Or any duration if hospitalization is necessary
Cause marked impairment
What is the diagnostic criteria for hypomania?
3+ sx
4+ consecutive days
Not severe enough to cause marked impairment
What are the sx of mania/hypomania?
Grandiose; increase self-esteem Increased activity (goal directed/highly risky) Decreased judgement Distractibility; flight of ideas Irritability Need less sleep Elevated mood Speedy talking/thoughts
What are the diagnostic criteria for rapid cycling?
4+ mood episodes (MDD, manic, mixed, hypomanic)/year
What are the criteria for cyclothymia?
Numerous periods with hypomanic sx and depressive sx for at least 2 years that do not meet criteria for MDD
For more than 2 months at a time
Present for at least 1/2 the time
What is the criteria for mixed BD?
Patient w/sx of both mania and depression simultaneously
What are the characteristics of BP I?
Mania Psychosis often present Impaired functioning Hospitalization often required Duration = months
What are the characteristics of BP II?
Hypomania Psychosis often not present Slightly impaired to improved functioning Hospitalization not required Duration = weeks
What are the first line therapy for MDD?
SSRI
SNRI
Mirtazapine
Bupropion
What are the first line therapy for acute mania?
Lithium
VPA
SGA
Consider 2 drug combination, if severe (MS + SGA)
CBZ 1st or 2nd line depending on guideline
What are the first line therapies for BD?
Lithium
Lamictal
Quetiapine
What are the first line therapies for Mixed BD?
CBZ
VPA
Olanzapine
What length of time is considered an adequate trial before adjusting/augmenting MDD therapy?
4-8 weeks
What do we do if a patient with MDD is non-responsive to therapy?
Change/switch to a drug in a different/same class
What do we do if a patient with MDD is partially responsive to therapy?
Ensure optimized dose
Can switch/augment
Augment/adjunctive therapy should target remaining sx
Augmentation is better strategy when response is seen
What is the gold standard for augmentation in partial response for MDD?
Lithium
What drugs are options for MDD augmentation/adjustments?
AAP (low dose SGAs in MDD w/o psychosis) Anticonvulsants Omega-3 Folic acid Psychostimulants Buspar Ketamine
Where is psychostimulants in MDD partial response therapy?
Controversial
May consider short course if severe depression (fatigue, not getting out of bed or if immediate response required)
May exacerbate anxiety
Abuse potential
What is the DOT of MDD?
12 months with the first episode for most patients
12-26 months for patients w/recurrent and/or severe MDD
Potentially indefinitely depending on severity
What is the DOT of BD?
Typically lifelong
Which medication decreases SI in MDD?
Lithium
Which screening tool in MDD is used for screening?
PHQ-9
Who gets PHQ-9 and HAM-D?
All adults at least every 5 years
Those at high risk
Who is at high risk in MDD?
PMH
FH of depression/bipolar disorder
Chronic illness ("frequent flyers")
High utilization of services
PregnancyWhat is the screening tool for BD?
MDQ
Who gets screening with BD?
Young adults - 40’s with RFs
Patients not feeling themselves
What are RFs for BD?
FH, stressors, head trauma, environment
Medical diagnosis, psychitric diagnosis or medications known to contribute
What is the role of antidepressants in BD?
Should be used with mood stabilizers
Can cause “switching”
How do we treat comorbid anxiety in patients with BD?
Gabapentin
Quetiapine
