Test 1 - Depressive Disorders Flashcards by Alice Richards

major depressive disorder is also known as

unipolar dpn

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for dx of mdd, pt must have __ of the 9 symptoms

for __

at least 2 weeks

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what are the 2 must have symptoms for mdd (pt must have one of these PLUS at least 4 of the others)

depressed mood
loss of interest /pleasure

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SIGECAPS describe

the additional symptoms for mdd

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what does SIGECAPS stand for

Sleep disturbance

Interest

Guilt

Energy change

Concentration

Appetite

Psychomotor retardation or agitation

Suicidal

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what are 3 atypical patterns of mdd

increased appetite

increased sleep

seasonal pattern

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what is the highest risk pt population for suicide

elderly

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what is minor dpn

depressed mood OR loss of interest/pleasure

PLUS

2-4 of SIGECAPS

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in major depressive d.o, a pt must have __ associated symptoms;

in minor dpn, a pt must have __ associated symptoms

2-4

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in mdd and minor dpn, a pt must have symptoms for at least

2 weeks

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what are vegetative symptoms

physiologic/body fxn → sleep, appetite, energy, sexual interest

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name 2 cognitive symptoms

poor concentration

low self esteem

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what is an emotional symptom

crying spell

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dpn is a __ d.o

__% of pt’s who have first episode will have another

recurring

50&

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when does dpn become an issue

when it interferes w. ADLs

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what is melancholic dpn

mdd w. an emphasis on lack of pleasure or lack of reactivity to pleasure

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melancholic dpn is harder or easier to treat

harder

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for melancholic dpn, a pt must have at least __ of what symptoms

at least 3 of:

depressed mood worst in AM

early morning awakening

psychomotor agitation/retardation

significant wt loss

inappropriate guilt

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persistent depressive d.o is also called

dysthymia

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what is persistent depressive d.o / dysthymia

dpn for most of the day for more days than not

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dysthymia / pdd can be an ___ or

__ account

subjective

objective

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for persistent depressive d.o / dysthymia, a pt must have at least __ of the following symptoms

for at least __ years

with no more than __ without symptom

at least 2 for at least 2 years, with no more than 2 months w.o symptoms:

poor appetite

insomnia/hypersomnia

low energy/fatigue

low self-esteem

poor concentration/difficulty making decisions

feelings of hopelessness

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for persistent dpn / dysthymia, a pt must have never been w.o symptoms for

more than 2 months at a time

if pt less than 18, 1 year

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what is double dpn

mdd + persistent dpn

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are men or women more likely to get depressed

women! 2x

what are more common mood d.o pathologies in men

etoh substance abuse

which mood d.o that we've discussed has the highest suicide rate

bipolar ¼ will attempt → 10-20% will die

\_\_ are more likely to attempt suicide, but __ are more likely to be successful

women more likely to attempt men more likely to be successful

for dx of bipolar I, pt must have __ manic **(not hypomanic)** episodes

1 or more

in addition to manic episodes, \_\_ or __ may also be present in bipolar I

psychotic symptoms minor or major depressive episodes

what is the criteria for a manic episode

distinct period of abnormally persistently elevated, expansive, or irritable mood **lasting at least 1 week, present most of the day, nearly every day**

what is the length of time criteria for a manic episode

at least 1 week, present most of the day, nearly every day

at least __ of the following symptoms must be present for a manic episode dx (7)

at least 3 of 1. inflated self esteem/grandiosty 2. decreased need for sleep 3. more talkative/pressure to keep talking 4. flight of ideas or subjective experience of thoughts racing 5. distractibility to irrelevant stimuli 6. increase in goal-directed activity/psychomotor agitation 7. excessive involvement in pleasurable activities w. high potential for painful consequences

what is the definition of bipolar II

at least 1 major depressive episode PLUS one hypomanic episode

a hypomanic episode must last at lest __ days

what are the symptoms of a hypomanic d.o

same as for manic

how is a hypomanic episode different from a manic episode (3)

length of time impairment not as severe may not be viewed by pt as pathological but others may be troubled by erratic behavior

what is a main distinguishing factor for a manic episode vs hypomanic

in manic episode, pt's behavior gets them into trouble

what are specifiers for bipolar (8)

1. anxious distress 2. mixed features 3. rapid cycling 4. melancholic features 5. atypical features 6. catatonia 7. peripartum onset 8. seasonal pattern

what are 4 red flags for bipolar d.o

1. early onset of mood d.o 2. family hx 3. atypical features 4. recurrent course

what are symptoms of manic/hypomanic episodes with mixed features

1. depressed mood 2. diminished interest/pleasure in most activities 3. psychomotor agitation 4. low energy 5. excessive guilt or thoughts of worthlessness 6. recurrent thoughts about death or suicide attempt

\_\_% of bipolar pt's have mixed features

50%

what are 4 common comorbidities w. bipolar d.o

etoh drugs panic OCD

what is the criteria for bipolar w. rapid cycling

4x / year

does bipolar + dpn respond well to SSRIs

no!

what can SSRIs cause in bipolar w. dpn

manic episodes

are tricyclic antidepressants (TCAs) good for bipolar w dpn

no → cause worse manic episodes than SSRIs

which SSRI is a category D in pregnancy

paroxetine

most frequent s.e of SSRIs

sexual dysfxn

what med is good for a pt w. depression and psychotic features

antipsychotic → quetiapine OR lurasidone

what should you not prescribe to a pt w. dpn and psychotic episodes

SSRIs

are SSRIs the go to tx for bipolar

no!

what is a downside of lithium

renal toxicity

what is a good monotherapy for bipolar

lamotrigene

what med reduces suicidal ideation

lithium

what is cyclothymic dpn

fluctuating hypothymic + dpn w.o ever meeting criteria for either symptoms for at least half the time x 2 years - *1 in kids -* not absent for \> 2 mo **low grade hypomanias + brief fleeting lows** not better explained by other d.o not induced by substance or other condition significant distress/impaired fxn

tx for cyclothymic d.o

mood stabilizers atypical antipsychotics lamotrigene for dpn

avoid __ in cyclothymic d.o

antidepressants → risk for hypomanic episodes

lifetime prevalence of bpd

3.9%

what dpn responds better to tca's/ssnri's than ssri's

melancholic

what is the go to drug for mod-severe dpn

SSRIs

all SSRIs are equally efficacious except for

trazadone (desaryl)

common s.e of SSRIs

nausea nervousness insomnia sexual dysfxn → long term effect HA

what are 2 pros of SSRIs

low CV effectse low overdose/sz potential

does newest research suggest a link btw SSRIs and suicide risk in youths

why do pt's stop using meds

they feel better bc of s.e

which drug should be used w. caution as it is a very effective way to kill yourself

TCAs

which SSRI has the longest half life

prozac (fluoxatine)

which SSRI has the shortest half life

paxil

according to the guidelines, what is 1st line tx for acute bipolar w. dpn

lurasidone OR cariprazine monotherapy

according to guidelines, what is 1st line tx for mild/mod bipolar w. mania

lithium monotherapy

according to the guidelines, what is 1st line tx for acute severe bipolar w. mania

lithium OR divalproex PLUS aripiprazole, quetiapine, or risperidone

when is ECT recommended for bipolar

if med emergency/pt welfare is at risk and meds are ineffective

1st line tx for preventative dpn in bipolar

lamotrigine

1st line tx for continuation/maintenance therapy for bipolar

lithium monotherapy

onset of post partum dpn much be within __ weeks of delivery