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Psychosocial Care > Test 1 - Depressive Disorders > Flashcards

Test 1 - Depressive Disorders Flashcards

1
Q

major depressive disorder is also known as

A

unipolar dpn

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2
Q

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

for __

A

5

at least 2 weeks

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3
Q

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

A
  1. depressed mood
  2. loss of interest /pleasure
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4
Q

SIGECAPS describe

A

the additional symptoms for mdd

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5
Q

what does SIGECAPS stand for

A

Sleep disturbance

Interest

Guilt

Energy change

Concentration

Appetite

Psychomotor retardation or agitation

Suicidal

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6
Q

what are 3 atypical patterns of mdd

A

increased appetite

increased sleep

seasonal pattern

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7
Q

what is the highest risk pt population for suicide

A

elderly

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8
Q

what is minor dpn

A

depressed mood OR loss of interest/pleasure

PLUS

2-4 of SIGECAPS

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9
Q

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

in minor dpn, a pt must have __ associated symptoms

A

5

2-4

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10
Q

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

A

2 weeks

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11
Q

what are vegetative symptoms

A

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

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12
Q

name 2 cognitive symptoms

A

poor concentration

low self esteem

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13
Q

what is an emotional symptom

A

crying spell

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14
Q

dpn is a __ d.o

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

A

recurring

50&

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15
Q

when does dpn become an issue

A

when it interferes w. ADLs

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16
Q

what is melancholic dpn

A

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

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17
Q

melancholic dpn is harder or easier to treat

A

harder

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18
Q

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

A

at least 3 of:

depressed mood worst in AM

early morning awakening

psychomotor agitation/retardation

significant wt loss

inappropriate guilt

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19
Q

persistent depressive d.o is also called

A

dysthymia

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20
Q

what is persistent depressive d.o / dysthymia

A

dpn for most of the day for more days than not

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21
Q

dysthymia / pdd can be an ___ or

__ account

A

subjective

objective

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22
Q

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

A

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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23
Q

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

A

more than 2 months at a time

if pt less than 18, 1 year

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24
Q

what is double dpn

A

mdd + persistent dpn

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25
Q

are men or women more likely to get depressed

A

women! 2x

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26
Q

what are more common mood d.o pathologies in men

A

etoh

substance abuse

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27
Q

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

A

bipolar

¼ will attempt → 10-20% will die

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28
Q

__ are more likely to attempt suicide,

but __ are more likely to be successful

A

women more likely to attempt

men more likely to be successful

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29
Q

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

A

1 or more

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30
Q

in addition to manic episodes, __

or __ may also be present in bipolar I

A

psychotic symptoms

minor or major depressive episodes

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31
Q

what is the criteria for a manic episode

A

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

32
Q

what is the length of time criteria for a manic episode

A

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

33
Q

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

A

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
34
Q

what is the definition of bipolar II

A

at least 1 major depressive episode PLUS one hypomanic episode

35
Q

a hypomanic episode must last at lest __ days

A

4

36
Q

what are the symptoms of a hypomanic d.o

A

same as for manic

37
Q

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

A

length of time

impairment not as severe

may not be viewed by pt as pathological but others may be troubled by erratic behavior

38
Q

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

A

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

39
Q

what are specifiers for bipolar (8)

A
  1. anxious distress
  2. mixed features
  3. rapid cycling
  4. melancholic features
  5. atypical features
  6. catatonia
  7. peripartum onset
  8. seasonal pattern
40
Q

what are 4 red flags for bipolar d.o

A
  1. early onset of mood d.o
  2. family hx
  3. atypical features
  4. recurrent course
41
Q

what are symptoms of manic/hypomanic episodes with mixed features

A
  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
42
Q

__% of bipolar pt’s have mixed features

A

50%

43
Q

what are 4 common comorbidities w. bipolar d.o

A

etoh

drugs

panic

OCD

44
Q

what is the criteria for bipolar w. rapid cycling

A

4x / year

45
Q

does bipolar + dpn respond well to SSRIs

A

no!

46
Q

what can SSRIs cause in bipolar w. dpn

A

manic episodes

47
Q

are tricyclic antidepressants (TCAs) good for bipolar w dpn

A

no → cause worse manic episodes than SSRIs

48
Q

which SSRI is a category D in pregnancy

A

paroxetine

49
Q

most frequent s.e of SSRIs

A

sexual dysfxn

50
Q

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

A

antipsychotic → quetiapine OR lurasidone

51
Q

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

A

SSRIs

52
Q

are SSRIs the go to tx for bipolar

A

no!

53
Q

what is a downside of lithium

A

renal toxicity

54
Q

what is a good monotherapy for bipolar

A

lamotrigene

55
Q

what med reduces suicidal ideation

A

lithium

56
Q

what is cyclothymic dpn

A

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

57
Q

tx for cyclothymic d.o

A

mood stabilizers

atypical antipsychotics

lamotrigene for dpn

58
Q

avoid __ in cyclothymic d.o

A

antidepressants → risk for hypomanic episodes

59
Q

lifetime prevalence of bpd

A

3.9%

60
Q

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

A

melancholic

61
Q

what is the go to drug for mod-severe dpn

A

SSRIs

62
Q

all SSRIs are equally efficacious except for

A

trazadone (desaryl)

63
Q

common s.e of SSRIs

A

nausea

nervousness

insomnia

sexual dysfxn → long term effect

HA

64
Q

what are 2 pros of SSRIs

A

low CV effectse

low overdose/sz potential

65
Q

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

A

no

66
Q

why do pt’s stop using meds

A

they feel better

bc of s.e

67
Q

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

A

TCAs

68
Q

which SSRI has the longest half life

A

prozac (fluoxatine)

69
Q

which SSRI has the shortest half life

A

paxil

70
Q

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

A

lurasidone OR cariprazine monotherapy

71
Q

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

A

lithium monotherapy

72
Q

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

A

lithium OR divalproex PLUS aripiprazole, quetiapine, or risperidone

73
Q

when is ECT recommended for bipolar

A

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

74
Q

1st line tx for preventative dpn in bipolar

A

lamotrigine

75
Q

1st line tx for continuation/maintenance therapy for bipolar

A

lithium monotherapy

76
Q

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

A

4

Psychosocial Care (6 decks)

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