Test 1 - Depressive Disorders Flashcards
major depressive disorder is also known as
unipolar dpn
for dx of mdd, pt must have __ of the 9 symptoms
for __
5
at least 2 weeks
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
SIGECAPS describe
the additional symptoms for mdd
what does SIGECAPS stand for
Sleep disturbance
Interest
Guilt
Energy change
Concentration
Appetite
Psychomotor retardation or agitation
Suicidal
what are 3 atypical patterns of mdd
increased appetite
increased sleep
seasonal pattern
what is the highest risk pt population for suicide
elderly
what is minor dpn
depressed mood OR loss of interest/pleasure
PLUS
2-4 of SIGECAPS
in major depressive d.o, a pt must have __ associated symptoms;
in minor dpn, a pt must have __ associated symptoms
5
2-4
in mdd and minor dpn, a pt must have symptoms for at least
2 weeks
what are vegetative symptoms
physiologic/body fxn → sleep, appetite, energy, sexual interest
name 2 cognitive symptoms
poor concentration
low self esteem
what is an emotional symptom
crying spell
dpn is a __ d.o
__% of pt’s who have first episode will have another
recurring
50&
when does dpn become an issue
when it interferes w. ADLs
what is melancholic dpn
mdd w. an emphasis on lack of pleasure or lack of reactivity to pleasure
melancholic dpn is harder or easier to treat
harder
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
persistent depressive d.o is also called
dysthymia
what is persistent depressive d.o / dysthymia
dpn for most of the day for more days than not
dysthymia / pdd can be an ___ or
__ account
subjective
objective
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
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
what is double dpn
mdd + persistent dpn
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
- inflated self esteem/grandiosty
- decreased need for sleep
- more talkative/pressure to keep talking
- flight of ideas or subjective experience of thoughts racing
- distractibility to irrelevant stimuli
- increase in goal-directed activity/psychomotor agitation
- 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
4
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)
- anxious distress
- mixed features
- rapid cycling
- melancholic features
- atypical features
- catatonia
- peripartum onset
- seasonal pattern
what are 4 red flags for bipolar d.o
- early onset of mood d.o
- family hx
- atypical features
- recurrent course
what are symptoms of manic/hypomanic episodes with mixed features
- depressed mood
- diminished interest/pleasure in most activities
- psychomotor agitation
- low energy
- excessive guilt or thoughts of worthlessness
- 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
no
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
4
