Mood Disorders Flashcards
Screen for Major Depresive DO (MDD)
PHQ-9, PHQ-2
How is MDD different than Bipolar?
MDD has NO MANIA
For MDD, you must R/O _____ and _____
Bipolar
Hypothyroidism
Persistent Depressive Disorder lasts:
___yr+ (Adult)
____yr+ (Child)
2yr+ (Adult)
1yr+ (Child)
1st line Tx for MDD and Persistent Depressive DO
MDD = Major Depressive DO
1 Psychotherapy + SSRI (Lexapro, Zoloft)
MDD and Persistent Depressive DO Tx Resistant
- ADD 2nd Gen Antipsychotic, Lithium, 2nd antidepressant from diff class, Thyroid hormone
- TMS
MDD and Persistent Depressive DO (SEVERE Tx)
- ECT (Electroconvulsive therapy)
- Esketamine, Ketamine
ECT is 1st line if suicidal, severe wt loss, real bad
Tx for Mod/Severe Premenstrual Dysphoric DO
- CBT
- SSRIs
- COCs or GnRH Agonists
- Last resort -> Bil (salping)oophorectomy
______ DO is when children have chronic irritability, anger, or tantrums
Disruptive Mood Dysregulation DO
Can last into adulthood but must be Dx as a child
Disruptive Mood Dysregulation DO
* Lasts: ___yr+
* Peds onset: ___ - ___yo
* Dx: ___ - ____yo
- Last: 1yr+
- Peds onset: 6-10yo
- Dx: 6-18yo
Must start b/w 6-10yo but can be Dx anytime from 6-18yo (peds only).
Disruptive Mood Disregulation DO Tx
- # 1 Psychotherapy
- Off-label meds
- Parent Education
- Refer to peds psychologist/psychiatrist
Bipolar is MC in which age groups?
15-24yo
45-54yo
Bipolar I Manic episodes last for _____
1+ week
Bipolar II Hypomanic episodes last for _____
1st line Tx for Bipolar DEPRESSION
Monotherapy 2nd Gen “Atypical” Antipsychotic (Quetiapine or Lurasidone)
Tx for REFRACTORY Bipolar Depression
ECT
rapid response if real bad
Bipolar I pts NEED and anti-depressant + _______
Mood Stabilizer
Antidepressants can unmask Bipolar bc theyre no longer depressed and have the potential to become HIGHLY MANIC
1st line Tx for Bipolar Mania/Hypomania
- Mood stabilizer (Lithium, Valproate)
- Antipsychotic (Ariprazole, Asenapine, Cariprazine, Quetiapine, Rispiridone)
Tx for poorly controlled or Severe Bipolar Mania/Hypomania
Mood stabilizer + Antipsychotic
Tx for Bipolar Mania/Hypomania if Tx Resistant or Preg
ECT
Mono or in combo with other Tx options
1st Line Tx for Bipolar in PEDS
Pharmacotherapy + Psychotherapy
unique that pills is 1st line before therapy
1st Line Therapy for Bipolar Depression in PEDS
Pick 1:
* Lurasidone
* Alt 2nd gen antipsychotic + SSRI
I guess Lurasidone is the only “Atypical” that can be taken w/o an SSRI in peds for this
Tx for Bipolar Depression in PEDS if:
* Tx Resistant ->
* Partial Response ->
* Tx Refractory
- Tx Resistant -> Lithium, Lamotrigine, or Omega-3 Fatty Acids
- Partial Response -> ADD Lithium, Lamotrigine, or Omega-3 Fatty Acids
- Tx Refractory -> Lithium + (Lamotrigine or Antidepressant), ECT, Bright Light Therapy
Order ___ prior to giving Lithium to Peds
- BUN, Creat
- E-
- TSH
- ECG
- Urine Preg
- Measure [Lithium] after 1st week of taking
- Stable dose -> repeat initial WU q 3-6mo
1st Line Tx for Bipolar Mania/Hypomania in PEDS
2nd gen antipsychotic +/- Lithium
Tx for Bipolar Mania/Hypomania in PEDS if
* Tx Resistant ->
* Partial Response or Refractory ->
- Tx Resistant -> try diff antipsychotic
- Partial Response or Refractory -> antipsychotic + LITHIUM
Tx for Bipolar Mania/Hypomania in PEDS if Refractory to 8-10med trials
- Cloazapine
- ECT
Tx for Bipolar Mania **W/Mixed or Psychotic Features **in PEDS
2nd Gen Antipsychotic
NO LITHIUM?
______ Mood DO = Chronic mood instability W/O Extreme mood episodes
Cyclothymic
Not Hypomanic enough for Bipolar II. Not Depressed enough for MDD
Cyclothymic Mood DO Lasts:
____yr+ (Adult)
____yr+ (Peds)
2yr+ (Adult)
1yr+ (Peds)
Ss for half the time.
Max: 2mo in b/w episodes
Cyclothymic Mood DO Tx
NO FDA approved meds
* #1 Mood Stabilizer
* 2nd Gen “Atypical” Antipsychotics +/- Mood Stabilizer
* CBT
