Depression

Question 1

Mania

Answer 1

Distinct period of abnormally and persistently elevated, expansive or irritable mood

Abnormally and persistent increased goal-directed activity or energy

True manic episode lasts 1+ week

Severe enough to cause more than 1:
Impaired functioning
Hospitalization (prevent harm)
Psychotic features

3/7 sx: “DIG FAST”
Distractibility
Irresponsibility
Grandiosity
Flight of ideas
Activity/agitation
Sleep – less needed
Talkativeness – pressured speech, louder

Question 2

Hypomania

Answer 2

Same mania sx, less severe
4+ days
no impairment in social or occupational functioning

Question 3

Bipolar treatment

Answer 3

Mood stabilizer

• lithium
• atypical antipsychotics: risperidone, aripiprazole, olanzapine
• antiepleptics : lamotrigine, valproic acid, carbamazepine

If give antidepresent to bipolar -> mania

Question 4

Lithium

Answer 4

Narrow TI

SE:
Sedation and dizziness
Tremors – first start or increased dose
Arrhythmias – sick sinus sn, bradycardia, heart block
Hypothyroidism, goiter
Polyuria and diuresis– block ADH effects in kidney -> nephrogenic DI

Teratogenic – Epstein anomaly

Question 5

Bipolar I vs Bipolar II

Answer 5

I: manic episode +/- major depression

II: hypomanic episode + episode of major depression

Question 6

Cyclothymic ds

Answer 6

Milder bipolar disorder
-mild hypomania sx, mild depressive sx

lasts 2+ yrs
don’t have to be continuous
normal mood lasts only up to 2 mo

Question 7

Dissociative identity ds

Answer 7

“multiple personality ds”

2+ identities or personalities
MC in women
Assoc w/ sexual abuse

Question 8

Depersonalization/derealization ds

Answer 8

Persistent feelings of detachment from own body and thoughts

Outside observer, like dream

Question 9

Dissociative amnesia

Answer 9

Event/series of events

Generalized amnesia of identity and life hx

Question 10

Major depressive ds w/ atypical features

Answer 10

MC subtype
Mood reactivity – respond to + with +
Increased appetite or wt gain
Hypersomnia
Leaden paralysis
Hypersensitivity to rejection

Responds to MAOIs

Question 11

Major depressive disorder w/ peripartum onset

Answer 11

5/9 DIGS CAPES sx 2+ wks
-not just baby blues

during preg or w/in 4 weeks of delivery sx start

postpartum psychosis

• may hurt baby
• > hospitalize
• > anti psychotic meds
• electroconvuslive tx

Question 12

Major depressive disorder w/ psychotic features

Answer 12

Delusions/hallucinations

Psychotic features always w/ depressive

Question 13

Major depressive disorder w/ seasonal pattern

Answer 13

Recurrent
Temporal/seasonal patterns – fall/winter
Sunlight exposure

Dx 2+ yrs to establish
No non-seasonal episodes of major depression during this period

Tx: light exposure

Question 14

Persistent depressive ds

Answer 14

Chronic persistent depression
2+ yrs in adults, 1+ yr kids and adolescents

no more than 2 mo w/o sx in 2 yrs

Question 15

Prementstral dysphoric ds

Answer 15

Sx connected to menstrual cycle

Severe enough to interfere w/ function

Question 16

Kubler Ross stages of Grief

Answer 16

“DABDA”

Denial
Anger
Bargaining
Grieving (depression)
Acceptance

Question 17

Major risk factors for suicide

Answer 17

Psychiatric disorders
Feelings of hopelessness or worthlessness
Impulsivity more likely to act
Increased age
Males
Access to weapons – firearms
Hx of suicide attempts

Young females more likely to attempt, older males more likely to succeed