Mood Disorders Flashcards
30 yo woman presents to the psychiatrist with a 2-month hx. of difficulty in concentrating, irritability, and depression. She has never had these sx before. 3 mo prior to her visit to her psychiatrist, the pt noted that she had experienced a short-lived flu-like illness with a rash on her calf, but has noted no other sx since then until the mood sx began. Her physical exam was WNL. Which of the following is the most likely dx?
a. Neurosyphilis
b. Chronic meningitis
c. Lyme disease
d. CJD
e. Prion disease
c. Lyme Disease
Tx consists of a 2- to 3- week course of doxycycline.
25 yo man has cc of depressed mood for 1 month. His mother, to whom he was very close died 1 month ago, and since that he has felt sad and been very tearful. He has difficulty concentrating, has lost 3 lb, and is not sleeping soundly through the night. Which of the following is the most likely dx?
a. Major depression
b. Dysthymia
c. PTSD
d. Adjustment disorder
e. Uncomplicated bereavement
e. Uncomplicated bereavement
The loss of a loved one is often accompanied by sx reminiscent of major depression, such as sadness, weepiness, insomnia, reduced appetite, and weight loss. When these symptoms do not persist beyond 2 months after the loss, they are considered a normal manifestation of bereavement.
A dx of adjustment disorder with depressed mood would not normally be given to someone when the “adjustment” is to the recent death of a loved. one–instead, bereavement is the dx given (complicated or uncomplicated).
A 30 yo man comes to the psychiatrist for the eval of a depressed mood. He states that at least since his mid-20s he has felt depressed. He notes poor self-esteem and low energy, and feels hopeless about his situation, though he denies suicidal ideation. He states he does not use drugs or alcohol, and has no medical problems. His last physical exam by his physician 1 month ago was entirely normal. Which of the following treatment options should be tried first?
a. ECT
b. Hospitalization
c. Psychoanalysis
d. Venlafaxine
e. Amoxapine
d. Venlafaxine
This pt has dysthymic disorder. While many clinicians do not believe that these disorders should be treated pharmacologically, there are a number of studies that show positive respnoses to antidepressanst with these pts. Venlafaxine and bupropion are generally believed to be the treatments of choice fo dysthymic disorder, though. there is a subgroup of pts that will respond to the MAOIs as well.
What % of new mothers is believed to experience postpartum blues?
50% (3-5 days postpartum)
A 22 yo college student calls his psychiatrist because for the past week, after cramming hard for finals, his thoughts have been racing and he is irritable. The psychiatrist notes that the patient’s speech is pressured as well. The pt has been stable for the past 6 mo on 500 mg of valproate twice a day, and a blood level is in the therapeutic range. Which of the following is the most appropriate first step in the mgmt of this patient’s symptoms?
a. Hospitalize the pt
b. Inc. the valproate by 500 mg/day
c. Prescribe clonazepam 1 mg qhs
d. Start haloperidol 5 mg qd
e. Tell the pt to begin psychotherapy one time per week
c. Prescribe clonazepam 1 mg qhs
Sleep deprivation has an antidepressant effect in depressed pts and may trigger a manic episode in bipolar patients. The patient is not ill enough to require hospitalization. The use of a long-acting benzodiazepine will allow the pt to return to a normal sleep pattern and generally will abort the manic episode.
A 27 yo woman has been feeling blue for the past 2 weeks. She has little energy and has trouble concentrating. She states that 6 weeks ago she had been feeling very good, with lots of energy and no need for sleep. She says that this pattern has been occurring for at least the past 3 years, though the episodes have never been so severe that she couldn’t work. Which of the following is the most likely dx?
a. Borderline personality disorder
b. Seasonal affective disorder
c. Cyclothymic disorder
d. Major depression, recurrent
e. Bipolar disorder
c. Cyclothymic disorder
Characterized by recurrent periods of mild depression alternating with periods of hypomania.
Pattern must be present for at least 2 years before dx made
Common side effect of ECT?
Headache, nausea
A 14 yo boy is brought to doctor b/c for past 15 months he has been irritable and depressed almost constantly. The boy notes that he has difficulty concentrating, and he has lost 5 lb during that time period without trying. He states that he feels as if he has always been depressed, and he feels hopeless about ever feeling better. He denies suicidal ideation or hallucinations. He is sleeping well and doing well in school, though his teachers have noticed that he does not seem to be able to concentrate as well as he used to. Most likely dx?
a. Major depression
b. Dysthymic disorder
c. Mood disorder 2/2 general medical condition
d. Normal adolescence
e. Cyclothymia
b. Dysthymic disorder
For adults dx req > 2 years
For childen dx req > 1 yr
Which of the following is a contraindication for ECT?
a. Space-occupying lesion in the brain
b. Pregnancy
c. HTN
d. Seizure disorder
e. Status post-MI 6 mo earlier
a. Space-occupying lesion in the brain
ECT is safe procedure with v few contraindications (MIs within the past 4. weeks, increased ICP, aneurysms, bleeding disorders, and any condition that disrupts the BBB).
MDD is associated with:
- Decreased NE, serotonin, dopamine, and REM latency
- Increased REM
SSRIs are first line tx for MDD.
What are the two exceptions?
- Depression + neuropathic pain
- Tx: DULOXETINE
- Depression + fearful of weight gain or sexual side effects or is a smoker trying to quit
- Tx: BUPROPION
What is bipolar disorder associated with (Neurotransmitter)?
Increased levels o f norepi and serotonin
You must distinguish whether you are treating acute mania or bipolar depression.
If acute mania: lithium, valproic acid, atypical antipsychotics
If bipolar depression: lithium, quetiapine, lurasidone, lamotrigine
Tx of atypical depression
MAOIs
