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Psychiatry Exam 1 > Depressive/Bipolar Disorders > Flashcards

Depressive/Bipolar Disorders Flashcards

(51 cards)

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1
Q

MDD Diagnostic Criteria

A

5+ for more than 2 wks
- One must be depressed mood or anhedonia
Others (4+):
- Significant weight change
- Sleeping change nearly every night
- Psychomotor changes
- Fatigue
- Feelings of worthlessness/excessive built
- Diminished concentration, ability to make decisions
- Recurrent thoughts of death, suicide, or suicide attempt
(Present every day w/ weight and sleeping exceptions)

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2
Q

SIGECAPS

A

Depression mnemonic for 4+ symptoms/anhedonia:

Sleep disturbance
Interest
Guilt
Energy
Concentration
Appetite
Psychomotor
Suicide
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3
Q

MDD

A

One or more MDEs

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4
Q

MDD Delusions

A

“I am worthless” “I will be dying shortly”

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5
Q

MDD Perceptual Distubances

A

“You are worthless” “You should kill yourself”

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6
Q

Assc. Features of MDD

A

Somatic complaints, irritability, decreased libido, negative ruminations, hoplessness/helplessness, tend to smoke, less physically active, obesity

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7
Q

Sleep problems in depression

A

Prolonged/increased sleep latency, decreased REM latency, decreased nREM

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8
Q

PFC MDD Correlates

A

Concentration, interest , pleasure, psychomotor fatigue (mental), guilt, suicidality, worthlessness, mood

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9
Q

Amygdala MDD Correlates

A

Guilt, suicidality, worthlessness, mood

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10
Q

Hypothalamus MDD Correlates

A

Sleep, appetite

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11
Q

NA MDD Correlates

A

Pleasure, interests, fatigue/energy

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12
Q

Striatum MDD Correlates

A

Psychomotor fatigue (physical)

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13
Q

Cerebellum MDD Correlates

A

Psychomotor

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14
Q

Spinal cord MDD Correlates

A

Fatigue (physical)

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15
Q

MDD PET Scan

A

Hypoactivity of cortex compared to nondepressed

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16
Q

MDD Risk Factors for BPAD I

A

Onset of illness in adolescence, psychotic features, family history of BPAD

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17
Q

MDD factors assc w/ worse prognosis

A

Younger pt, personality disorders, symptom severity, psychotic features, prominent anxiety, current episode duration, multiple episodes

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18
Q

Remission

A

Return to pts baseline level of symptom severity and fxn (HAMD-17 <7)

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19
Q

Time between MDE to be considered separate?

A

2 months

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20
Q

Stages of tx for MDD

A

Acute, continuation, maintenance

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21
Q

Acute stage of tx of MDD

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A

Time from diagnosis –> initial reductino of symptoms – response defined as >50% reduction in symptom severity; meet 2x q/mo; medication tx typically for 6-8wks

22
Q

Indications for MDD Hospitalization

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A

Suicide/homicide risk, inability to care for self, rapidly progressive symptoms, lack of social supports, need for diagnostic procedures

23
Q

Continuation phase of MDD tx

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A

After remission has been achieved, 6mo-1yr of pharmacotherapy (see pt q2wks or qmo); goal to prevent relapse and consolidate response –> remission

24
Q

Maintenance phase of MDD tx

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A

Primary goal to prevent relapse (reactivation of index episode)/recurrence (new episode of illness); meet qmo or q3mo

25
PDD Mnemonic
HCASES (Depressed mood and 2+ for most days x2yrs): ``` Hopelessness Concentration Appetite Sleep Energy Self esteem ```
26
PMDD Diagnostic Criteria
In week prior to most menstrual cycles over last yr (at least 2 cycles), 5+ of: 1+ MUST be present: - Affective lability -Irritability/anger/increased IP conflicts - Depressed mood, hopelessness, self-deprecating thoughts -Anxiety, tension Other: - Anhedonia, fatigue, inability to concentrate - Change in appetite or sleep - Overwhelmed/feel out of contorl - Physical symptoms (breast tenderness/swelling, joint/muscle pain, sensation of "bloating" or wt gain)
27
Tx of PMDD
Lifestyle: exercise, nutrition (less Na and caffeine); supplements: B6, E, Ca2+, Mg2+; pharmacotherapy: SSRIs
28
Manic episode diagnostic criteria
At least 1 wk of distinct period of abnormally/persistently elevated, expansive, or irritable mood AND persistently increased goal-directed activity or energy, and 3+ of: DIGFAST ``` Distractability Indiscretion Grandiosity Flight of ideas/racing thoughts Activity increase Sleep deficit (decreased need) Talkativeness (pressured speech) ```
29
Hypomanic diagnostic criteria
Same as manic but at least 4 days (not 1 wk), assc w/ change in fxn uncharacteristic for pt instead of significant impairment, can NOT have psychotic symptoms
30
BPAD I
At least 1 manic episode (can/cannot have MDE)
31
BPAD II
At least 1 hypomanic and 1 MDE
32
Triggers for manic episodes
Sleep disturbance, or psychosocial trigger
33
Rapid cycling
4+ BPAD I episodes in 1 yr
34
Manic episode BPAD I Pharmacotherapy
Li, Valproic Acid, antipsychotics (sedation w/ benzo or antipsychotic if severe)
35
Maintenance BPAD I tx
Li, Valproic Acid, antipsychotics, carbamazepine, lamotrigine (combo if severe)
36
Tx of BPAD I MDE
Li, lamotrigine, atypical antipsychogtics, antidepressants (MUST HAVE ADEQUATE MOOD STABILIZATION OR RISK RAPID CYCLING)
37
Tx of BPAD I Psychosis
Antipsychotic
38
Cyclothymia Diagnostic Criteria
For 2+ yrs, numerous episodes of hypomania and dysthmia (don't meet MDE criteria); cannot be w/o symptoms for >2mos; clinically significant distress or impairment in social, occupations, or other fxning
39
Common assc medical illnesses to BPAD and MDD
Alzheimers, Huntingtons, Parkinsons, CVA, MS, TBI, thyroid/parathyroid/adrenal dysfxn, hepatitiis, HIV, pancreatic cancer
40
Substances assc w depression
Antidepressants, anticonvulsants, anti-migraine, antipsychotics, antivirals, cardiovascular, hormonal (steroids, OCP), interferon, retinoic acid derivatives, smoking cessation
41
Substances assc w mania
Antidepressants, amphetamines, L-dopa, steroids
42
Criteria differences for children with MDE or PDD
MDE: irritability can replace depression, inability to make weight gains instead of weight loss PDD: one year instead of 2
43
Criteria differences for children with BPAD and cyclothymia
BPAD: NONE Cyclothymia: one year instead of two
44
Anxious distress specifier (disorders and criteria)
``` Disorders: MDE, mania, hypomania Diagnostic criteria -- 2+ for majority of episode: - Keyed up or tense - Unusually restless - Difficulty concentrating due to worry - Fear that something awful will happen - Fear of losing control ``` Assc w increased suicide risk, longer duration illness, and great tx non-response
45
Mixed features specifier (disorders and criteria)
Disorders: MDE, mania, hypomania Criteria: Combo of symptoms of mania/hypomania and MDE simultaneously Assc w/ MDE increases risk of BPAD I or II
46
Seasonal pattern specifier (disorders and criteria)
Disorders: MDD, BPAD I and II Cirteria: - Regular assc between onset and time of year OR - Full remission or change to mania/hypomania at a specific time of year - During past 2 yrs, 2+ episodes demonstrate pattern and no-nonseasonal episodes have occurred (seasonal episode outweight non-seasonal in total)
47
Psychotic features specifier (disorders and criteria)
Disorders: MDE, mania Criteria: delusions and hallucinations (usually mood congruent)
48
Catatonic features specifier (Disorders and criteria)
``` Disorders: MDE, mania Criteria: - Immobility: catalepsy or stupor - Excessive purposeless activity - Extreme negativism - Mutism - Posturing, stereotypies, prominent mannerisms or grimacing - Echolalia or echopraxia ```
49
Atypical features specifier (Disorders and criteria)
``` Disorder: MDE only Criteria: - Mood reactivity - Significant weight gain/increase in appetitie - Hypersomnia - Leaden paralysis - Long standing rejection sensitivity ```
50
Melancholic features (Disorders and criteria)
Disorder: MDE only Criteria: - Loss in pleasure in all/almost all activities - Lack of mood reactivity - Distinct quality of depressed mood (worse in AM, early morning awakening, marked psychomotor abnormalities/feels slowed down, significant anorexia/weight loss, excessive guilt)
51
Peripartum onset (Disorders and criteria)
Disorders: MDE, manic, hypomanic Criteria: symptoms during pregnancy or w/in 4 wks of delivery

Psychiatry Exam 1 (9 decks)

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