Depressive Disorders and Bipolar Related Disorders

Question 1

what do you think when you see a 27 yo m who presents with pressured speech who is squandering savings, destroying relationships, and neglecting work activities

Answer 1

bipolar 1

Question 2

definition of bipolar I

Answer 2

a manic episode with OR without major depressive episodes

Question 3

according to DSM5, in order for the diagnosis of mania, what characteristics must be met (2)

Answer 3

affects occupation or relationships with others
OR
requires hospitalization

Question 4

1st line med for bipolar 1

Answer 4

lithium

Question 5

tx options for acute mania (4)

Answer 5

lithium - 1st line
valproate
SGA’s
carbamazepine

Question 6

name 2 SGA’s

Answer 6

olanzapine
aripiprazole

Question 7

tx for mania maintenance (3)

Answer 7

SGA’s
gabapentin
lamotrigine

Question 8

tx for mania w. agitation

Answer 8

add antipsychotics (haldol vs risperidone) OR
benzos

Question 9

t/f: family/group/CBT is effective for bipolar I

Answer 9

t!

Question 10

what do you think when you see a pt who presents w. bouts of sadness and distractibility plus an episode of decreased need for sleep with a flight of ideas and buying sprees

Answer 10

bipolar II

Question 11

definition of bipolar II

Answer 11

at least one hypomanic episode
AND
at least one major depressive episode
PLUS
the absenve of manic episodes

Question 12

definition of hypomania

Answer 12

not severe enough to cause marked impairment in social or occupational functioning or to necessitate hospitalization

Question 13

1st line tx for bipolar II

Answer 13

lithium

Question 14

tx for bipolar II depressive episodes (3)

Answer 14

SSRIs
quetiapine
olanzapine + fluoxetine

Question 15

t/f: CBT/fam/group therapy is effective for bipolar II

Answer 15

t!

Question 16

what do you think when you see a patient who presents w. episodes of depression alternating with times of increased energy, restlessness, and decreased sleep x 2 years

Answer 16

cyclothymic disorder

less intense, but often longer-lasting version of bipolar disorder

Question 17

in order for dx of cyclothymic disorder, symptoms must be present for at least

Answer 17

2 years

Question 18

what is dysthymia

Answer 18

persistent mild dpn

Question 19

a person with dysthymia never experiences _ (2)

Answer 19

mania
major dpn

Question 20

4 types of depressive disorders

Answer 20

major depressive
persistent depressive
premenstrual dysphoric
suicidal/homicidal behaviors

Question 21

mood disorder in which a person experiences (in the absence of drugs or medical condition), two or more weeks of significantly depressed moods, feelings of worthlessness, and diminished interest or pleasure in most activities

Answer 21

major depressive disorder

Question 22

mood disorder involving persistently depressed mood w. low self-esteem, withdrawal, pessimism, or despair - present for at least 2 years

Answer 22

persistent depressive disorder

Question 23

for dx, persistent depressive disorder must be present for at least _ with no absenve of symptoms for more than _

Answer 23

2 years
2 months

Question 24

disorder makred by repeated episodes of significant dpn and related symptoms during the week before menstruation

Answer 24

premenstrual dysphoric disorder

Question 25

mood disturbances, somatic complaints, feelings of hopelessness, worthlessness, or helplessness

Answer 25

suicidal/homicidal behaviors

Question 26

what do you think when you see a pt who c.o fatigue and decreased interest in the things that used to make her happy - is forcing herself to eat, spending less time w. kids, and feels guilty about lack of energy/enthusiasm

Answer 26

major depressive disorder

Question 27

what is SIGECAPS

Answer 27

sadness interest/anhedonia guilt energy concentration appetite psychomotor activity suicidal

Question 28

dsm 5 for mdd

Answer 28

5 or more SIGECAPS for 2 weeks or more nearly every day at least 1 of sx is depressed mood OR anhedonia

Question 29

what is anhedonia

Answer 29

inability to feel pleasure

Question 30

first line tx for mdd

Answer 30

SSRIs

Question 31

how do you titrate SSRIs

Answer 31

continue to increase dose q 3-4 weeks until sx are in remission

Question 32

how long do SSRI's take to be effective

Answer 32

4-6 weeks

Question 33

how long until you see sx improvement w. SSRIs

Answer 33

2-4 weeks

Question 34

what do you think when you see a pt who feels down most of the time x 3 years - experiences intrusive thoughts of inadequacy despite success - tries to overcompensate by taking on more than he can handle, which leads to failure and worse feelings of inadequacy

Answer 34

persistent depressive disorder

Question 35

dsm 5 for persistent depressive disorder (3)

Answer 35

-chronic dpn > 2 years -pt has never been w.o depressive sx for > 2 mnonths at a time -there has never been a manic or hypomanic episode

Question 36

tx for persistent depressive disorder (3)

Answer 36

SSRI's psychotherapy PA

Question 37

s.e of lithium (7)

Answer 37

tremor sedation acne heart block hypothyroidism diabetes insipidus leukocytosis

Question 38

3 contraindications for lithium

Answer 38

renal failure hyponatremia dehydration increase risk for toxicity

Question 39

4 conditions frequently associated w. bipolar disorder

Answer 39

SAD ADD/ADHD anxiety disorders other mood disorders

Question 40

t/f: dpn in the setting of other comorbid conditions leads to increased mortality

Answer 40

t!

Question 41

hypomania w. more dpn

Answer 41

bipolar II

Question 42

more manic w. some dpn

Answer 42

bipolar I

Question 43

class of medication you never give to bipolar I

Answer 43

antidepressants

Question 44

-dpn with a change from previous functioning -difficult to perform ADLs

Answer 44

mdd

Question 45

what condition manifests as a chronically depressed mood for more than 2 years

Answer 45

persistent depressive d.o