Mood and Other Disorders Flashcards

Question

Persistent Depressive Disorder (Dysthymia) prognosis ?

Answer 1

~40% recover in 2 yrs and 30% in 5 years ( not that great) its pretty resistant to treatment **Major depression can remit or go away this one tends to stick around for a while **

Answer 2

SSRI (typically 9 months to lifetime) MAOI’s (many side effects)

Answer 3

CBT Couples / Marriage Counseling

Answer 4

Recurrent Major Depressive Episodes with MANIC Episodes

Answer 5

Abnormal and persistent elevated, expansive, or irritable mood lasting at least 1 wk During this period 3 or more present to a significant degree: Grandiosity - impressive appearance Decrease need for sleep (i.e. <3 hrs) Talkative / pressure to keep talking Flight of ideas / racing thoughts that come out through speaking Distractibility Increase in goal-directed activity - Excessive involvement in pleasurable activities (i.e. spending, sex) Not due to direct causes (i.e. drugs) SEVERE enough to caused marked impairment MAY INCLUDE psychotic features If a manic episode triggered by antidepressants consider BP activation ( bipolar) **super talkative, racing thoughts, these people are really smart sometimes CEOs of companies **

Answer 6

0.6-1.1% men=women, women typically worse + rapid-cycling

Answer 7

Generally <50 yo – if older consider medical cause Generally upper socioeconomic class Can be misdiagnosed as ADHD - cause of the mania

Answer 8

Strong association – about 66% have family Hx 80% concordance with monozygotic twins very strongly genetic

Answer 9

Medications (i.e. isoniazid, anticonvulsants) Neuro (i.e. MS, Post stroke) /Neoplasms knock out inhibition in the brian Schizophrenia / Schizoaffective Disorder Major Depressive Disorder (and irritability) Substance Abuse

Answer 10

Variable (the earlier the onset the worse the prognosis) variable cause they like the high mania is energy to the point where it is not useable (cant harness it)

Answer 11

Mood stabilizers (i.e. Lithium), Anticonvulsants (i.e. valproic acid), 2nd generation antipsychotics (i.e. quetiapine) - fewer side effects and more tolerable then 1st generations, 1st generation antipsychotics (i.e. haloperidol)

Answer 12

Behavioral, cognitive, interpersonal, social rhythm therapy

Answer 13

increased risk of suicide (cycles up up and down )

Answer 14

may not have a manic episode for years

Answer 15

is considered a first-line agent for long-term prophylaxis in bipolar illness, especially for classic bipolar disorder with euphoric mania. It also can be used to treat acute mania, although it cannot be titrated up to an effective level as quickly as valproate can. Evidence suggests that lithium, unlike any other mood stabilizer, may have a specific anti suicide effect

Answer 16

Monitoring blood levels is critical with this medication. Serum levels should be determined twice weekly during the acute phase, and until the serum level and clinical condition of the patient has been stabilized.

Answer 17

is indicated for acute treatment of manic (immediate release and extended release [XR]) or mixed (XR) episodes that are associated with bipolar I disorder. It can be used as monotherapy or adjunctively with agents such as lithium or divalproex.

Answer 18

is indicated for the acute and maintenance treatment of manic or mixed episodes associated with bipolar I disorder. It can be used alone or in combination with lithium or valproate.

Answer 19

is used for the acute treatment of mania or mixed episodes in patients with bipolar disorder. It can be used alone or in combination with lithium or valproate in an adult patient. Haloperidol blocks postsynaptic dopamine receptors (D2) in the mesolimbic system and increases dopamine turnover by blockade of the D2 somatodendritic autoreceptor

Answer 20

HYPOMANIC or MANIC Episodes **bipolar II is hypomanic sxs. **

Answer 21

Abnormal and persistent elevated, expansive, or irritable mood lasting at least 1 wk ``` During this period 3 or more present to a significant degree: Grandiosity Decrease need for sleep (i.e. <3 hrs) Talkative / pressure to keep talking Flight of ideas / racing thoughts Distractibility Increase in goal-directed activity Excessive involvement in pleasurable activities (i.e. spending, sex) ``` NOT severe enough to caused marked impairment NO psychotic features otherwise it is BP Type I Not due to direct causes (i.e. drugs) **this one cannot have any psychotic features at all **

Answer 22

0.6-1.1% men=women, women typically worse

Answer 23

Generally <50 yo – if older consider medical cause Generally upper socioeconomic class Can be misdiagnosed as ADHD

Answer 24

Strong association – about 2/3rds have family Hx 80% concordance with monozygotic twins

Answer 25

Medications (i.e. isoniazid, anticonvulsants) Neuro (i.e. MS, Post stroke) / Neoplasms Schizophrenia / Schizoaffective Disorder Major Depressive Disorder (and irritability) Substance Abuse

Answer 26

Variable (the earlier the onset the worse the prognosis) Medications do reduce the length of an acute episode

Answer 27

Mood stabilizers (i.e. Lithium), Anticonvulsants (i.e. valproic acid), 2nd generation antipsychotics (i.e. quetiapine), 1st generation antipsychotics (i.e. haloperidol)

Answer 28

Behavioral, cognitive, interpersonal, social rhythm therapy

Answer 29

Major depressive disorder with: Regular time relationship with particular times of the year (e.g. winter, fall) Full remission in between. Occurs over 2 years without non seasonal episodes Seasonal depressive episodes outnumber non-seasonal episodes over pt lifetime. Does not include caused by social stressors that are seasonal . (e.g. unemployed in winter) **still sxs. in the summer then it is not seasonal cant have nonseasonal episodes **

Answer 30

Does not meet all criteria for Major Depression or Bipolar Qualifier applies if: - full criteria are not currently met for a major depressive episode - onset during pregnancy or in the 4 weeks following delivery

Answer 31

Can have severe anxiety or panic Can have psychotic episodes Command hallucinations to kill infant Hallucinations that infant is possessed - severe make sure they are not having hallucinations about the baby common and happends a lot screen for it a lot in the US **specifically do to a lack of light from winter - they have broad spectrum light boxes for tx**

Answer 32

3% and 6% of women in weeks or months after delivery more than bipolar 50% of episodes begin prior to delivery ( before they deliver) Psychosis occurs in 1:500-1000 women

Answer 33

First pregnancy Increased risk if had with previous pregnancies Previous depression anxiety

Answer 34

More common in family with bipolar

Answer 35

Bipolar Anxiety Depression

Answer 36

Variable with reasonable prognosis

Answer 37

SSRI’s - unless they are having psychotic thoughts Antipsychotic may be beneficial if psychosis Need to stop breast feeding **SSRIs are the safest in pregnancy **

Answer 38

Therapy CBT

Answer 39

Think: Low-grade persistent Bipolar They are moody, impulsive, erratic, and volatile but do not meet full criteria for Bipolar Disease Irregular and abrupt changes in mood For at least 2 years numerous depressive and hypomanic episodes Not without symptoms for more than 2 months No major depressive or manic episodes within the 2 year period Not better accounted for by schizoaffective disorder and are not superimposed on other psychotic disorders Not due to direct substances (i.e. drugs) or medical conditions (i.e. hyperthyroidism) Causes clinically significant distress or impairment **this has to be over a long period of time **

Answer 40

refers to the education offered to individuals with a mental health condition and their families to help empower them and deal with their condition in an optimal way. Frequently psychoeducational training involves individuals with schizophrenia, clinical depression, anxiety disorders, psychotic illnesses, eating disorders, and personality disorders, as well as patient training courses in the context of the treatment of physical illnesses. Family members are also included. A goal is for the consumer to understand and be better able to deal with the presented illness. Also, the patient's own capabilities, resources and coping skills are strengthened and used to contribute to their own health and wellbeing on a long-term basis.

Answer 41

is a time-limited treatment that encourages the patient to regain control of mood and functioning typically lasting 12–16 weeks. IPT is based on the principle that there is a relationship between the way people communicate and interact with others and their mental health.

Answer 42

0.4-1% men = women

Answer 43

Unknown but probably similar to Bipolar

Answer 44

Familial risk but unclear association

Answer 45

Borderline personality disorder Medical conditions (see Bipolar)

Answer 46

Variable but between 15-50% probability BP I or BP II will develop

Answer 47

Unclear data but low dose SSRIs may be helpful TCA’s, bupropion

Answer 48

Psychoeducational therapy Interpersonal psychotherapy

Answer 49

Severe form of premenstrual syndrome Five (or more) of the following symptoms occurred during the final week before the onset of menses, started to improve within a few days after the onset of menses, and were minimal or absent in the week post menses. Marked irritability or anger Markedly depressed Market anxiety Decreased interest in activities Difficulty in concentrating Lethargy / fatigue Marked change in appetite Insomnia / hypersomnia Overwhelmed Physical (i.e. breast tenderness, bloating, joint pain) **related to a shift in hormones **

Answer 50

Hx of anxiety, depression, SAD ( seasonal defective dx), or mother with condition ETOH, obesity, caffeine, lack of exercise

Answer 51

Variants in the estrogen receptor alpha gene are associated with PMDD

Answer 52

Anemia Bipolar / Anxiety / Depression Hypo/hyperthyroidism Somatoform disorders SLE

Answer 53

Hormone Tx Estrogen Estrogen - OCP with estrogen tend to work NSAIDs Beta blockers - BB work better if it is all anxiety type sxs but it can slow heart rate SSRIs Anxiolytics / mood stabilizers **over a short period of time - so SSRI? no cause they feel fine in between**

Answer 54

CBT helps a little bit

Answer 55

A pervasive distrust and suspiciousness of others motives and interpreted as malevolent, beginning by early adulthood and in a variety of contexts, by four (or more) of the following: Suspects, without sufficient basis, that others are exploiting, harming, or deceiving him or her Preoccupied with unjustified doubts about the loyalty or trustworthiness of friends or associates Reluctant to confide in others because of unwarranted fear that the information will be used maliciously against him or her Reads hidden demeaning or threatening meanings into benign remarks or events Persistently bears grudges Perceives attacks on his or her character or reputation that are not apparent to others Recurrent suspicions, without justification, regarding fidelity of spouse or sexual partner **these dx are hard to diagnose because people do not like to talk to them **

Answer 56

0.5-4.5% slightly more common in women

Answer 57

Enhanced in families with schizophrenia and delusional disorders Environment risk for fearful children to have a higher probability

Answer 58

Schizoid personality (very high association with Paranoid Personality) Schizotypal personality Narcissistic personality disorder Schizophrenia

Answer 59

Variable with reasonable prognosis however may revert under stress

Answer 60

Little evidence of effectiveness of Medications Antipsychotic may be beneficial if delusional

Answer 61

Individual however no therapeutic techniques proven beneficial Cognitive therapy may be of some benefit

Answer 62

Two or more for a significant portion of time within a 1 month period and continuous for at least a 6 month period: - Delusions - Hallucinations - visual - Disorganized speech - Grossly disorganized - Diminished emotional expression - Diminished self-care - Marked decreased level of functioning in work and/or social and/or academic After 1 year of symptoms additional qualifiers: See DSM 5 (First, multiple, acute, remission,…with catatonia ( pinch them and they dont know or feel it) Substance abuse a significant comorbidity ** these people are always in the ED and they cannot hold jobs **

Answer 63

1% worldwide

Answer 64

Most likely genetic and perinatal

Answer 65

Risk in 1st deg relatives is 10%. If both parents have schizophrenia, the risk of in their child is 40% Concordance ~10% for dizygotic 40-50% for monozygotic

Answer 66

Alcohol-Related or Cocaine- Related Psychosis Bipolar Affective Disorder Brief Psychotic Disorder - shorter period of time Delusional Disorder - delusional with no hallucinations Depression Secondary to General Medical Conditions Schizoaffective Disorder / Schizophreniform Disorder

Answer 67

Generally poor

Answer 68

``` 1st gen (i.e. Haldol)- acutely psychotic ( sedating) -Geodon works acutely as well - ziprasadone ``` 2nd gen antipsychoitics (i.e. Abilify) - most of the time now

Answer 69

Primarily antipsychotic medications Transcranial magnetic stimulation (TMS) possibly

Answer 70

Schizophreniform disorder is characterized by the presence of the symptoms of schizophrenia, but it is distinguished from that condition by its shorter duration, which is at least 1 month but less than 6 months. Think “Schizophrenia Lite” meaning it’s a form of schizophrenia but less than 6 months **schizo is more than 6 months **

Answer 71

Schizophrenia WITH a major mood disorder (i.e. depressive or manic, usually BP1) concurrent Delusions or hallucinations for 2+ weeks Symptoms of major mood disorder See DSM 5 for subtypes (e.g. catatonia) **like Bipolar with hallucinations ** **depressed and then they have hallucinations **

Answer 72

rare: 0.5% - 0.8%

Answer 73

Amphetamine-Related Psychiatric Disorders Bipolar Affective Disorder / Brief Psychotic Disorder Cocaine-Related Psychiatric Disorders Cushing Syndrome Depression / Hallucinogens Hyperparathyroidism Phencyclidine (PCP)-Related Psychiatric Disorders Schizophrenia

Answer 74

highly variable

Answer 75

Generally a combination of an SSRI and antipsychotics (SSRIs) are greatly preferred to the other classes of antidepressants – less prob. of adverse effects if overdose

Answer 76

Behavioral therapy

Answer 77

Pervasive pattern of detachment from social relationships and a restricted range of expression of emotions in interpersonal settings (removed from social settings), beginning by early adulthood and present in a variety of contexts, as indicated by 4 or more: -Neither desires nor enjoys close relationships, including being part of a family they do not want to be friends with anyone - Mostly choses solitary activities - Has little if any interest in having sexual experiences with another - Lacks close friends or confidants other than 1st deg relatives -Appear indifferent to praise or criticism of others: very flat, and dont care about any one around them -Shows emotional coldness, detachment or flattened affect Does not occur exclusively during schizophrenia or other conditions… it occurs all the time ( something that is there all the time - low level - not from another cause) **Low level long time!** **schizo part think hallucinations etc. **

Answer 78

0.5-7% more men

Answer 79

Not well understood Possible relationship to Asperger syndrome ( because of the social detachment)

Answer 80

Rule out transient causes of detachment i.e. depression

Answer 81

May live relatively well adjusted lives just in isolation May not seek out mental health counseling May be challenging in work situations (i.e. supervisor or employee who is isolated may need to adjust career options) -they just want to work alone, go home and mind there own business

Answer 82

Little evidence of effectiveness

Answer 83

Usually come at request of family members Group and family counseling may be beneficial Individual therapy may not be beneficial because these patients tend to intellectualize and distance themselves from treatment

Answer 84

A pervasive pattern of social and interpersonal deficits marked by acute discomfort with close relationships-by cognitive/perceptual distortions and eccentricities of behavior… five (or more) (odd beliefs in magic) Ideas of reference Odd beliefs or magical (e.g., superstitions, clairvoyance, telepathy) Unusual perceptual experiences Odd thinking Suspiciousness or paranoid ideation Inappropriate or constricted affect -they do not take care of themselves very well Odd appearance -maybe they wear different socks etc… Lack close friends even 1st deg relatives Excessive social anxiety that does not diminish with familiarity and associated with paranoid fears Does not occur exclusively during the course of Schizophrenia, or other mood disorders… **think schizoid with weird magical thoughts ( not like the devil is in you and they need to cut it out, it is more like they can hear other peoples thoughts) ** ** they dont want to be apart of a group and they have magical thoughts **

Answer 85

3-5% slightly more men

Answer 86

Significantly more prevalent with biological relatives of schizophrenic individuals and thus appears a reasonably strong genetic component

Answer 87

Considered to be a schizophrenia spectrum disorder

Answer 88

Generally poor

Answer 89

Low-dose antipsychotics Lithium and mood stabilizers may be of some benefit

Answer 90

Group therapy to address social anxiety and awkwardness can be beneficial Individual counseling may have some benefit to teach patients to understand and corroborate their odd ideas and thoughts with environmental evidence and not personal impressions / feelings

Mood and Other Disorders Flashcards

(118 cards)