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Master the boards: Psychiatry > Mood disorders > Flashcards

Mood disorders Flashcards

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1
Q

What are the diagnostic criteria for Major Depressive Disorder?

A

At least 5 symptoms observable for 2 or more weeks that represent a change from baseline in functioning

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2
Q

What symptoms must always be included to diagnose MDD?

A

Depressed mood or anhedonia (absence of pleasure)

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3
Q

What Mnemonic is used for MDD symptoms?

A

SIG E CAPS

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4
Q

What does SIG E CAPS stand for?

A

Sleep, Interest, Guilt
Energy
Concentration, Appetite, Psychomotor, Suicidal Ideation

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5
Q

What Neurotransmitter changes are seen in MDD?

A

Decreased Serotonin
Decreased NE and DA

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6
Q

What sleep changes are associated with MDD?

A

Decreased REM latency
Increased REM sleep

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7
Q

What is the first line treatment for MDD?

A

SSRI drugs

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8
Q

What are commonly used SSRI drugs?

A

Fluoxetine, paroxetine, Sertraline, Citalopram and Escitalopram

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9
Q

How long does it take for SSRIs to have an effect?

A

4 to 6 weeks

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10
Q

What drugs should you not take with SSRIs?

A

MAO-Inhibitors: rick of serotonin syndrome

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11
Q

What is the second line treatment for MDD?

A

SNRI

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12
Q

What are common SNRI drugs?

A

Venlafaxine, Duloxetine, Desvenlafaxine

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13
Q

What are common side effects of SNRI drugs?

A

Hypertension and sweating

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14
Q

What types of therapy can be used for MDD?

A

Psychotherapy and CBT

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15
Q

How long should treatment be continued for a single episode of depression?

A

6 months after return to baseline then taper off

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16
Q

How long should treatment be continued for 2 or more episodes of depression?

A

1-3 years due to high risk of recurrence

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17
Q

Instead of SSRIs what should you use in a patient with depression and Neuropathic Pain?

A

Duloxetine: approved for both depression and peripheral neuropathy

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18
Q

What should be used instead of an SSRI in a patient with depression who is fearful of weight gain or sexual side effects or trying to quit smoking?

A

Bupropion

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19
Q

What is a common side effect of Bupropion you need to keep in mind?

A

Lowers seizure threshold: easier to have seizures

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20
Q

What Neurotransmitter changes are associated with Bipolar Disorder?

A

Increased NE and Serotonin

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21
Q

What is Bipolar Disorder Type I Characterized by?

A

Mood disorder with manic symptoms that cause significant distress in the level of functioning for at least 1 week

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22
Q

What are common manic symptoms?

A

Elevated mood, increased self-esteem
Distractibility, Pressured speech, decreased need for sleep
Increase in goal-directed activity, racing throughts
excessive involvement in pleasurable activities

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23
Q

How does Bipolar Disorder Type I typically start?

A

Depression and increased energy despite a lack of sleep

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24
Q

What is the definition of manic symptoms?

A

Last >1 week: affect functioning and are severe enough to warrant hospitalization

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25
What defines Hypomanic symptoms?
Last <1 week: do not severely affect functioning and are not severe enough to warrant hospitalization
26
What is the Mneomonic for Mania?
DIG FAST
27
What does DIG FAST stand for?
Distractibility Indiscretion or excessive involvement in pleasurable activities Grandiosity Flight of Ideas Activity Increase Sleep Deficit Talkativeness
28
What is the key difference between Bipolar Type I and Bipolar Type II?
Bipolar Type I has mania and depression, type II has hypomania: by definition if mania is present it must be Bipolar Type I
29
What is considered Rapid-Cycling Bipolar disorder?
4 or more mood episodes in a 12 month period
30
What are the common treatment options for Acute mania?
Lithium, Valproic acid and atypical antipsychotics
31
What are the common treatment options for Bipolar Depression (non-acute mania)?
Lithium, Quetiapine, Lurasidone, Lumateperone or Lamotrigine -Lurasidone can be used in pregnant if benefits>risk
32
What do fetuses exposed to Lurasidone in the 3rd trimester have an increased risk of developing?
Extrapyramidal symptoms
33
What drug do you need to avoid in Patients with compromised renal function?
Lithium
34
What can trigger mania in patients with Bipolar?
SSRIs
35
What is Persistent Depressive Disorder?
Presence of depressed mood most of the day and almost continuously Symptoms must be present for at least 2 years
36
How do you treat Persistent Depressive Disorder?
Antidepressants and Psychotherapy
37
What is Cyclothymic Disorder?
Presence of hypomanic episodes and mild depression: present for >2 years
38
How do you treat Cyclothymic disorder?
Lithium, Valproic acid, antipsychotics or psychotherapy
39
What is Major Depressive Disorder (MDD) with Atypical Features?
Characterized by reverse "vegetative changes": increased sleep, weight and appetite combined with interpersonal rejection sensitivity and significant social or occupational impairment Mood tends to be worse in the evening: Extremities feel "heavy"
40
How do you treat MDD with Atypical Features?
SSRI: Fluoxetine, Sertraline , Paroxetine, Citalopram, Escitalopram *MAO-I: Phenelzine, isocarboxazid, Tranylcypromine
41
What are common MAO-I Drugs?
Phenzine Isocarboxazid Tranylcypromine
42
What is MDD with seasonal pattern?
Seasonal changes in mood during fall and winter
43
What are common symptoms of MDD with seasonal pattern?
Weight gain, increased sleep and lethargy
44
How do you treat MDD with seasonal pattern?
Phototherapy and Bupropion or SSRIs
45
What hormone is believed to play a role in MDD with seasonal pattern?
Melatonin
46
When does Postpartum Blues ("Baby Blues") onset?
immediately after birth up to 2 weeks
47
What are common symptoms of Postpartum Blues ("Baby Blues")?
Sadness, mood lability, tearfulness
48
What are the mother's feelings toward the baby in Postpartum Blues ("Baby Blues")?
No negative feelings
49
How do you treat Postpartum Blues ("Baby Blues")?
Supportive: self-limited
50
what does Depressive Disorder with Peripartum Onset present?
within 1-3 months after birth
51
What are common symptoms in Depressive Disorder with Peripartum Onset?
Depressed mood, weight changes, sleep disturbances and excessive anxiety
52
What are the mother's feelings toward the baby in Depressive Disorder with Peripartum Onset?
May have some (-) feelings toward the baby
53
How do you treat Depressive Disorder with Peripartum Onset?
Antidepressant medications
54
When do Bipolar disorder with peripartum onset/ Brief psychotic disorder with peripartum onset present?
During pregnancy up to 4 weeks after birth
55
What are common symptoms of Bipolar disorder with peripartum onset/ Brief psychotic disorder with peripartum onset?
Depression, Mania, hallucinations, delusions and thoughts of harm
56
What are the mother's feelings toward the baby in Bipolar disorder with peripartum onset/ Brief psychotic disorder with peripartum onset?
may have thoughts of harming the baby
57
How do you treat Bipolar disorder with peripartum onset/ Brief psychotic disorder with peripartum onset?
Antipsychotic medications Lithium Hospital Admisson
58
What is Brexanolone?
Synthetic Neuroactive steroid indicated for treatment of Postpartum Depression
59
How does Brexanolone work?
Modulates the GABA-A Receptor
60
What is Bereavement (Grief)?
Normal: begins after the death of a loved one and typically lasts <6 months to 1 year
61
What are common symptoms of Bereavement (Grief)?
Feelings of sadness, worry about the deceased, irritability, sleep difficulties, poor concentration and tearfulness
62
How is Bereavement (Grief) typically treated?
Supportive Psychotherapy
63
What are common Tricyclic Antidepressant Drugs?
Amitriptyline Nortriptyline Imipramine
64
What are common side effects of Tricyclic antidepressant drugs?
Hypo/hypertension, dry mouth, constipation, confusion, arrhythmias, sexual side effects, weight gain, GI disturbances
65
What are common Monoamine Oxidase-Inhibitor drugs?
Phenelzine Isocarboxazid Tranylcypromine
66
What are common side effects of MAO-I drugs?
Monitor diet: foods with tyramine can cause HTN -Unsafe: red wine, aged cheese, chocolate
67
What are common SSRI drugs?
Fluoxetine Paroxetine Sertraline Citalopram Escitalopram Fluvoxamine
68
What are common side effects of SSRi drugs?
HA, Weight changes, sexual side effects, GI disturbances
69
What are common SNRI drugs?
Venlafaxine Duloxetine Desvenlafaxine
70
What are common side effects of SNRI drugs?
Hypertension, blurry vision, weight changes, sexual side effects, GI disturbances
71
What side effect is associated with Bupropion?
Increased risk of seizures: lowers seizure threshold
72
What side effect is associated with Trazodone?
Priapism
73
What side effect is associated with Mirtazepine?
Weight gain and sedation
74
What are common side effects of Lithium?
Nephrotoxic, Leukocytosis, tremors, weight gain teratogenic, Diabetes Insipidus ataxia, lethargy, confusion, abnormal reflexes
75
What are common side effects of Valproic Acid?
Hepatotoxic, tremors, weight gain , GI disturbances, alopecia, teratogenic Hyponatremia, coma, death
76
What are common side effects of Lamotrigine?
SJS
77
What are common side effects of ECT?
Headaches, transient amnesia
78
is ECT safe for pregnant patients?
yes
79
When can Serotonin syndrome occur?
with use of SSRIs and unintentional interactions between drugs, recreational drug use of serotonergic drugs
80
What are common symptoms of Serotonin Syndrome?
Cognitive: Agitation, confusion, hallucinations, hypomania autonomic: sweating, hyperthermia, tachycardia, nausea, diarrhea, shivering Somatic: Tremors, myoclonus, hyperreflexia
81
How do you treat Serotonin Syndrome?
Stop SSRI drugs treat fever, diarrhea, HTN Cyproheptadine: serotonin antagonist
82
What is the antidote for serotonin syndrome?
Cyproheptadine
83
What is the mechanism of Cyproheptadine?
Serotonin Antagonist
84
What drugs are commonly associated with precipitating serotonin syndrome?
Meperidine Lithium Linezolid Metoclopramide

Master the boards: Psychiatry (15 decks)

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