Mood disorders Flashcards
(47 cards)
DSM diagnostic criteria (duration of sx) of MDE
5/9 sx of Mr. SIGECAPS for >2 weeks Mood (depressed) Sleep Interest Guilt Energy Concentration Appetite Psychomotor activity Suicidal Ideation
DSM diagnostic criteria (duration of sx) of manic episode
3/7 sx of DIGFAST for >1 week Distractibility Insomnia/Inpulsivity Grandiosity/Goal directed activity Flight of ideas Activity/Agitation Speech (pressured) Thoughtlessness
+ severe impairment in social/occupational functioning
+ psychotic features
DSM diagnostic criteria (duration of sx) of mixed episode
criteria met for both manic and MDE for >1 week
DSM diagnostic criteria (duration of sx) of hypomanic episode?
3/7 sx of DIGFAST for 4 days Distractibility Insomnia/Inpulsivity Grandiosity/Goal directed activity Flight of ideas Activity/Agitation Speech (pressured) Thoughtlessness
no severe impairment in social/occupational functioning
no psychotic features
What two medical disorders are at very high risk of developing depression
pancreatic cancer
stroke
DSM diagnostic criteria (duration of sx) of MDD
at least 1 episode of MDE with no hx of mania/hypomania
What should you suspect in a patient with weight gain and increased appetite?
Major depression with atypical features
What should you suspect in a patient with weight gain without appetite?
metabolic disorder (ie hypothyroidism)
How do you differentiate between MDD vs dementia in terms of effort during cognitive testing, insight to intellectual difficulties, cortical/neurological signs?
MDD: very little effort during cognitive testing, increased insight to intellectual difficulties, ø cortical/neurological signs
dementia: lots of effort during cognitive testing, decreased insight to intellectual difficulties, + cortical/neurological signs
How do adults with MDD often present? children?
Adults: sad, depressed
Children: angry, mad, irritable/short-tempered
What are the sleep problems associated with MDD?
multiple awakenings throughout the night
ntial and terminal insomnia (difficulty falling asleep, early morning awakenings)
hypersomnia (excessive sleepiness)
decreased REM sleep
4 pathophysiological findings of depression
decreased serotonin
abnormal upregulation of ß-receptors
high cortisol (due to hyperactivity of HPA)
abnormal thyroid axis
T/F if untreated, MDE will last for 6-13 months
True. MDE are self-limiting, but will generally occur more frequently as the disease progresses
black box warning for antidepressants use in pediatric patients?
increases risk of suicidality
SSRIs are notorious for these ADRs
sexual dysfunction, GI disturbance, HA
MAOi are notorious for this ADR
serotonin syndrome, esp. when used in combination with SSRI or when tyramine-rich foods are consumed
TCAs are notorious for this ADR
QT prolongation
Others: anticholinergic effects (dry-mouth, constipation), sedation, weight gain, orthostatic hypotension
Non-responders to antidepressants can be converted to responders using which medications? (ie augmentation therapies)
Thyroid hormone
Lithium
L-tryptophan
What are MAOi’s generally indicated for?
Atypical depression
When is ECT indicated?
when a patient is refractory to or can’t tolerate pharmacotherapy, or if a rapid reduction of symptoms is desired (imminent suicide risk)
common ADRs of ECT
retrograde/anterograde amnesia
HA
Nausea
muscle soreness
what is the melancholic subtype of MDD
anhedonia, early AM awakenings, psychomotor disturbance, excessive guilt, anorexia
what is the atypical subtype of MDD
hypersomnia hyperphagia -> weight gain reactive mood leaden paralysis hypersensitivity to interpersonal rejection
what is the catatonic subtype of MDD
immobility, purposeless motor activity, extreme negativism or mutism, bizarre postures, echolalia
