Mood Disorders

Question 1

Depression Dx

Answer 1

5/9 symptoms (1 must be anhedonia) for 2+ weeks :
Sleep changes, Interest↓ (anhedonia), Guild, Energy↓, Concentration problems, Appetite changes, Psychomotor retardation or agitation, Suicide

Question 2

Dysthymia Dx

Answer 2

3/9 symptoms for 2+ years (cannot have gone more than 2mo w/o symptoms)

Question 3

Physiologic cause of depression

Answer 3

↓NE, ↓serotonin, ↓DA d/t post-synaptic receptor problem

Question 4

Mania Dx

Answer 4

euphoric mood for 1+ week + 3 DIGFAST symptoms (distractibility, irresponsibility, grandiosity, flight of ideas, activity↑/agitation, sleep↓, thoughtlessness/talkativeness)

Question 5

Hypomania Dx

Answer 5

euphoric mood for 4days - less severe, no psychosis

Question 6

Bipolar Type I Dx

Answer 6

1 manic episode (+/- MDD)

Question 7

Bipolar Type II Dx

Answer 7

Hypomania + MDD

Question 8

Cyclothymic Disorder

Answer 8

mild depression + mild hypomania that lasts 2+ years

Question 9

NT associated w/ mania, psychosis, euphoria, etc

Answer 9

high DA & NE & low Serotonin

Question 10

Atypical depression

Answer 10

mood reactivity + hypersomnia + over-eating/weight gain

Question 11

Peripartum depression

Answer 11

onset w/in 4 weeks of delivery , lasts >10d (postpartum blues <10d)

Question 12

Recurrent Depression

Answer 12

period of 2mo rest with NO depressive symptoms

Question 13

Seasonal affective disorder

Answer 13

2+ years with 2 major depressive episodes showing temporal association & no non-seasonal depression

Question 14

MDD Neuroanatomy

Answer 14

Left prefrontal cortex w/ decreased BF

Question 15

Bipolar Neuroanatomy

Answer 15

Right prefrontal cortex w/ decreased BF

Question 16

Neuroanatomy of MDD & Bipolar

Answer 16

high amygdala activity, low cingulate gyrus & hippocampus activity (high cortisol)

Question 17

Cognitive distortions

Answer 17

all or nothing thinking, over-generalization, magnification, jumping to conclusions

Question 18

Diathesis-Stress Model

Answer 18

Biological component (predisposition) + Stressor (environment shapes it)

Question 19

Depression Tx

Answer 19

1. SSRI (MDD w/ atypical)
2. SNRI (MDD w/ melancholy, diabetic peripheral neuropathy)
3. TCA (MDD w/ melancholy)
4. MAO-I

Question 20

Tri-C Syndrome

Answer 20

TCA S/E (convulsion, coma, cardiac arrhythmias)

Question 21

TCA S/E

Answer 21

Tri-C Syndrome, Orthostatic hypotension, anticholinergic effects

Question 22

Which TCA is very sedating

Answer 22

Amitriptyline

Question 23

Which TCA is less sedative, but higher risk for seizures?

Answer 23

Desipramine

Question 24

Which TCA is preferred by elderly?

Answer 24

Nortriptyline

Question 25

Hypertensive crisis (w/ ingestion of tyramine)?

Answer 25

MAO-I - risk of stroke/MI/arrhythmia

Question 26

tranylcypromine, phenelzine, isocarboxazid, slegiline

Answer 26

MAO-I

Question 27

What drug can not be mixed with SSRIs & TCAs d/t excessive Serotonin risk?

Answer 27

MAO-I (2wk break b/w)

Question 28

Non-responders for MDD Tx

Answer 28

SSRIs: + SSRI + lithium + thyroid + bupropion

Question 29

MDD Tx length

Answer 29

6 months and then taper gradually over 1-2 weeks

Question 30

Options for non-seponders

Answer 30

vagal n. stimulation, transcranial magnetic stimulation, ECT (last line)

Question 31

Bipolar

Answer 31

1. Lithium (acute & long-term) 2. Anticonvulsants (rapid cyclers) 3. Atypical antipsychotics (acute)

Question 32

Lithium S/E

Answer 32

hypothyroidism, renal dysfunction, seizures, tremors, nephrogenic diabetes insipidus, teratogenic

Question 33

Anticonvulsant Valproate S/E

Answer 33

hepatic failure, pancreatitis

Question 34

Anticonvulsant Carbamazepine S/E

Answer 34

rash

Question 35

Clozapine S/E

Answer 35

Agranulocytosis

Question 36

Bipolar: Acute Manic Phase Tx

Answer 36

Lithium + | Oxcarbazepine or valproate +/- benzo

Question 37

Bipolar: Acute Depressive Phase Tx

Answer 37

Lamotrigine + | Antidepressant + atypical antipsychotic

Question 38

Bipolar Maintenance:

Answer 38

Lithium, Carbamazepine, Valproate, Lamotrigine

Question 39

Suicide risk is most related to

Answer 39

degree of hopelessness

Question 40

A depressive episode is not required in which of the following?

Answer 40

Bipolar Type I

Question 41

Which antidepressant has a mechanism of action as an α2-receptor antagonist?

Answer 41

Mirtazapine

Question 42

Which agent is best known to have SE of decreasing thyroid function?

Answer 42

Lithium

Question 43

Drug with significant α1 receptor antagonism, causing orthostatic hypotension?

Answer 43

Imipramine