Mood Disorders

Question 1

Define Mood Disorder

Answer 1

1 or more major depressive episodes

Question 2

Onset of MDD

Answer 2

usually in mid 20s

Question 3

Male-to-female ratio for mood disorder

Answer 3

1:2

Question 4

Symptoms of depressive episode

Answer 4

Sleep; Interest(decreased); Guilt; Energy (decreased); Concentration (decreased); appetite or weight; Psychomotor agitation or retardation; Suicide ideation

Question 5

Requirement for MDD

Answer 5

depressed mood or anhedonia and 5 more S&S from SIG E CAPS for 2-week period

Question 6

Atypical Depression

Answer 6

weight gain, hypersomnia, and rejection sensitivity

Question 7

Postpartum Depression

Answer 7

Occurs within 1 month postpartum, psychotic symptoms are common

Question 8

Seasonal Depression

Answer 8

Depressive episodes during a particular seasons, usually in the winter. Responds well to light therapy +/- antidepressants

Question 9

Double Depression

Answer 9

major depressive episode in a patient with dysthymia. Has poorer prognosis that MDE alone

Question 10

Pharmacotherapy Timeframe for MDD

Answer 10

effective in 50-70% patient, allow 2-6weeks to take effect; treat for 6+ months

Question 11

Pharmacotherapy for MDD (drug classes)

Answer 11

SSRIs, Atypicals, SNRIs, TCAs, MAOIs

Question 12

Best treatment combination for MDD

Answer 12

Pharmacotherapy + Psychotherapy

Question 13

When to use ECT

Answer 13

Refractory depression or psychotic depression, or if rapid improvement in mood is needed; also used for intractable mania and psychosis

Question 14

Adverse Effects of ECT

Answer 14

postictal confusion, arrhythmias, HA, and anterograde amnesia

Question 15

TCA toxicity

Answer 15

3 C’s; Convulsions, Coma, Cardiac Arrhythmias

Question 16

Medical conditions that can cause mood disorder

Answer 16

hypothyroid, parkinson, CNS neoplasm, ceoplasms, stroke (esp ACA), dementias, parathyroid

Question 17

Substances that can cause mood disorders

Answer 17

illicit drugs, alcohol, antihypertensives, corticosteroids, OCPs

Question 18

A constellation of symptoms that resemble MDE but do not meet the criteria for MDE. Occurs within 3 onths of an identifiable stressor

Answer 18

Adjustment disorder with depressed mood

Question 19

Timeframe for normal bereavement

Answer 19

after loss of loved one, no severe impairment/suicidality. Should last

Question 20

milder, chronic depression with depressed mood present most of the time for at least 2 years; often resistent to treatment

Answer 20

Dysthymia

Question 21

Contraindications of ECT

Answer 21

MI/stroke, intracranial mass, and high anesthetic risk

Question 22

Length of time to wait to start MAOI if patient was on fluoxetine

Answer 22

5 weeks

Question 23

Length of time to wait to start MAOI if pateint was on SSRIs

Answer 23

2 weeks

Question 24

Time of onset for postpartum blues

Answer 24

within 2 weeks of delivery

Question 25

Sadness, moodiness, emotional lability. No thoughts about hurting the baby.

Answer 25

Postpartum "blues"

Question 26

Time of onset for postpartum psychosis

Answer 26

2-3 weeks postdelivery

Question 27

Delusions and depression after giving birth. May have thoughts about hurting the baby.

Answer 27

Postpartum psychosis

Question 28

Time of onset postpartum depression

Answer 28

1-3 months postdelivery

Question 29

Delusions and depression, sleep disturbances and anxiety, thoughts about hurting the baby

Answer 29

Postpartum depression

Question 30

Average age of onset for bipolar and gender preference

Answer 30

20y/o; male and female are equal

Question 31

Bipolar I

Answer 31

Involves at least 1 manic or mixed episode (usually requires hospitalization)

Question 32

Bipolar II

Answer 32

Involves at least 1 MDE and 1 hypomanic episode

Question 33

Rapid cycling

Answer 33

Involves 4+ episodes (MDE, manic, mixed, or hypomanic) in 1year

Question 34

Cyclothymic

Answer 34

Chronic and less severe, alternating periods of hypomania and moderate depression for >2years

Question 35

Symptoms of Mania

Answer 35

DIG FAST Distractibility, Insomnia, Grandiosity/Goal directed, FLight of ideas, Acitivities/Agitation, Sexual indiscretions, Talkativeness/pressured speech

Question 36

Describe a manic episode

Answer 36

1 week or more of persistently elevated, expansive, or irritable mood plus 3 DIGFAST symptoms (can have psychotic symptoms)

Question 37

Acute therapy for bipolar mania

Answer 37

Antipsychotics

Question 38

Maintenance therapy for bipolar mania

Answer 38

mood stabilizers such as lithium, carbamazepine, valproic acid, lamotrigine

Question 39

Drug for refractory agitation associated with bipolar mania

Answer 39

Benzodiazepines

Question 40

Treatment for bipolar depression

Answer 40

Mood stabilizers 1st and then add an antidepressant to avoid inducing mania ECT for refractory cases

Question 41

Treatment for patients with severe depression or bipolar II with predominantly depressive features

Answer 41

Augment antidepressants with low-dose lithium (blood levels 0.4-0.6mEq/L)