mood disorders

Question 1

major depressive episode-contingent on two conditions

Answer 1

cannot be due to substance use or meds

must cause social or job impairment

Question 2

manic epidosde criteria

Answer 2

period of abrnomally and persistently elevated, expansive or irritable modd lasting at least 1 wk (or any duration if hospitalization is needed) and including at least 3 of following (4 is mood is irritable)

distractibility
inflated self esteem
increase in goal directed activity
decreased need for sleep
flight of ideas or racing thoughts
more talkative or pressure speech 
excessive involvement in pleasurable activtiies that have high risk of neg consequences

can’t be due to substance use or med conditions and must cause social or job impairment

Question 3

what percentage of manic pts have psychotic symptoms

Answer 3

75

Question 4

mixed episode

Answer 4

criteria met for both manic and major depressive episode

these criteria must be present nearly everyday for at least 1 week

Question 5

hypomanic episode

Answer 5

distinct period of elevated, expansive, or irritable mood that includes at least 3 of symptoms listed for manic episode criteria (4 if modd is irritable)

Question 6

differences btwn hypomania and mania

Answer 6

see pg 37

Question 7

what is the predominant mood state in mixed episodes

Answer 7

irritability

Question 8

mixed episodes-tx?

Answer 8

poorrer response to lithium

anticonvulsants may help

Question 9

diagnosis of major depressive disorder

Answer 9

at least 1 major depressive episode

no hx of manic or hypomanic episode

Question 10

main pathogenesis in MDD

Answer 10

decreased serotonin and 5-HIAA

abnormal regulation of beta adrenergic receptors

Question 11

drugs that increase levels of what alleviate depression

Answer 11

serotonin
NE
dopamine

Question 12

loss of a parent before age what is associated with the later development of major depression

Answer 12

11

Question 13

what percentage of pts respond to SSRIs for depression?

Answer 13

50-60

Question 14

side effects of SSRIs

Answer 14

headache
GI disturbance
sexual dyxfxn
rebound anxiety

Question 15

side effects of TCAs

Answer 15

lethal in overdose
sedation
weight gain
orthostatic hypotension
anticholinergic effects
can aggravate prlonged QTC

Question 16

most common side effect of MAOIs

Answer 16

orthostatic hypotension

Question 17

what meds can be added for tx of depression to convert nonresponders to responders

Answer 17

liothyronin T3
T4
lithium
L tryptophan

Question 18

ECT is performed by doing what

Answer 18

premedication w atropine
then general anesthesia and muscle relaxant
then induced generalized seizure under 1 min

Question 19

compare effectiveness of diff antidepressant meds

Answer 19

equally effective but differ in side effects

Question 20

serotonin syndrome

Answer 20

autonomic instability
hyperthermia
seizures
coma or death

Question 21

features of atypical depression

Answer 21

hypersomnia
hyperphagia
reactive mood
leaden paralysis
hypersensitivity to interpersonal rejection

Question 22

catatonic depression

Answer 22

catalepsy(immobility)
purposeless motor activity
extreme negativism or mutism
bizarre postures
echolalia

Question 23

types of depressive disorders

Answer 23

melancholic
atypica
catatonic
psychotic

Question 24

cortisol is increased in MDD-true or false?

Answer 24

true

Question 25

with mania or depressive symptoms, what is it important to assess first?

Answer 25

is it med induced or medical condition induced?

Question 26

normal grief usually lasts

Answer 26

under 2 months

Question 27

bipolar I diagnosis

Answer 27

one manic or mixed episode

Question 28

Kubler Ross model of grief has what stages?

Answer 28

denial, anger, bargaining, depression, acceptance

Question 29

always remember to include what in your differential of a psychotic patient?

Answer 29

bipolar disease

Question 30

rapid cycling

Answer 30

occurrence of four or more mood episodes in 1 year (major depressive, manic, mixed. etc)

Question 31

what has the highest genetic link of all major psychiatric disorders

Answer 31

bipolar I disorder

Question 32

what btwn episodes helps decrease risk of relapse in bipolar I?

Answer 32

lithium prophylaxis

Question 33

tx for bipolar I

Answer 33

mood stabilizers: lithium anticonvulsants (carbamazepine, valproic acid) atypical antipsychotics (olanzapine, quetiapine, ziprasidone)-both as monotherapy and adjunct therapy psychotherapy (prolongs remission once acute episode controlled) ECT

Question 34

what is the disadvantage of anticonvulsants for tx of bipolar I?

Answer 34

increased risk of suicide (as opposide to long term lithium use which reduces suicide risk)

Question 35

side effects of lithium

Answer 35

``` weight gain tremor GI disturbances fatigue cardiac arrhythmias seizures goiter/hypothyroidism leukocytosis coma polyuria (nephrogenic diabetes insipidus) polydipsia alopecia metallic taste ```

Question 36

what is best tx for manic woman in pregnancy

Answer 36

ECT

Question 37

anticonvulsants are especially useful in what case for bipolar I?

Answer 37

rapid cycling bipolar disorder and mixed episodes

Question 38

diagnosis of bipolar II

Answer 38

hx of one or more major depressive episodes and at least one hypomanic episode

Question 39

tx for bipolar II

Answer 39

same as for bipolar I disorder

Question 40

dysthymic disorder

Answer 40

chronic, mild depression with no discrete episodes

Question 41

diagnosis for dysthymic disorder

Answer 41

depressed modd for majority of time most days for at least 2 years (in children or adolescents at least 1 year) ``` at least two of the following: poor concentration or difficulty making decisions feelings of hopelessness poor appetite or overeating insomnia or hypersominia low energy or fatigue low self esteem ``` CHASES mnemonic during the two year period: - the person has not been w/o above symptoms for more than 2 months at a time - no major depressive episode - never had manic or hypomanic episode

Question 42

mnemonic for dysthymic disorder

Answer 42

2 Ds 2 years of depression 2 listed criteria never asymptomatic for more than 2 months

Question 43

tx for dysthymic disorder

Answer 43

cognitive therapy, insight oriented psychottherapy most effective antidepressant meds (SSRIs, TCAs, MAOIs) useful when used concurrently w psychotherapy

Question 44

cyclothymic disorder diagnosis

Answer 44

numerous periods with hypomanic symptoms and periods with depressive symptoms for at least 2 years must never have ben symptom free for more than 2 months no hx of major depressive episode or manic episode

Question 45

cyclothymic disorder may coexist with

Answer 45

borderline personality disorder

Question 46

seasonal affective disorder

Answer 46

at least 2 consecutive yrs of 2 major depressive episodes during same season

Question 47

triad for seasonal affective disorder

Answer 47

irritability carb craving hypersomnia

Question 48

adjustment disorders criteria

Answer 48

emotional or behavioral symptoms within 3 months after stressful life event. symptoms produce either: - severe distress in excess of what wuld be expected after event - significant impairment in daily functioning symptoms are not those of bereavement symptoms resolve within 6 months after stressor has ended