Quiz

Question 1

What are the starting doses of SSRIs?

Answer 1

Fluoxestine 20mg
Paxil 20mg
Zoloft 50mg
Fluvox 50mg
Celexa 20mg
Lexapro 10mg

Question 2

What are the starting doses of SNRIs?

Answer 2

Effexor 37.5-75mg

Cymbalta 30-60mg

Question 3

What is the starting dose of mirtazapine?

Answer 3

15mg

Question 4

What is the starting dose of wellbutrin?

Answer 4

100-150mg

Question 5

What is the duration of MDD therapy?

Answer 5

4-8 weeks

Question 6

What is the diagnostic criteria for MDD?

Answer 6

2+ weeks

5+ sx

Question 7

What are the sx of MDD?

Answer 7

Sleep (insomnia/hypersomnia)
Interest (loss of interest/pleasure)
Guilt (feeling of worthlessness; excessive/inappropriate guilt)
Energy (Fatigue/loss of energy)
Concentration
Appetite (change in appetite/wt)
Psychomotor
Suicidal thoughts
Low mood

Question 8

What is the diagnostic criteria for mania?

Answer 8

3+ sx
1+ week
Or any duration if hospitalization is necessary
Cause marked impairment

Question 9

What is the diagnostic criteria for hypomania?

Answer 9

3+ sx
4+ consecutive days
Not severe enough to cause marked impairment

Question 10

What are the sx of mania/hypomania?

Answer 10

Grandiose; increase self-esteem
Increased activity (goal directed/highly risky)
Decreased judgement
Distractibility; flight of ideas
Irritability
Need less sleep
Elevated mood
Speedy talking/thoughts

Question 11

What are the diagnostic criteria for rapid cycling?

Answer 11

4+ mood episodes (MDD, manic, mixed, hypomanic)/year

Question 12

What are the criteria for cyclothymia?

Answer 12

Numerous periods with hypomanic sx and depressive sx for at least 2 years that do not meet criteria for MDD
For more than 2 months at a time
Present for at least 1/2 the time

Question 13

What is the criteria for mixed BD?

Answer 13

Patient w/sx of both mania and depression simultaneously

Question 14

What are the characteristics of BP I?

Answer 14

Mania
Psychosis often present
Impaired functioning
Hospitalization often required
Duration = months

Question 15

What are the characteristics of BP II?

Answer 15

Hypomania
Psychosis often not present
Slightly impaired to improved functioning
Hospitalization not required
Duration = weeks

Question 16

What are the first line therapy for MDD?

Answer 16

SSRI
SNRI
Mirtazapine
Bupropion

Question 17

What are the first line therapy for acute mania?

Answer 17

Lithium
VPA
SGA
Consider 2 drug combination, if severe (MS + SGA)
CBZ 1st or 2nd line depending on guideline

Question 18

What are the first line therapies for BD?

Answer 18

Lithium
Lamictal
Quetiapine

Question 19

What are the first line therapies for Mixed BD?

Answer 19

CBZ
VPA
Olanzapine

Question 20

What length of time is considered an adequate trial before adjusting/augmenting MDD therapy?

Answer 20

4-8 weeks

Question 21

What do we do if a patient with MDD is non-responsive to therapy?

Answer 21

Change/switch to a drug in a different/same class

Question 22

What do we do if a patient with MDD is partially responsive to therapy?

Answer 22

Ensure optimized dose
Can switch/augment
Augment/adjunctive therapy should target remaining sx
Augmentation is better strategy when response is seen

Question 23

What is the gold standard for augmentation in partial response for MDD?

Answer 23

Lithium

Question 24

What drugs are options for MDD augmentation/adjustments?

Answer 24

AAP (low dose SGAs in MDD w/o psychosis)
Anticonvulsants
Omega-3
Folic acid
Psychostimulants
Buspar
Ketamine

Question 25

Where is psychostimulants in MDD partial response therapy?

Answer 25

Controversial May consider short course if severe depression (fatigue, not getting out of bed or if immediate response required) May exacerbate anxiety Abuse potential

Question 26

What is the DOT of MDD?

Answer 26

12 months with the first episode for most patients 12-26 months for patients w/recurrent and/or severe MDD Potentially indefinitely depending on severity

Question 27

What is the DOT of BD?

Answer 27

Typically lifelong

Question 28

Which medication decreases SI in MDD?

Answer 28

Lithium

Question 29

Which screening tool in MDD is used for screening?

Answer 29

PHQ-9

Question 30

Who gets PHQ-9 and HAM-D?

Answer 30

All adults at least every 5 years | Those at high risk

Question 31

Who is at high risk in MDD?

Answer 31

``` PMH FH of depression/bipolar disorder Chronic illness ("frequent flyers") High utilization of services Pregnancy ```

Question 32

What is the screening tool for BD?

Answer 32

MDQ

Question 33

Who gets screening with BD?

Answer 33

Young adults - 40's with RFs | Patients not feeling themselves

Question 34

What are RFs for BD?

Answer 34

FH, stressors, head trauma, environment | Medical diagnosis, psychitric diagnosis or medications known to contribute

Question 35

What is the role of antidepressants in BD?

Answer 35

Should be used with mood stabilizers | Can cause "switching"

Question 36

How do we treat comorbid anxiety in patients with BD?

Answer 36

Gabapentin | Quetiapine