Psych 4 - Mood Disorders

Front 1

what are four different types of mood disorders?

Back 1

depressive disorders, bipolar disorders, secondary mood disorders, mixed anxiety depression

Front 2

substance use disorders, pathological gambling, personality disorders, anxiety are all co-morbidities of the most common psychiatric illness you are likely to see as a physician. This illness is?

Back 2

depression

Front 3

T or F

women are 70% more likely than men to experience depression

Back 3

true

Front 4

1/4 of medical students are depressed, only 1/4 of those seek treatment. What did schwenk et al. find out as a difference b/w 1st/2nd years and 3rd/4th years?

Back 4

3rd/4th years are more suicidal

Front 5

what is one explanation as to why suiccide rates are higher among physcians?

Back 5

suicide is often mroe successfully completed among physicians b/c doctors know how to do it

Front 6

the main cost of depression are due to?

Back 6

lost productivity and other workplace costs

Front 7

when making the diagnosis of depression you should consider what other possibites.

Back 7

bereavement, normal reaction to stress, adjustment disorder, cultural factors

Front 8

according to the DSM-IV what is the diagnostic criteria for depression?

Back 8

5 or more of possible 9 symptoms, one of which must be depressed moddd or loss of interest/pleasure for two weeks (sleep disturbance, interest reduced, guilt, energy, concentration, appetite changes, psychomotor changes, suicidal thoughts, depression)

Front 9

what is the median age of onset for MDD?

Back 9

32

Front 10

MDD can be a chronic relapsing disorder with 70% recurrence, 15% suicide. Discribe dysthymic disorder

Back 10

2 years of low mood, milder, more fluctuating symptoms, presence of 2 additional symptoms (appetite, sleep, fatigue, self exteem, concentration, hopelessness) *longer lasting more mild depression

Front 11

neurologic, metabolic, gastrointestinal, endocrine, cardivascular, pulmonary, malignancy, autoimmune, infectious decribes?

Back 11

depression secondary to medical conditions

Front 12

drugs (alcohol, benzo's, opioids, hallucinogens, withdrawal) oral contraceptives, steriods, antihypertensives represents?

Back 12

depression secondary to medical conditions

Front 13

according to the DSM, symptoms of grief should clear in?

Back 13

2 months

**DSM V may drop the 2 month exclusion

Front 14

grief symptoms should not include

Back 14

suicidal idealation
psychotic symptoms
excessive guilt
fuctional impairment

Front 15

decribe the learned helplessness model

Back 15

exposure to uncontrollable negative events plus attributional style, Rat that’s exposed to shocks, even when they are given an opportunity to stop the shocks they don’t. Applied to humans who have given up.

Front 16

decribe the cognitive theory

Back 16

depression results from cognitive errors, patterns in thinking (generalization, etc.)

Front 17

describe the genetics of depression

Back 17

strong familial pattern, strong concordance rates
2-5x the risk in first degree relatives than the general popultion

Front 18

what are the 6 pertinent biogenic amines

Back 18

dopamine, epinephrine, acetylcholine, norepinephrine, histamine, serotonin

Front 19

norepinephrine is made in the?

Back 19

locus ceruleus

Front 20

what biogenic amine is decreased in those who die of violent suicide?

Back 20

serotonin (made in the dorsal raphe nuclei in the pons)

Front 21

what biogenic amine is made in the VTA of the midbrain, substantia nigra pars compacta, and arcuate nucleus

Back 21

dopamine

Front 22

what is the indoleamine hypothesis

Back 22

defictis of 5HT cause depression

Front 23

what is the catecholamine hypothesis

Back 23

defictis of NE or DA cause depression

Front 24

what is the cholinergi-adrenergic balance hypothesis

Back 24

depression occurs when NE and DA are low relative to Ach and mania occurs when the reverse occurs

Front 25

neuroendocrine model:

Back 25

the hypothalamus hypersecretes CRF in depression, resulting in elevated ACTH, which triggers the adrenal cortex to release extra cortisol. Unipolar and bipolar depress patients often have elevated cortisol that can't be suppress (ketoconazole lowers cortisol levels and lowers cortisol levels)

Front 26

infectious model

Back 26

the borna virus can cause depression, antiviral amantadine can be helpful

Front 27

what do these words have in common?
psychotherapy, medication, ECT, light therapy, VNS, TMS, deep brain stimulation, nutritional supplements

Back 27

all treatments of depression

Front 28

what is the STAR*D trial?

Back 28

landmark study on antidepressant failure, most medications that they tried worked with the same efficicacy so decide meds on SE profile rather than efficacy

Front 29

what are the 3 mechanisims in which antidepressants work?

Back 29

reuptake inhibition, enhance release, inhibit degradation

Front 30

what is the only FDA approved antidep for kids <18y

Back 30

prozac

Front 31

what is significant about the slow onset of antidepressants

Back 31

many patients lose hope after a few days or week, but they take 4-6 weeks to take effect

Front 32

what are MAOI's and it's SEs/restrictiosn

Back 32

monoamine oxidase inhibitors
Sexual Se, CNS, insominia/sedation, weight gain
**better efficacy for "atypical" depression than other AD's

Front 33

this AD, has serious risk in overdose, cardiac SE's adn sedation, seizures, anticholinergic effects.

Back 33

TCA's (tricyclic acids)

Front 34

this AD is the first generation of rationally designed AD's, first line for depressive disorders, social anziety,"", panic disorders, OCD. Increased suicidal activity for those under 24 yers

Back 34

SSRI's (selective seretonin reuptake inhibitors)

Front 35

effexor, pristiq, cymbalta (longer acting) are examples of?

Back 35

SNRI's (selective NE reuptake inhibitors)

Front 36

what is Bupropion (wellbutrin)

Back 36

NDRI's (NE?dopamine reuptake inhibitors)

Front 37

mirtazapine (remeron) can make you tired, but main SE is?

Back 37

significant weight gain

Front 38

SSRIs didn't separate from placebos statistically significantly in what patient pop?

Back 38

mildly depressed
*people who started taking the pills got better, maybe not much better than a placebo, but still they work and they should not be taken away from those mildly depressed

Front 39

when do you recommend lifelong treatment of antidepressants?

Back 39

if patient has suffered 3 or more episodes

Front 40

what is standard of care for antidepressants

Back 40

treat to remission of all symptoms, continue ADs at full dose for 6+ months following remission for the index episode

Front 41

when is electroconvulsive (ECT) therapy indicated; and what is the mechanism of action

Back 41

severe depression, mania, catatonia, acute psychosis;

mech: induces therapeutic clonic seizures (increases BDNF)

Front 42

what is the treatment for seasonal affective disorder (SAD)

Back 42

sunlight (treatment of choice) or light boxes (10,000 lux)

Front 43

what is the treatment for treatment-resistant depression? Mech: regulation of NE replease by solitary tract projections to the locus coeruleus

Back 43

vagus nerve stimulation
transcranial magnetic stimulation ($500,000 per machine and no good data)

Front 44

what treatment is FDA approved for Parkinson's, dystonia, and essential tremor, but not MDD?

Back 44

deep brain stimulation - brain pacemaker is palce in the subgenual cingulate region of the brain

Front 45

which nutritional treatment reduce depression?

Back 45

omega 3 FA
lithium

Front 46

which nutritional treatments treats apical mood disorders

Back 46

chromium

Front 47

which nutritional treatment treat depression and profoundly decrease the rate of completed suicide?

Back 47

lithium

Front 48

name the dz

Mood: elevated (or Irritable, can be labil) lasting at least 1 week.
At least 3 symptoms (4 if just irritable): gradiosity, decr need for sleep, pressured speech, flight f ideas/racing thoughts, distractibility, incr goal-directed activity or psychomotor agitation, risky behaviors

Back 48

bipolar I

Front 49

how do you classify bipolar I types?

Back 49

by the most recent episode
single manic episode, most recent episode hypomanic, manic, mixed, depressed, unspecified

Front 50

name the dz
the disorder is characterized by severe recurrent temper outbursts in response to common stressors

Back 50

temper dysregulation disorder w/dysphoria aka tantrum diagnosis

Front 51

name the dz
age of onset 20's or 30's, first episode can be manic or depressed, manic episodes last weeks to months (NOT transient mood swings)

Back 51

bipolar I

Front 52

describe the genetics of Bipolar I

Back 52

very high concordance higher than unipolar depression and EVEN SCHIZOPHRENIA

Front 53

head trauma to the right frontal area causes?

Back 53

mania

Front 54

head trauma to the right frontal area causes

Back 54

depression

Front 55

head trauma to the medial frontal area causes?

Back 55

apathy, spontaneous mvmt, gesture

Front 56

head trauma to the orbitofrontal lobe

Back 56

profanity, irritability, irresponsibility

Front 57

name the dz

at least 4 days of elevated mood, 3 or more other sx, change in functioning, not severe enough to severely impair funcitoning or necessitate hospitalization, no psychosis

Back 57

hypomania

Front 58

name the dz
hypomania + major depression, never a hx of manic or mixed episoides

Back 58

bipolar type II; tx same as BP I

Front 59

difference b/w manic episode and hypomanic episode

Back 59

manic episode is at least 1 week, impairment in functioning, often a need for hospitalization
hypomanic episodes, change in functioning but episode not sever enough to impair functioning

Front 60

difference b/w bipolar I and bipolar II

Back 60

bipolar I can dx at manic state and equally common in males and females, bipolar II at least one major depressive episode and one hypomanic episode more common in females

Front 61

name the dz
combining aspects of two different disorders (psychosis, negative symptoms with prominent affective (mood) symptoms; psychotic symptoms present even when mood symptoms absent

Back 61

schizoaffective

Front 62

name to dz
chronic mood disturbance (over 2 years) hypomanic episoides, mild depressions (but not MDD), no functional impairment

Back 62

cyclothymia

Front 63

treatment of bipolar disorder

Back 63

lithium (gold standard)
anticonvulsants
antipsychotics
ECT

Front 64

what drug reduces homicide, suicide, rape, robbery, burglary, etc. (reduction of suicidal behaviors 67% with bipolar I 82% with bipolar II 100% with MDD)

Back 64

lithium

Front 65

common side effects: GI, N/V/D, weight gain, incr thirst, polyuria, dermatological, cognitive slowing are common with what drug

Back 65

Litium

Front 66

what is so dangerous about lithium

Back 66

requires regular plasma level monitoring b/c low therapeutic index. 0.8-1.2 therapeutic

Front 67

name the drug
lower toxicity in overdose, more efficacy in mixed states/rapid cycling.
SE: weight gain, dyspepsia, alopecia, tremor, ataxia, decreased, independent efficacy for alzheimers

Back 67

anticonvulsants: valproate (depakene)

Front 68

in anticonvulsants like lamorigine you want to monitor for?

Back 68

steven's johnson syndrome (SJS)

Front 69

what two atypical mood stabilizers are the only FDA approved for bipolar depression?

Back 69

seroquel and symbyax