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30 Cards in this Set
- Front
- Back
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31. Tyramine?
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a. Tyramine is an intermediate in the conversion of tyrosine to NE.
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32. Adjunct meds for MDD?
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a. Stimulates (such as methylphenidate)
b. Antipsychotics c. T3 and T4, Lithium, L-tryptophan (serotonin precursor) may be added to convert non-responders to responders. |
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33. Use of MAOIs?
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a. Often useful in treatment of “atypical” depression.
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34. How is ECT performed?
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a. By premedication w/atropine, followed by general anesthesia and administration of a muscle relaxant.
b. A generalized seizure is then induced by passing a current of electricity across the brain (either unilateral or bilateral). c. The seizure lasts < 1 minute. |
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35. Serotonin syndrome?
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a. Marked by autonomic instability, hyperthermia, and seizures.
b. Coma or death may result. |
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36. Usual time required for antidepressants to start working?
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a. 4-8 wks.
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37. Unique features of Depressive disorders?
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a. Melancholic
b. Atypical c. Catatonic d. Psychotic. |
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38. Melancholic features of depressive disorders?
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a. 40-60% of hospitalized pts w/major depression.
b. Characterized by anhedonia, early morning awakenings, psychomotor disturbance, excessive guilt, and anorexia c. i.e. you may diagnose MDD w/melancholic features. |
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39. MDD w/atypical features?
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a. Characterized by hypersomnia, hyperphagia, reactive mood, leaden paralysis, and hypersensitivity to interpersonal rejection.
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40. MDD w/Catatonic features?
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a. Include catalepsy (immobility)
b. Purposeless motor activity c. Extreme negativism or mutism d. Bizarre postures e. Echolalia. |
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41. Tx of the catatonic type of major depression?
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a. Usually tx’d w/antidepressants and antipsychotics concurrently.
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42. MDD w/psychotic features?
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a. 10-20% of hospitalized depressions.
b. Characterized by the presence of delusions or hallucinations. |
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43. Bereavement aka simple grief?
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a. Is a reaction to a major loss, usually of a person.
b. Sx often last for 2 months and include crying spells, problems sleeping, and trouble concentrating at work. c. Normal bereavement should not include gross disorganization or suicidality. d. It is important to differentiate bereavement from psychiatric disorders (major depression, acute stress disorder, adjustment disorder). |
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44. Normal grief vs. depression?
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a. In normal grief, illusions are common but suicidal thoughts are rare and sx usually last < 2 months.
b. Mild cognitive disorder typically last < 1 yr and pts can be tx’d w/BZDs for sleep. c. In depression, however, hallucinations and delusions are common, suicidal thoughts may be present, and sx generally persist for > 2 months. d. Mild cognitive disorder usually lasts > 1 yr and pts can be tx’d w/antidepressants, mood stabilizers, or ECT. |
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45. Bipolar I disorder?
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a. Involves episodes of mania and of major depression.
b. However, episodes of major depression are not required for this diagnosis. c. It is traditionally known as manic depression. |
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46. DSM-IV criteria for bipolar I?
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a. The only requirement for this diagnosis is the occurrence of 1 manic or mixed episode (10-20% of pts experience only manic episodes).
b. Between manic episodes, there may be interspersed euthymia, major depressive episode, dysthymia, or hypomanic episodes, but none of these are required for diagnosis. |
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47. Rapid cycling?
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a. Rapid cycling is defined by the occurrence of 4 or more episodes in 1 yr (major depression, manic, mixed, etc).
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48. Kubler-Ross stages of grief?
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1. Denial
2. Anger 3. Bargaining 4. Depression 5. Acceptance |
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49. Prevalence of bipolar I?
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a. 1%.
b. F:M c. No ethnic differences. d. Onset usually before age 30. e. Frequently misdiagnosed and thereby mistreated. |
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50. How long do untreated manic episodes generally last?
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a. ~ 3 months.
b. The course is usually chronic w/relapses. |
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51. Note: 90% of individuals w/1 manic episodes will have a repeat manic episode w/in 5 yrs.
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51. Note: 90% of individuals w/1 manic episodes will have a repeat manic episode w/in 5 yrs.
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52. Rx used to tx Bipolar I?
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a. Lithium
b. Anticonvulsants: Carbamazepine and valproic acid. Especially useful in rapid cycling bipolar disorder and mixed episodes, although associated w/↑ risk of suicide. c. Atypical antipsychotics-olanzapine (Zyprexa), quetiapine (Seroquel), ziprasidone (Geodon). d. Antidepressants are discouraged as a monotherapy due to concerns of activating mania or hypomania. The addition of antidepressants as adjunctive therapy to mood stabilizers has NOT shown to be effective. |
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53. Side effects of lithium? (12)
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1. Weight gain
2. Tremor 3. GI disturbances 4. Fatigue 5. Cardiac arrhythmias 6. Seizures 7. Goiter/Hypothyroidism 8. Leukocytosis (benign) 9. Coma 10. Polyuria/polydipsia (nephrogenic DI) 11. Alopecia 12. Metallic taste |
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54. Best tx for a manic woman in pregnancy?
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a. ECT!
b. It provides a good alternative to antipsychotics and can be used w/relative safety in all trimesters. |
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55. Tx for bipolar disorder (summary) includes?
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a. Lithium
b. Carbamazepine (for rapid cyclers) c. Valproic acid. |
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56. Prophylaxis for a pregnant woman w/a hx of postpartum mania?
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a. Should be tx w/antidepressants and lithium in subsequent pregnancies as prophylaxis.
b. However, these are relative contraindications to breast-feeding. |
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57. Bipolar II disorder is also known as?
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a. Recurrent major depressive episodes w/hypomania.
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58. Diagnosis of Bipolar II?
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a. Hx of 1 or more major depressive episodes and at least 1 hypomanic episode.
b. Remember: If there has been a full manic episode even in the past, then the diagnosis is not bipolar II but bipolar I. |
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59. Epidemiology of bipolar II?
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a. More prevalent than BP I.
b. Slightly more common in women c. Onset usually before age 30. d. No ethnic differences seen. e. Frequently misdiagnosed as unipolar depression and thereby mistreated. |
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60. Course and prognosis of BP II?
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a. Tends to be chronic, requiring long-term tx.
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