(Iii-Psych) Depression, Bipolar, And Related Disorders

Front 1

Lifetime prevalence of depression:

Back 1

16.20%

Front 2

Which ethnicity has the highest rate of depression?

Back 2

Trick question – All groups have the same prevalence

Front 3

Enzyme that converts Tryptophan into 5-hydroxytryptophan:

Back 3

Tryptophan Hydroxylase

Front 4

Enzyme that converts 5-hydroxytryptophan into 5-Hydroxytryptamine:

Back 4

Amino acid decarboxylase

Front 5

What is the chemical name for serotonin?

Back 5

5-Hydroxytryptamine

Hence 5HT

Front 6

AA precursor of NE?

Back 6

Tyrosine

Front 7

Enzyme that converts Tyrosine to DOPA?

Back 7

Tyrosine hydroxylase

Front 8

Enzyme that converts DOPA to Dopamine?

Back 8

DOPA decarboxylase

Front 9

Enzyme that converts Dopamine to Norepinephrine?

Back 9

Dopamine Beta-hydroxylase

Front 10

Precursor chemical of NE?

Back 10

Dopamine

Front 11

Describe the monoamine hypothesis of antidepressants:

Back 11

Theory that antidepressants increase the amount of serotonin and norepinephrine in the synaptic junction

Front 12

Why is the monoamine hypothesis of antidepressants no longer considered to be the complete answer?

Back 12

The lag time between initial administration of antidepressants and their onset of action.

Also, monoamine depletion in healthy folks does not result in depression.

Front 13

What role does the hippocampus play in depression?

Back 13

Hippocampus is sensitive to cortisol (released during stress)

Cortisol is neurotoxic.... studies show that people with repeated depressive episodes have smaller hippocampi.

Front 14

What is the single greatest risk factor for having a major depressive episode?

Back 14

Having a previous MDE.

Front 15

What are some common risk factors for depression?

Back 15

Having a previous MDE
Family Hx
Female
Youth
Single/divorced/widowed
Poor medical health
Dysthymia
Having subthreshold depressive symptoms (eg sleep problems)

Front 16

What life event in childhood is most frequently associated with depression in adult years?

Back 16

Death of a parent before age 11

Front 17

What stressor is associated with triggering mania?

Back 17

None

Front 18

What did the SADHART trial indicate about treating depression in pts with a myocardial infarction?

Back 18

Not only does it help the mind, but it improves survival

Front 19

What symptoms must be present to diagnose a major depressive episode?

Back 19

Either depressed mood or anhedonia present the majority of time for two consecutive weeks.

Front 20

Criteria for diagnosing depression:

This question is tough!

Back 20

1. Either depressed mood or anhedonia and 4 of SIGECAP

Must be present for 2 weeks.

Symptoms cannot be accounted for by another diagnosis (hypothyroidism) or drugs.

Front 21

How to differentiate between MDE and adjustment disorder:

Back 21

If MDE criteria can be met, that dominates

Otherwise, diagnose adjustment disorder if you cannot meet all the criteria, has not lasted for 2 weeks, and occur within 3 months of a stressor.

Also symptoms do not persist for more than 6 months after termination of the stressor.

Front 22

When does normal bereavement give way to a diagnosis of depression.

Back 22

When symptoms persist beyond 2 months, or symptoms are way out of the ordinary (hallucinations, suicidality, excessive guilt, psychomotor retardation)

Front 23

How to differentiate depression from dysthymic disorder:

Back 23

In dysthymic disorder, pt must have depressed mood for >2 years.

Also, you only need 2 of SIGECAP, not 4 criteria as in depression.

Front 24

What features qualify for atypical depression?

Back 24

Weight gain / increase in appetite
Sleeping more often
Leaden paralysis
Hypersensitivity to rejection

Need 2 of the above criteria

Front 25

What features qualify for postpartum MDE?

Back 25

When the symptoms appear within 4 weeks of childbirt

Front 26

Two groups of people where bipolar disorder tends to be under-diagnosed:

Back 26

Young people
Ethnic groups

Front 27

Do males with bipolar tend to present more with mania or depression first?

Back 27

Males tend to present with mania first.

(opposite for females)

Front 28

Women who have a history of bipolar I tend to present with this postpartum condition:

Back 28

Postpartum psychosis

Note that many women are first diagnosed with bipolar during the postpartum period

Front 29

What percentage of folks with hx of manic episode will go on to develop another manic episode?

Back 29

90.00%

Front 30

Diagnosis criteria for mania:

Back 30

Distinct period of elevated, expansive, irritable mood.

Sx must be present > 1 week unless patient is hospitalized.

Front 31

Medical DDX of mania:

Back 31

Endocrine disorders (hyperthyroid / Cushing's)
Multiple sclerosis
Huntington's
Viral encephalitis
Cerebral tumors
Vitamin deficiencies / overdoses
Carcinoid syndrome

Front 32

Distinguish between bipolar I and bipolar II:

(I'd call this a k-n-o-w)

Back 32

If the patient has had a full-blown manic episode, call it bipolar I
If just hypomania, call it bipolar II.

Front 33

Time duration needed to diagnose hypomania -

Back 33

4 days

Note that you need one week to diagnose mania

Front 34

Describe a bipolar mixed episode:

Back 34

Mood disturbance lasting 1 week that meets criteria for both MDE and manic episodes

Note that in the clinic, many doctors are liberal in meeting this criteria

Front 35

What is the criteria for diagnosing rapid cycling bipolar:

Back 35

Four or more episodes of mood disturbance within the past year.

Front 36

Which risk factors are associated with higher completed suicides?

Back 36

Caucasians
Males
Ages 18-25 or above 65
Co-morbid medical problems
Living alone
Poor social support
Previous attempts

Front 37

What is the most compelling use of ECT?

Back 37

MDE with psychotic features.

Other uses include debilitating MDE with failure to maintain caloric intake, refractory mania
pt has contraindications for using antidepressants

Front 38

What is the primary indication for ECT?

Back 38

Affective illness

Front 39

What are the relative contraindications for ECT?

Back 39

Brain tumor or high risk for stroke

ECT raises intracranial pressure.

Also appropriately manage blood pressure.

Front 40

Is osteoporosis a contraindication for treatment with ECT?

Back 40

No

Front 41

Which medications should be stopped prior to starting ECT?

Back 41

Benzos and anticonvulsants that lower seizure threshold.

Also lithium has been associated with post ictal delirium

Front 42

Which type of electrical current is used in ECT in the USA due to less cognitive impairment:

Back 42

Brief pulse current

Front 43

What is the biggest drawback to ECT?

Back 43

High relapse rate

Front 44

Which type of depression improves with phototherapy:

Back 44

SAD

Front 45

Chances that a twin will have depression if the other one does:

Back 45

70%

Front 46

Frequency of postpartum blues

Back 46

20-40%

Front 47

Percentage of post-stroke patients who report depression

Back 47

35-45%

Front 48

Percent of mothers who develop postpartum depression:

Back 48

10-15%

Front 49

Lifetime risk of suicide in patients who have mood disorders:

Back 49

10-15%