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49 Cards in this Set
- Front
- Back
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external expression of present emotional content
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affect
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sustained internal emotional state of a person
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mood
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How is major depressive disorder characterized?
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one or more major depressive episodes
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How is dysthmymic disorder characterized?
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At least 2 years (1 year in kids) of depressed mood for more days than not, accompanied by additional depressive symptoms but not meeting critera for depressive episode. Mild, chronic form of depression.
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What is Bipolar I?
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One or more manic of mixed episodes usually accompanied by major depressive episodes (major depressive episode not required)
MORE MANIC |
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What is Bipolar II?
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One of more major depressive episodes accompanied by at least one hypomanic episode (a minor manic episode)
MORE DEPRESSED |
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WHat is cyclothymic disorder?
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At least 2 years of numerous periods of hypomanic symptoms that don't meet criteria for a manic episode and numerous periods of depressive symptoms that don't meet criteria for a major depressive episode.
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Frequency of MDD in general, and in women
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15%; 25% in women
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Frequency of Bipolar I disorder
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about 1%
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How do the following differ in occurrence among genders?
A) MDD B) Bipolar I |
A) 2x more in women
B) equally prevalent |
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Average age of onset for bipolar I
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30 years
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Average age of onset for MDD
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40 years
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How do SES factors play in mood disorders?
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No difference in MDD, but there is an INCREASE in Bipolar I for upper SES.
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two NTs most implicated in pathophys of mood disorders
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NE and 5HT
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most compelling data indicating direct role for noradrenergic system in depression
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correlation between down regulation of β adrenergic receptors and clinical antidepressant response.
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What hormone is oversecreted in depression?
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cortisol
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What are common polysomnogram abnormalities in depressed patients?
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Delayed sleep onset, shortened REM latency, increased length of first REM, abnormal delta sleep.
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What hormones are undersecreted in depression?
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GH release in sleep. Also a blunted response of TSH to infusion of TRH
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life event most associated with later development of depression
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loss of a parent before age 11
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environmental stressor most associated with onset of episode of depression
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loss of a spouse
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ego ideal: defn
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the inner image of oneself as one wants to become
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How many symptoms of MDD must be present in order to diagnose?
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5 of 9
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What are the symptoms?
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SIG E CAPS
1) Change in Sleep 2) Loss of Interest 3) feelings of Guilt 4) feeling depressed 5) weight change 6) change in movement (psychomotor agitation or depression) 7) fatigue, loss of energy 8) diminished ability to think and concentrate 9) recurrent thoughts of death/suicide |
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What does the presence of psychotic depressive features portends?
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reflects severe disease. poor prognostic indicator.
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Criteria to dx dysthmic disorder
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1) Presence of two of more of the following:
poor appetite or overeating; insomnia or hypersomnia; low energy or fatigue; low self-esteem; poor concentration or difficulty making decisions; feeligns of hopelessness 2) Depressed mood most of the day more days than not for at least two years. |
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How long does a manic episode have to last in order to meet criteria?
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at least 1 week (or any duration if hospitalized)
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How many symptoms must be present for a manic episode diagnosis?
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3 of 7 (4 is the mood is only irritable, not elevated)
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What is a hypomanic episode?
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distinct period of persistently elevated or irritable mood lasting throughout four days, clearly different from usual nondepressed mood
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How long must a hypomanic episode last?
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at least 4 days
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What si double depression?
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A MDD imposed on dysthymic disorder.
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Most common neurological problems manifesting depressive symptoms
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1) PD
2) Dementia 3) Epilepsy 4) CVD 5) Tumors |
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What tumors may mimic depression?
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particularly pancreatic and other abdominal tumors.
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Most common neurological problems associated with manic symptoms
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epilepsy, huntington's disease
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Hwo does bipolar I usually start?
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With depression and is recurrent. But 10-20% of patients ONLY have manic episodes.
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How long does an untreated episode of
A) Mania B) Depression usually last? |
A) 3 months
B) 1 year |
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Which patients have best prognosis?
A) Bipolar I B) MDD |
B
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About 1/3 of cyclothymic patients develop what major mood disorder?
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Usually bipolar II
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What are clear indications for hospitalization?
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1) Need for dx procedures
2) Risk of suicide or homicide 3) Grossly reduced ability to function in community |
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What is most effective tx for mood disorders?
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combo of pharmacotherapy with psychotherapy
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How long should antidepressant treatment be maintained?
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At least 6 months or the length of a previous episode, whichever is greater.
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First line tx of drugs for Bipolar I
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Lithium
Carbamazepine Valproate |
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T/F use of antidepressants in bipolar I is associated with rapid cycling.
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T
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What is first line of treatment for dysthymic disorder?
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Antidepressants, MAOIs or SSRIs
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What is first line of treatment for cyclothymic disorder?
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Antimanic drugs, same as bipolar I
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What is treatment for bipolar II disorder?
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same as bipolar I
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Most common indication for ECT
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MDD
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When should ECT be considered?
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Failed medication trial
Elderly Severe or psychotic sx Acutely suicidal/homicidal Marked symptoms of agitation or stupor |
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T/F ECT is at least to and perhaps superior to Lithium in tx of acute mania.
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T
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What drugs are given to minimize oral/respiratory secretions?
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mucarinic
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