The Mind, Mood Disorders

Front 1

how long do symptoms of depression have to last to be considered major depressive disorder?

Back 1

2 weeks or longer

Front 2

when a patient presents with anxiety and/or somatic complaints (pain, nausia, etc.) what type of depression might they be suffering from?

Back 2

masked depression

Front 3

when is suicide most likely in a depressed patient?

Back 3

in severe cases where the patient begins to lose touch with reality, experiences delusions, and can have hallucinations

Front 4

who is more likely to become depressed? Men or women?

Back 4

women are 2x more likely to become depressed (20-25%) as compared to men (8-12%)

Front 5

what age group is most likely to get depression?

Back 5

40's

Front 6

what is the time frame of the untreated major depressive episode?

Back 6

6-13 months

Front 7

when is risk of reccurrence greatest for depression?

Back 7

within 1 year of the episode

Front 8

what are the chances a patient with one depressive episode will have another?

Back 8

50%

Front 9

what percentage of depressed patients think about attempting suicide?

Back 9

66%

Front 10

what percentage of depressed patients actually complete suicide?

Back 10

10-15%

Front 11

when dealing with a depressed patient what is the single most important question to ask?

Back 11

are you thinking about suicide

Front 12

who is most likely to commit suicide?

Back 12

elderly males

Front 13

when in a depressed patient most likely to commit suicide?

Back 13

when they first start getting better, they have more energy and drive, but still the depressed feelings which allows them to actually follow through with ideation

Front 14

what percentage of patients that complain of 9 or more physical symptoms have depression?

Back 14

60%

Front 15

an elderly person in a nursing home who appears cognitively impaired may not be suffering from dementia, but actually this type of depression?

Back 15

pseudodementia

Front 16

Name the type of depression?
-anhedonia and/or loss of
-decreased reactivity to pleasurable stimuli
-distinct quality of depressed mood
-depression worse in a.m.
-early morning awakening
-psychomotor agitation or retardation
-significant weight loss
-excessive guilt

Back 16

Depression with melancholic features

Front 17

Name the type of depression?
-Preserved mood reactivity
-Reversed neurovegetative signs
-Leaden paralysis
-Rejection sensitivity

Back 17

Depression with atypical features specifier

Front 18

Name the type of depression?
-When severe, patient can experience psychosis
-Medical emergency if experiencing command hallucinations, or if not attending to basic human needs

Back 18

Depression with psychotic features specifier

Front 19

Name the type of depression?
-Stupor
-Mute/Very Negative
-Lays around hardly moving

Back 19

Depression with catatonic features specifier

Front 20

Name the type of depression?
-Onset of episode within four weeks parturition
-Medical emergency in severe cases, especially if psychotic
-Examine with the baby, and other family members

Back 20

Depression with postpartum onset specifier

Front 21

Name the type of depression?
-Recurrent episodes of depression with a pattern on onset at same time of year
-Full remissions occur at a characteristic time of year

Back 21

Depression with seasonal pattern specifier

Front 22

Name the type of depression?
-Symptoms persist for at least 2 years

Back 22

Depression with chronic specifier

Front 23

what percentage of women experience post-partum depression?

Back 23

10%

Front 24

what is a big difference between the typical "baby blues" that a lot of pregnant women experience and the true post-partum depression?

Back 24

women experiencing the baby blues do not contimplate suicide

Front 25

whats the "big picture" difference between hypermanic and hypomanic states?

Back 25

both present with similar symptoms, but hypomanic is simply a lesser degree than hypermanic meaning hospitalization or interference with work is unlikely

Front 26

what are the 4 types of bipolar disorders?

Back 26

1. Type I
2. Type II
3. Mixed
4. Rapid Cycle

Front 27

which type of bipolar disorder is this?

Manic episode with or without a history of depressive episodes

Back 27

type I

Front 28

which type of bipolar disorder is this?

Hypomanic episodes with history of major depressive episodes

Back 28

type II

Front 29

which type of bipolar disorder is this?

Features of both depression and mania or hypomania present at the same time

Back 29

mixed

Front 30

which type of bipolar disorder is this?

Four or more mood episodes are present within a year

More common in females

Back 30

rapid cycling

Front 31

What psychiatric disorder does this describe?
-Little sleep
-Grandiosity
-Pressured speech
-Physical restlessness
-Half present with psychotic symptoms

Back 31

Bipolar disorder

Front 32

how much time must elapse for a diagnosis of a manic episode?

Back 32

1 week

Front 33

how much time must elapse for a diagnosis of a hypomanic episode?

Back 33

4 days

Front 34

how much time must elapse with both major depressive and manic episodes occuring everyday for mixed bipolar disorder to be diagnosed?

Back 34

1 week

Front 35

what is the median age of onset for bipolar disorder?

Back 35

18-21

Front 36

how long will an untreated bipolar episode last?

Back 36

3 months

Front 37

what is the recurrence percentage with bipolar disorder?

Back 37

90%

Front 38

why can bipolar disorder be very hard to diagnose?

Back 38

long lag time between symptoms onset and treatment/hospitalization (5-10)

Front 39

what systemic factor can lead to bipolar disorder?

Back 39

hyperthyroidism

Front 40

what specific drug class is associated with bipolar disorder?

Back 40

corticosteroids

Front 41

how long does it take to make a diagnosis of dysthymic disorder?

Back 41

2 years of depressed mood

Front 42

who is affected more by bipolar disorder, men or women?

Back 42

both are equally represented

Front 43

who is more likely to be affected by dysthymic disorder, men or women?

Back 43

women

Front 44

what is the term used to describe the 40% of MDD patients who also could be classified at dysthymic?

Back 44

double depressed

Front 45

what psychiatric disorder does this describe?

A chronic mood disorder of at least two years duration with periods of hypomania and depression (that does not meet criteria for major depression) - with no symptom free period of more than two months.

Back 45

Cyclothymic Disorder (mild form of bipolar type II)

Front 46

30% of patients with Cyclothymic Disorder have a family history of what other psychiatric disorder?

Back 46

bipolar type I

Front 47

what drug type is most effective in patients with Cyclothymic Disorder?

Back 47

antimanic

Front 48

what psychiatric disorder does this describe?

A reaction (depression) to an identifiable psychosocial stressor within 3 previous months, resulting in impairment of occupational or social functioning

Back 48

Adjustment Disorder with Depressed Mood

Front 49

How long do symptoms of Adjustment Disorder with Depressed Mood persist?

Back 49

Symptoms do not persist beyond 6 months

Front 50

while bereavement can present very similarly to a major depressive episode, what two key features of major depression are lacking in bereavement?

Back 50

1. guilt or feelings of worthlessness
2. Suicidal thoughts

Front 51

normal bereavement with severe symptoms should not last longer than what time frame?

Back 51

2 months

Front 52

These symptoms describe which psychiatric disorder?

-Depressed mood
-Anxiety or tension
-Affective lability
-Decreased interest in usual activities
-Difficulty concentrating
-Lethargy
-Appetite changes
-Hypersomnia or insomnia
-Feeling of being overwhelmed
-Physical symptoms

Back 52

Premenstrual Dysphoric Disorder

Front 53

describe when the symptoms of Premenstrual Dysphoric Disorder develope?

Back 53

the begin before menses, wane during menses, and are absent post-menses

Front 54

how long does it take to confirm Premenstrual Dysphoric Disorder diagnosis?

Back 54

1 year of consistent episodes

Front 55

how can PMDD be differentiated from PMS symptoms?

Back 55

PMDD symptoms are much more severe and often can interfere with baseline functioning and relationships

Front 56

what type of drugs are most effective in treating PMDD resulting in a reduction of symptoms in 60% of cases?

Back 56

SSRI's

Front 57

give the percentage likelyhood for developing major depressive disorder for

1. Monozygotic twins
2. Dizygotic twins
3. First-degree relatives

Back 57

1. 50%
2. 15-25%
3. 10-20%

Front 58

loosing a parent when below the age of ___ is a predisposing factor for depression?

Back 58

11

Front 59

what are the three NT systems implicated in the cause of major depressive disorder?

Back 59

1. Norepinephrine
2. Serotonin
3. Dopamine

Front 60

Alertness, Concentration, and Energy are all regulated by what NT?

Back 60

Norepinephrine

Front 61

Obsessions, compulsions, and memory are all regulated by what NT?

Back 61

Serotonin

Front 62

Pleasure, Reward, Motivation/Drive are all regulated by what NT?

Back 62

Dopamine

Front 63

Appetite, Sex, and Agression are all regulated by what NT?

Back 63

Serotonin and Dopamine

Front 64

Anxiety, Impulse, and irritability are all regulated by what NT?

Back 64

Serotonin and Norepinephrine

Front 65

Attention is regulated by what NT?

Back 65

Norepinephrine and Dopamine

Front 66

is problems with the serotonin system more likely a dysregulation of receptors in post-synaptic membrane or a depletion of the serotonin NT (unknown cause)?

Back 66

dysregulation of receptors

Front 67

where might grey matter be lacking in the depressed brain?

Back 67

subgenual prefrontal cortex

Front 68

to what brain area is there 50% increased blood flow in the depressed brain?

Back 68

the amygdala

Front 69

describe how the use of cellular mechanisms is currently being researched to improve depression?

Back 69

-Increased intersynaptic levels of NT's
-Increased CREB expression
-Increased BDNF
-Regulate neurogenesis, thus structural brain changes

Front 70

describe the likelyhood of this person developing bipolar if...
1. Monozygotic twin has it
2. Dizygotic twin has it
3. First degree relative has it

Back 70

1. 80%
2. 10-14%
3. 4-18 times normal population

Front 71

what is the single most effective treatment for major depression?

Back 71

electroconvulsive therapy

Front 72

what patients will most likely require electroconvulsive therapy?

Back 72

extremely psychotic or suicidal patients

Front 73

what are the 5 main antidepressent medications?

Back 73

1. Selective serotonin re-uptake inhibitors
2. Dual serotonin and norepinephrine reuptake inhibitors
3. Tricyclic and tetracyclic antidepressants
4. Monoamine oxidase inhibitors
5. Sympathomimetics

Front 74

how long does medication need to be at therapeutic levels for its effects to become evident?

Back 74

4 weeks

Front 75

after remission of symptoms how long should patients continue on there antidepressent medication?

Back 75

1 year

Front 76

why is it important to perscribe minimum quantities of an antidepressent medication?

Back 76

suicidal patients may use medication to OD (esp. tricyclics)

Front 77

what are the 5 SRI's we have to know?

Back 77

1. flouxetine
2. sertraline
3. paroxetine
4. fluvoxamine
5. citalopram

Front 78

what drug does this describe?

is a mildly stimulating antidepressant and is particularly useful in patients who have had sexual impairment from other drugs. It is unique in having effects on dopamine neurotransmission. There is a very low incidence of sexual dysfunction, and is weight neutral.

Back 78

Bupropion

Front 79

what drug does this describe?

is a selective inhibitor of serotonin in higher doses and affects norepinephrine reuptake. Insomnia, nervousness and nausea are common side effects. Diastolic blood pressure can be elevated, thus requiring the monitoring of blood pressure

Back 79

Venlafaxine

Front 80

what drug does this describe?

is an alpha-2adrenegic antagonist that enhances noradrenergic neurotransmission. Additionally, increases transmission of serotonin and is a 5HT2A and 5HT3 blocker. Marked sedation and weight gain (antihistamine effects) are common, usually decreasing after the first weeks of treatment and at higher doses, which may provide more activation due to greater noradrenergic enhancement. There is a low incidence of sexual dysfunction.

Back 80

Mirtazapine

Front 81

phenelzine and tranylcypromine are examples of what type of drug?

Back 81

MAO inhibitors

Front 82

what are three special considerations to make when using MAOI's?

Back 82

1. Tyramine free diet
2. Orthostatic hypotension is common
3. Coadministration of epinephrine, ephedrine, meperidine, and SSRIs can be life threatening

Front 83

what psychotherapy does this describe?

The main goal is to link the patient’s past experience of loss or guilt to current life conflicts that recreate earlier feelings of abandonment or unworthiness. The therapist examines the patient’s personality and life-long habits of thought, feelings or behaviors.

Back 83

Psychodynamic Psychotherapy

Front 84

what psychotherapy does this describe?

Based on the theory that negative perceptions of oneself and the environment causes depression. The therapist teaches the patient how to systematically monitor the thoughts that accompany depressed feelings, examining automatic thoughts. The goal is to develop new cognitive strategies to alter the negative perception of self.

Back 84

Cognitive Behavioral Therapy

Front 85

what psychotherapy does this describe?

The premise is that those patients’ painful social experiences and troubled interpersonal relationships contribute to depression. The goal is to develop better strategies for coping effectively with interpersonal problems.

Back 85

Interpersonal Psychotherapy

Front 86

which antidepressent drug should not be used in women of child-bearing age?

Back 86

valproic acid

Front 87

which drug has the best efficacy in treating fast cycling bipolar disorder?

Back 87

valproic acid

Front 88

what is the safest treatment for a pregnant woman for major depression?

Back 88

electroconvulsant therapy

Front 89

What disorder does this represent?

Back 89

Bipolar Disorder Type I

Front 90

what psychiatric disorder does this represent?

Back 90

bipolar type II

Front 91

what psychiatric disorder does this represent?

Back 91

Cyclothymic Disorder

Front 92

What psychiatric disorder does this represent?

Back 92

Dysthymic Disorder

Front 93

What psychiatric disorder does this represent?

Back 93

Major Depression Disorder