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94 Cards in this Set

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What are the characteristics of Major depressive disorders?
Mood disorder for more than 2 WEEKS!!!

at least 2 Weeks!
Change in the level of functioning (not working, in bed..etc.)
What is anhedonia?
don't enjoy what you use to

shopping, fishing, hunting

absence of pleasure
Why do women have more depression?
1) Hormonal Theory
2) Stress (Child Birth, Child Rearing)
3) Diagnosis Biased (Doctor's miss dianosing it)
What is the age of major depression?
40 year old
Who has higher depression?
no close relatives
divorce
separated
What neurotrasmitters are associated to depression?
NE, Serotonin, Dopamine

low

specially serotonin or NE
Tx for Depression?
combination of Serotonin/NE
or pure Serotonin
What is the metabolite of serotonin?
5-HIAA

5-hydroxy indolacetic acid
Why is 5-HIAA important?
Found decreased levels of 5-HIAA in Suicide

Agression also has low levels of 5-HIAA
Alcohol is involved in what?
Alcohol Disinhibits you

Kill someome
or get killed
Why is alcohol like serotonin?
low levels of serotonin tend to tender patients uninhibited
Is family history involved in Major Depressive Disorder?
Yes
Behavioral Reasons?
Learned helplessness

Give up and prone to depression

Animal/Model

Cat in cage/electrified
So cat wont move
What is characteristic of Major Depression?
Weight Loss
Insomnia
Retardation
What is also associated with Major depression?
Suicide
Diminsh ability to concentrate
Stoop Posture
Barely Audible
Cognitive Impairment?
Serial 7
Serial 3
What lab tests are given to Major Depresion?
Usually for monitoring

1) Dexamethaosone Supression Test
2) Thyrotropin-Releasing Hormonte Test (TRH)
Dexamethasone test is what?
Steroid suppress cortisol


administer dexamethasone
measure cortisol next day
increase in cortisol
TRH test?
measure thyroid stimulation hormone...

normally increase TSH

give TRH
see blunted response
low TSH
Major depression mimics what other condition?
hypothyroidism

TSH low
Major Depressive Disorder with Psychotic features?
Worst than Major Depression

meets criteria for Major Depression
but also psychotic disorders
hearing dead sister's voice
Major depression with atypical features?
increase weight
increase appetite
increase sleep

gain 40 pounds
sleepin 14 hours a day
eats 10 times a day
Important to ask about suicide?
yes
to make sure they are thinking about it

or immediately admit or hospitalization
Tx to increase NE, Serotonin, DOPA?
SSRI (Ser only)

TCA (Ser+NE)

MAOI (all)
Which is best?
SSRI

cleanest
least S/E
Compliace increases
Is ECT used?
YES

Electro-Convulsive Therapy
Who is Tx w/ ECT?
Patient w/ suicide tendencies
Medication and Therapy is better than medication alone?
or only therapy?
Both is better

Meds and Therapy
ECT S/E?
Intracranial Pressure increases

safe for pregnancy
safe for patient w/ MI
Differential Diagnosis for Major Depressive Dsor?
hypothyroidism

parkinson

dementia

medication (like beta-blockers)

Tumors (CT head not routine)

CVA (right side causes apathy)


Cocaine Withdrawal (suicidal)
cocaine crash no energy, apetite disturbances

Grief
Bipolar disorder is seen at what age?
Usually peak at 30
When are first episodes seen?
College
What is the race biased?
African American Psychotic

White Mood Dz

Mood gender (female)
Is there genetic linkage?
The highest genetic component

Both parents (then really high 50-75% chance)
Manic have a coexisting drug dependence?
They use alcohol (self-medicate) to calm down when they are manic
What are the symtoms of mania?
Euphoria

Smartest, grandiosity, distracted easily

involved in many activities

pressured speech

less sleep (insomnia)

libido goes up
What is pressured speech?
fast speech
flight of ideas
Libido in patients w/ depression?
decreased
What do you find in signs and symptoms of bipolar dz?
pressured speech
psychomotor agitation
Tx of bipolar?
lithium
carbamazepine

(Also benzodiazepines
anti-psychotics)
What works faster mood stabilizers or anti-psychotics?
Anti-psychotics in a few days... so in E.R. start the patient w/ anti-psychotics and then go into mood stabilizers in 14 days

Tx w/ individualized psychotherapy
Do Bipolar pat. has psychotic disorders?
yes
schizophrenia could be perceived
What other disorders can mimmick bipolar dz?
CNS infection
tumors
hyperthyroidism
Medications
What medications can mimmick bipolar dz?
Amphetamines
Stimulants (Caffeine)
How much time do you look for in Dysthymnic Dz?
2 years is key!!!!
Dysthymia is called what?
Mild form of Major Depression
What sex if MC for dysthymia?
Females

young (<64), low income

anxiety
substance abuse present
What personality is involved w/ dysthymia?
borderline personality
Do you usually hospitalize dysthymia pat?
not usually
What tx is given?
Same as major depression

SSRI
MAOI
NE
What do you give if you can give only one drug for Dysthymia?
SSRI is best

less S/E
What is cyclothymic Dsord? Key... is time?
2 years

periods of hypomanic/depressed mood
Do you hospitalize cyclothymic disorder?
not really

if you think of hospitalizing then it is Mania
Hypomania?
You feel up
buying a lot of things

but still basically functioning

sex drive is up
What is bipolar I?
Mania and Major Depression
Bipolar II?
Hypomania and Major Depression
Key for Mania?
tapping on strangers for sex
Cyclothymia is?
Minor Bipolar II Disorder
Tx for cyclothemia?
lithium
carbamazepine
valproic acid
DOC for cyclothemia?
Mood stabilizers
Diff Diag for cyclothemia?
seizures
drugs
What personality disorder is similar to cyclothemia?
Borderline Personality
Patient w/ every winter get depressed. Diagnostic?
Cyclic pattern
Seasonal Affective Disorder
What is decreased in seasonal affective disorder?
melatonin
Tx for Seasonal Affective Disorder?
Phototherapy
Sleep Deprivation
What do you treat first? Mood disorder or anti-psychotic symptoms?
First treat the worst

Psychotic Symptoms
If you have mania and depression? What tx first?
Tx give mania first
Tx for Antipsychotic + Mood disorder?
Risperidone

the best is both Risperidone and Fluoxetine
What's another name for Grief?
Bereavement


so if you see two words in the same answer choices don't pick it
What is another name for depression?
pathological grief
Normal Grief is how long?
< 1 year
What if you have grief for more than a year?
Depression

Need to tx it won't go away
What is characteritic of symptoms of Grief?
waxing and waning
Major depression involves what symptoms?
Symptoms do not get better
affects level of fx
don't get out of bed
don't pay bill
children taken care by Babysitter
Suicide in grief or depression?
depression

thinking of doing it
How long does it takes for grief to go back to normal?
Usually several months (2)
How long does postpartum blues occur?
lasts up to 2 weeks
What is more stressfull? 1st 2nd or 3rd?
1st baby

so the worst prognosis from 1st baby on
Pospartum Psychosis occurs with 1st baby
When does baby blues start? Postpartum blues...
at birth
When does postpartum depression or psychosis begin?
1 month after birth
How long do pospartum depression last? Psychosis?
they may continue

so Tx is needed
Does mother care for baby in postpartum blues?
yes
Which mother tend to kill their babies?
Postpartum Psychosis

more than Postpartum Depression
Why do postpartum psychosis kill babies?
because of their psychosis
they have an evil eye
he is the anti-christ
I see horns growing on them
the baby is trying to control my mind
Why do Postpartum depression women kill their children?
they feel pain suffering
I don't want my baby to suffer

this is a bad world

they kill their children because they want to limit their children's suffering
Tx of postpartum blues?
no treatment
What is the Tx for postpartum depression?
SSRIs

Antidepressants
What are the Tx for Postpartum Psychosis?
Antipsychotics

Mood stabilizers

antidepressants
Stages of Death and Dying?
Stage I
Shock and Denial

It's not possible
Stages of Death and Dying?
Stage II?
Anger

Why me?
Stages of Death and Dying?
Stage III?
Bargaining

Night before test going to pray
Stages of Death and Dying?
Stage IV?
Depression
Stages of Death and Dying?
Stage V?
Acceptance
Do the stages of death and dying are in what order?
Not in order

It can be any stage, in any order