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29 Cards in this Set

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What is this?



  • Symptoms of major depression
  • History of symptoms of major depression

Major Depressive Disorder, Recurrent

What are the first-line drugs for MDD, recurrent?

  • SSRIs

  • SNRIs

  • Buproprion

  • Mirtazapine

As a general rule, what drug should a patient take if they've already had a successful remission of a previous MDD episode?

The same one that caused remission in the previous episode.

What is the basic diagnostic criteria for MDD, Recurrent

Two or more episodes of major depression.




Five or more of the following symptoms for most of the time for at least 2 weeks.



  • Depressed Mood
  • Anhedonia
  • Significant Weight change or change in appetite
  • Insomnia or Hypersomnia
  • Psychomotor Agitation or Retardation
  • Fatigue or Loss of energy
  • Feelings of worthlessness or excessive guilt.
  • Decreased Ability to concentrate or indecisiveness
  • Thoughts of death or suicidal ideation



There has never been a manic, hypomanic, or mixed episode.




Symptoms cause significant distress or impairment in functioning.





What are the additional diagnostic criteria for MDD, Recurrent?


  • Symptoms are not caused by substance abuse, medication, or a medical condition (hypothyroidism)
  • Symptoms are not better accounted for by schizophrenia, schizoaffective disorder, delusional disorder, or a psychotic disorder not otherwise specified.
  • Symptoms are not better accounted for by bereavement.

1) Which drug class helps with Depression and GAD?




2) What are the conditions treated by Bupropion?




3) Which SNRI can also be used in diabetic neuropathy?

1) SNRIs



2) Depression, Anxiety associated with Depression, Smoking



3) Duloxetine (Cymbalta)

1) Which first-line depression drug is a tetracyclic?




2) What disorders can it help treat?

1) Mirtazapine (Remeron)




2) Depression, Anxiety, it also helps to induce sleep.

What's SIGECAPS




Which must be present to diagnose MDD?


  • Sleep Disorders
  • Interest (Anhedonia)
  • Guilt, Worthlessness
  • Energy (fatigue)
  • Concentration
  • Appetite
  • Psychomotor agitation or retardation
  • Suicidal Thoughts



Anhedonia OR Depressed Mood

1) What is the medical condition differential for MDD?




2) What is the substance differential for MDD?




3) What is the psychiatric illness differential for MDD?

1) Hypothyroidism, MS




2) Antihypertensives, alcohol, steroids, cocaine withdrawal




3) Bipolar Disorder (depressed)

What are the risk factors for suicide? (5)

  • Male
  • Substance Abuse
  • Prior attempts
  • Older Age
  • Family History of suicide

1) What is the difference between postpartum blues and postpartum depression?




2) Which one is treated and how?




3) What is a complication of untreated Postpartum Depression? How is it treated?

1) PP Blues only lasts for several days to a week and the symptoms are less severe.




2) PP Depression is treated similarly to depression




3) Psychosis. Treat with antipsychotics and think of admission.

When is ECT indicated for a MDD episode?

MDD with psychotic features or where rapid response is required.

How long should depression be pharmacologically treated?

6-9 months

1) Which SSRI side effects start early?




2) Which SSRI side effects only occur later in treatment?

1) Activation, GI symptoms, Tremor




2) Sexual Dysfunction, it doesn't occur for weeks or months.

How does Bipolar Disorder in a child present?

More with a mixed or dysphoric picture characterized with short periods of intense mood lability and irritability.

What is the fist line treatment for Bipolar of no psychosis is present?




What is the tradtional recommendation?

Monotherapy with a traditional mood stabilizer like lithium, divalproex, and carbamazepine OR an atypical antipsychotic like olanzapine, quetiapine, or resperidone.




Lithium or Divalproex

How often do episodes have to occur to diagnose rapid-cycling bipolar disorder?

4 episodes of both depression and mania/hypomania in a year.

What is this?


- Patient with increased stress after job that requires more interpersonal contact.


- MSE is normal except for having constricted emotional range.


- Lack of delusions or hallucinations

Schizoid Personality Disorder

Do patients with ego-syntonic personality disorders tend to seek treatment?

No. The best strategy for treatment will be best if it's more lifestyle changes.

What is the difference between ego-syntonic and ego-dystonic?

Ego-dystonic personality disorders tend to cause distress, be inconsistent with the patient, and are objectionable to the patient.



Ego-syntonic is acceptable, unobjectionable, and consistent with self to the patient.

What is the difference between alloplastic defenses and autoplastic defenses?

Alloplastic defenses are reactions to stress by changing the environment (eg. manipulation of others)




Autoplastic defenses are reactions to stress by changing their internal psychological processes (denial)

Cluster A Personality Disorders?

Odd, Bizarre, eccentric




Schizoid


Schizotypal


Paranoid

Cluster B





Anti-social


Narcissistic


Histrionic


Borderline

Cluster C

Obsessive Compulsive PD


Avoidant PD


Dependent

What is Schizoid?


  • Loner
  • Detached
  • Flat affect
  • Restricted Emotions
  • Generally indifferent to interpersonal relationships outside of immediate family.

Schizotypal?

  • Odd
  • Eccentric
  • Magical Thinking
  • Paranoid
  • Not psychotic
  • Typical defense: Projection, regression, fantasy

Paranoid?

  • Distrustful and Suspicious
  • Constricted Affect
  • Typical Defense: Projection

Histrionic


What cluster? What is it?

Cluster B



  • Attention seeking
  • Excessively emotional
  • Reaction Formation defense

Continue Page 86

Continue Page 86