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Psych 3 Other Mood D
Other Mood Disorders: Bipolar and Anxiety
| Question | Answer |
|---|---|
| CT scan of the head shows a crescent-shaped lesion. What event most likely caused this lesion? | Rupture of bridging vv (subdural hematoma) |
| What is the initial radio study in a pt with TIA/Stroke sx? What radio studies need to be performed later to evaluate the underlying cause of the TIA/stroke? | INitially get a CT head withOUT contrast. Later get MRI, carotid doppler, echo, and MRA or CT angio. |
| What are 3 important distinctions of dysthymic disorder that distinguish it from MDD in making a dx? | TIme: dysthymia is >2yrs No suicidality No h/o major depressive disorder (MDD) |
| How is mild depression managed in pts with bipolar disorders? | Lithium or lamotrigine |
| Lamotrigine has significant interactions with which two anticonvulsants? | Valproate and carbamazepine |
| How is moderate depression managed in pts with bipolar disorder? | Can add a second mood stabilizer like lamotrigine or atypical antipsychotic (olanzapine, quetiapine, or ripseridone) |
| How is severe depression managed in pts with bipolar? | Consider ECT |
| Name 4 potential side effects of lithium use in the tx of bipolar disorder? | 1. CNS (depression, tremor) 2. Thyroid changes (hyper or hypothyroidism, or euthyroid goiter) 3. Nephrogenic DI 4. GI sx (n/v, diarrhea, wt gain) |
| What is the tx for nephrogenic diabetes insipidus caused by lithium toxicity? | HTZ and amiloride (closes Na channels rendering lithium ineffective) |
| What are 2 alternative drugs to treat bipolar disorder in a pt with renal failure? | Carbamazepine or valproic acid (metab by liver) |
| What is the most problematic congenital malformation assoc'd with maternal lithium use? | Ebstein's anomaly |
| What is an important difference between a manic episode and a hypomanic episode? | Hypomanic does not have significant impairment of functioning. |
| How is acute stress disorder different from pTSD? | ASD is w/in first 30d. PTSD is longer than 30days. |
| First line therapy for PTSD? | SSRIs |
| What drugs can be used to imporve impulsive behavior, arousal, and flashbacks in pts with PTSD? | Mood stabliizers like carbamazepine or valproate |
| What drug can improve nightmares and sleep disturbances in pts with PTSD? | PRAzosin, an alpha blocker (off-label use). I PRA I can sleep tonight. |
| What are the first and second line treatments of choices for OCDs. | SSRIs (first line). Clomipramine (second line). |
| What are the tx options for GAD? | SSRIs, buspirone, venlafaxine (SNRIs), and beta blockers |
| HOw does adjustment disorder with depressed mood differ from major depressive disorder? | Adjustment d/o begins with 3 mos of stressor and resolves within 6mos of stressor being removed; does NOT meet criteria for MDD. |
| A bipolar pt who is treated with a mood stabilizer has concurrent depression. What should you use to treat his depression? | COnsider atypical antipsychotics. |
| Cyclic depression and h/o at least 1 episode of mania that significantly impairs pt's ability to function | Bipolar I |
| Cyclic depression and h/o at least 1 episode of hypomania where pt's ability to f'n is not significantly compromised | Bipolar II |
| What is the difference in length of irritability/elation between a manic episode and a hypomanic episode? | Manic is >1wk. Hypomanic is >3d. |
| What is DIGFAST? | Distractibility, Insomnia, Grandiosity, Flight of Ideas, Activity (increase in goal-oriented), Speech (pressured), Taking risks |
| What is the drug of choice in pts with rapid cycling bipolar d/o? | Carbamazepine and valproic acid are more effective than lithium in this case. |
| Why is a thorough H&P needed before prescribing antidepressants to a pt suspected of having MDD? | B/c if they are bipolar and not on mood stabilizers, antidepressants can induce a manic episode. |
| What is the difference between adjustment disorder and bereavement? | In bereavement the ability to function is not impaired. In adjustment disorder, their ability to f'n is impaired. |
| What medical condition is associated with panic disorder? | Mitral valve prolapse |
| Name 4 comorbid psych conditions assoc'd with panic disorder. | 1. Depression 2. Agoraphobia 3. GAD 4. Substance abuse |
| Recurrent panic attacks plus a persistent fear that attacks will happen again | Panic disorder |
| First line tx for panic disorder? Second line? | SSRIs are first line for long-term therapy. TCAs are second line. Benzos for break-thru attacks. |
| Tx for specific phobia? | Psychotherapy |
| Tx options for social phobia? | Psychotherapy, beta blockers, SSRIs, Benzos (acute) |
| Pts with OCD are at a higher risk for what disorder? | Tic disorders |
| Tx for OCD? | Psychotherapy and SSRIs or clomipramine |
| Tx for PTSD | SSRIs, MAOIs, or mood stabilizers. Also psychotherapy. |
| Time frame for acute vs chronic PTSD? | Acute= >1mo Chronic= >3mos |
| Time frame for GAD? | At lease 6 months of generalized anxiety that occurs more days than not |
| Benzo antagonist used to reverse the effects of an overdose. | Flumazenil |
Created by:
sarah3148
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