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Mood Disorders
| Question | Answer |
|---|---|
| What controls mood? | Neurotransmitters - MAO System |
| What are the most common neurotransmitters that control mood within the MAO System? | 1) Norepinephrine 2) Serotonin and GABA 3) Dopamine |
| What are the "feel good" neurotransmitters? | Serotonin and GABA |
| What are the neurotransmitters that relate to concentration? | Norepinephrine and Dopamine |
| What are neurotransmitters? | They are chemical messengers that transmit messages between neurons in the synaptic cleft |
| What are the characteristics of the Serotonin (5-HT) and GABA neurotransmitters? | Well-being, Calmness, decreases impulsivity, decreases aggression, sleep, decreases sex drive, increases appetite |
| What are the characteristics of the Norepinephrine and Dopamine neurotransmitters? | Enhances concentration, ambition, and productivity |
| What is the most common psychiatric disorder? | Depression |
| Why do life's events precipitate this? | Most have a genetic predisposition, some may not have adequate neurotransmitters or ones not working as well |
| What can increase the production of neurotransmitters? | Exercise |
| What is the ability of a test to rule a problem out? | Specificity |
| Sensitivity | |
| What are 5 screening tools used for mood disorders? | 1) PHQ-2 2)PHQ-9 3) Beck's Depression Inventory 4) WHO-5 5) DSM 5 |
| What are the 2 geriatric screening tools for mood disorders? | 1) Geriatric Depression Scale (GDS) 2) PHQ-9 |
| What symptoms are associated with geriatric depression? | Impaired memory, low energy (anergy), inability to concentrate, socially withdrawn, and reduced appetite |
| If a patient has a positive depression screening, what should be done next? | Draw labs! |
| What are the indications to draw labs in a patient with a positive depression screen? | 1) First episode of depression 2) Precipitant unclear 3) Severe depression |
| What labs do you consider for a patient with a positive depression screen? | CBC, Chemistry panel, TSH, Glucose (FBS), B12, folate (older adults), UPT, UDS |
| What is the safest medication for women who are pregnant and diagnosed with depression? | Sertraline (Zoloft) |
| What are the 8 symptoms along with depressed mood to help diagnose depression in a patient? | "SIG E CAPS" 1) Sleep issues (too much/little) 2) Interests (loss=anhedonia) 3) Guilt(whorthlessness) 4) Energy 5) Concentration difficulties 6) Appetite 7) Psychomotor agitation or irritation 8) Suicidality |
| What would be a diagnosis of a patient with 5 or more symptoms of depression nearly every day for 2 or more weeks? | Major Depressive Disorder (MDD) |
| What would be a diagnosis of a patient with 2-4 symptoms of depression present most of the day but not present every day? | Mild to Moderate depressive disorder |
| What can be the presenting symptom of bipolar disorder? | Depression |
| Why do you ALWAYS screen for bipolar before starting SSRIs? | SSRIs increase manic episodes in patients with bipolar disorder |
| What is the average time for a patient to be diagnosed with bipolar disorder? | 7-10 years |
| What are the most commonly used screening tools for bipolar? | 1) Structured Clinical Interview for DSM-IV (SCID) 2) Schedule for Affective Disorders and Schizophrenia (SADS) 3) Mood D/O questionnaire (15 items) |
| What is the greatest symptom that is mostly seen in a patient who may have bipolar? | Not sleeping |
| What is the first line therapy for a patient with mild to moderate depression? | SSRI |
| What is the management plan for a patient with mild to moderate depression? | Psychotherapy, SSRIs, (BOTH), lifestyle changes |
| What is the most effective treatment for patients with mild to moderate depression d/o? | Combo therapy (psychotherapy and medication therapy) |
| What are examples of psychotherapy? | Cognitive behavioral therapy (CBT), social skills training, interpersonal psychotherapy, behavioral activation, problem-solving therapy, psychodynamic therapy |
| What are 2 common side effects of second generation antipsychotic medications like Abilify? | Increased weight gain and blood sugar problems |
| What is induced within the synaptic cleft with SNRIs? | Serotonin and Norepinephrine |
| What are the dual action agents used for mood disorders? | SNRIs |
| What are the two things SNRIs are used to treat? | Depression and chronic pain |
| What is important to monitor in patients on a SNRI? | BP |
| What is the only SNRI that doesn't require monitoring of BP? | Duloxetine (Cymbalta) |
| What is important to beware of with SNRIs? | Drug-drug interactions (due to being a dual action agent) |
| What is another dual action agent used to treat mood disorders other than the SNRIs? | NDRIs |
| What is the ONLY drug that is a NDRI? | Buproprion (Wellbutrin) |
| What is Buproprion (Wellbutrin) used to treat? | Depression, ADHD, smoking cessation |
| What is important to monitor in patients on an NDRI? | BP! |
| What are 2 benefits of NDRI? | 1) No sexual side effects 2) No weight gain |
| If a patient fails therapy with an SSRI in the past, what is a great option for patients? | NDRI |
| What historical finding contraindicates the use of bupropion in a patient who has depressive disorder? | History of seizures |
| What is a CV contraindication for use of Bupropion? | HTN |
| When would a young to middle aged adult expect improvement when taking a SSRI? | 2-4 WEEKS |
| When would a young to middle aged adult expect relief of symptoms when taking a SSRI? | 6-12 WEEKS |
| When would an older adult (>65 y/o) expect improvement when taking a SSRI? | 4-6 WEEKS |
| When would an older adult (>65 y/o) expect relief of symptoms when taking a SSRI? | 12-16 WEEKS |
| What class of antidepressant medications are on the Beers List? Why? | TCAs because they are so high risk |
| What is the first line choice medication for depression in older adults? Why? | SSRIs because of safety and tolerability |
| What is the third or fourth line therapy of antidepressant med class? Why? | TCAs because of arrhythmias, cognitive changes, and risk for overdose |
| What are potential side effects of SSRIs in older adults? | Parkinsonism, anorexia, sinus bradycardia, hyponatremia, bleeding (especially if taking ASA or other anticoagulant), fragility fractures (from minimal trauma) |
| What age group has the greatest number attempts of suicide? | Adolescents |
| What is the second age group with the greatest number attempts of suicide? | Middle-aged adults |
| What increases the risk of suicide? | risk increases with age |
| What group of people have the highest attempt of suicide? | Older men especially those that are not married and no children |
| What is the most common means of suicide for men? | Firearms and hanging |
| What is the most common means of suicide for women? | Poisoning (pills) |
| What are some suicidal risk factors? | Psych history, hopelessness, impulsivity, h/o attempts, marital status (never married, widowed, separated, divorced) |
| What is the 7th leading cause of death in the US? | Suicide |
| What are the 3 most important questions to ask a patient who may be suicidal? | 1) Are you thinking of harming yourself? (How long have you felt this way?) 2) Do you have a plan to harm yourself? 3) Do you have the means to harm yourself? |
| What are symptoms of anxiety? | Excessive worry, panic attacks, autonomic hyperactivity, muscle tension, exaggerated startle response |
| What are co-occurring conditions with GAD? | Anxiety disorders and depression |
| What is an anti-anxiety med class listed on the Beers List? | Benzodiazepines |
| What is the complex somatic, cognitive, affective, and behavioral effects of psychological trauma? | PTSD |
| What are the PTSD screening tools? | 1) PTSD Checklist (PCL-5) 2) Clinician administered PTSD Scale (CAPS) |
| If a patient has a positive PTSD screen, what is the next step? | Referral to psych for psychotherapy and prescribe |
| What is the first line tx for PTSD? | SSRI |
Created by:
alexandrat2008
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