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Psych 3 Other Mood D

Other Mood Disorders: Bipolar and Anxiety

QuestionAnswer
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