USMLE Step 2 Psychiatry Mood Disorders Chp. 5

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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

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