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