1 mania/manic episode lasts for ___ and present ____
about a week; most of the day, nearly everyday
1 major depressive episode lasts for ____
at least 2 weeks
Clinical features of Major depressive episode
- Depressed mood
- ↓ interest, poor concentration
- Ideas of guilt & worthlessness
- ↓ self esteem
- ↓ energy & activity
- Fatigue, insomnia, hypersomnia
- ↓ libido
- ↓ appetite, weight loss
- Somatic symptoms
Clinical features of both bipolar disorders
- Inflated self esteem
- ↓ need of sleep
- More talkative
- Flight of ideas
- Distractibility
- Psychomotor agitation (hypersexual)
- High risk behaviour
Just list treatments of major depressive disorder
- Tricyclic antidepressants (TCAs)
- Monoamine Oxidase Inhibitors (MAOIs)
- Selective serotonin reuptake inhibitors (SSRIs)
What are the unwanted effects of TCAs?
- sedation
- orthostatic hypotension
- anticholinergic side effects (eg. constipation, urinary retention, dry mouth, blurred vision and, at times, cognitive impairment.)
What to avoid when taking MAOIs?
- Tyramine-rich food
eg. red wine, cheese - Flu meds containing ephedrine, pseudoephedrine, SSRIs
What treatment of major depressive disorder is generally better tolerated and safer for elderly?
Selective serotonin reuptake inhibitors (SSRIs)
What are the anti-depressants which can produce substantial inhibition of some hepatic cytochrome P450 enzymes and thus higher risk of drug interactions?
SSRIs– Luvox, Prozac and Paxil
Just list treatments of bipolar disorder
- Lithium carbonate
- Anticonvulsants
- Atypical antipsychotics
What is the most effective treatment for bipolar disorder?
Lithium carbonate
Can changes in dietary Na intake affect Li levels?
Yes
Therapeutic range of Li
0.4-1.0mmol/L
How many hypomanic & manic episode does bipolar II disorder have?
at least 1 hypomanic episode
BUT has NOT had a full manic episode
How long are the manic episodes of cyclothymia?
a distinct period of severe mania for at least 1 week with rapid shift of mood
*** V IMPT!
List out at least 5 DSM V DIagnostic Criteria
5 or more of the following over 2 weeks:
- depressed mood most of the day, for most days
- diminished interest & pleasure on activities
- significant weigh tloss
- insomnia or hypersomnia
- psychomotor agitation or retardation
- feelings of worthlessness or excessive guilt
- insomnia or hypersomnia
The difference between manic and hypomanic episodes
Manic episodes:
- Symptoms are severe enough to cause marked impairment in social or occupational functioning + risk to self & others
- Last at least 1 week
Hypomanic episodes:
- Same as manic episodes but symptoms NOT severe enough to cause marked impairment..
- Disturbances in mood are observable by others
- Last at least 4 consecutive days
