Mood Disorders

Question 1

Screen for Major Depresive DO (MDD)

Answer 1

PHQ-9, PHQ-2

Question 2

How is MDD different than Bipolar?

Answer 2

MDD has NO MANIA

Question 3

For MDD, you must R/O _____ and _____

Answer 3

Bipolar
Hypothyroidism

Question 4

Persistent Depressive Disorder lasts:
___yr+ (Adult)
____yr+ (Child)

Answer 4

2yr+ (Adult)
1yr+ (Child)

Question 5

1st line Tx for MDD and Persistent Depressive DO

MDD = Major Depressive DO

Answer 5

1 Psychotherapy + SSRI (Lexapro, Zoloft)

Question 6

MDD and Persistent Depressive DO Tx Resistant

Answer 6

• ADD 2nd Gen Antipsychotic, Lithium, 2nd antidepressant from diff class, Thyroid hormone
• TMS

Question 7

MDD and Persistent Depressive DO (SEVERE Tx)

Answer 7

• ECT (Electroconvulsive therapy)
• Esketamine, Ketamine

ECT is 1st line if suicidal, severe wt loss, real bad

Question 8

Tx for Mod/Severe Premenstrual Dysphoric DO

Answer 8

• CBT
• SSRIs
• COCs or GnRH Agonists
• Last resort -> Bil (salping)oophorectomy

Question 9

______ DO is when children have chronic irritability, anger, or tantrums

Answer 9

Disruptive Mood Dysregulation DO

Can last into adulthood but must be Dx as a child

Question 10

Disruptive Mood Dysregulation DO
* Lasts: ___yr+
* Peds onset: ___ - ___yo
* Dx: ___ - ____yo

Answer 10

• Last: 1yr+
• Peds onset: 6-10yo
• Dx: 6-18yo

Must start b/w 6-10yo but can be Dx anytime from 6-18yo (peds only).

Question 11

Disruptive Mood Disregulation DO Tx

Answer 11

• # 1 Psychotherapy
• Off-label meds
• Parent Education
• Refer to peds psychologist/psychiatrist

Question 12

Bipolar is MC in which age groups?

Answer 12

15-24yo
45-54yo

Question 13

Bipolar I Manic episodes last for _____

Answer 13

1+ week

Question 14

Bipolar II Hypomanic episodes last for _____

Answer 14

Question 15

1st line Tx for Bipolar DEPRESSION

Answer 15

Monotherapy 2nd Gen “Atypical” Antipsychotic (Quetiapine or Lurasidone)

Question 16

Tx for REFRACTORY Bipolar Depression

Answer 16

ECT

rapid response if real bad

Question 17

Bipolar I pts NEED and anti-depressant + _______

Answer 17

Mood Stabilizer

Antidepressants can unmask Bipolar bc theyre no longer depressed and have the potential to become HIGHLY MANIC

Question 18

1st line Tx for Bipolar Mania/Hypomania

Answer 18

• Mood stabilizer (Lithium, Valproate)
• Antipsychotic (Ariprazole, Asenapine, Cariprazine, Quetiapine, Rispiridone)

Question 19

Tx for poorly controlled or Severe Bipolar Mania/Hypomania

Answer 19

Mood stabilizer + Antipsychotic

Question 21

Tx for Bipolar Mania/Hypomania if Tx Resistant or Preg

Answer 21

ECT

Mono or in combo with other Tx options

Question 21

1st line Tx for Bipolar in PEDS

Answer 21

Pharmacotherapy + Psychotherapy

very unique that pharmacotherapy is 1st line before therapy

Question 22

1st line Tx for Bipolar Depression in PEDS

Answer 22

Choose 1:

• Lurasidone
• Alt 2nd Gen Antipsychotic + SSRI

I guess Lurasidone is the only 2nd gen antipsychotic that can be taken w/o SSRI in peds for this

Question 23

Tx for Bipolar Depression (Tx Resistant) in PEDS

Answer 23

Lithium, Lamotrigine, or Omega-3 Fatty Acids

Question 24

Tx for Bipolar Depression (Tx Resistant) in PEDS

Answer 24

Lithium, Lamotrigine, or Omega-3 Fatty Acids

Question 25

1st Line Tx for Bipolar in **PEDS**

Answer 25

**Pharmacotherapy** + Psychotherapy ## Footnote unique that pills is 1st line before therapy

Question 26

1st Line Therapy for Bipolar Depression in **PEDS**

Answer 26

Pick 1: * Lurasidone * Alt 2nd gen antipsychotic + SSRI ## Footnote I guess Lurasidone is the only "Atypical" that can be taken w/o an SSRI in peds for this

Question 27

Tx for Bipolar Depression in **PEDS** if: * Tx Resistant -> * Partial Response -> * Tx Refractory

Answer 27

* Tx Resistant -> Lithium, Lamotrigine, or Omega-3 Fatty Acids * Partial Response -> **ADD** Lithium, Lamotrigine, or Omega-3 Fatty Acids * Tx Refractory -> Lithium + (Lamotrigine or Antidepressant), ECT, Bright Light Therapy

Question 28

Order ___ prior to giving Lithium to Peds

Answer 28

* BUN, Creat * E- * TSH * ECG * Urine Preg ## Footnote * Measure [Lithium] after 1st week of taking * Stable dose -> repeat initial WU q 3-6mo

Question 29

1st Line Tx for Bipolar Mania/Hypomania in **PEDS**

Answer 29

2nd gen antipsychotic +/- Lithium

Question 30

Tx for Bipolar Mania/Hypomania in **PEDS** if * Tx Resistant -> * Partial Response or Refractory ->

Answer 30

* Tx Resistant -> try diff antipsychotic * Partial Response or Refractory -> antipsychotic **+ LITHIUM**

Question 31

Tx for Bipolar Mania/Hypomania in **PEDS** if **Refractory to 8-10med trials**

Answer 31

* **Cloazapine** * **ECT**

Question 32

Tx for Bipolar Mania **W/Mixed or Psychotic Features **in **PEDS**

Answer 32

2nd Gen Antipsychotic ## Footnote **NO LITHIUM?**

Question 33

Suicide Attempt Tx: Give ___ to prevent suicide

Answer 33

Lithium

Question 34

Suicide Attempt Tx for severe depression

Answer 34

ECT

Question 35

Suicide Attempt Tx: **Alterantive** for Lithium to prevent suicide

Answer 35

Ketamine/Esketamine

Question 36

______ Mood DO = Chronic mood instability W/O Extreme mood episodes

Answer 36

Cyclothymic ## Footnote Not Hypomanic enough for Bipolar II. Not Depressed enough for MDD

Question 37

Cyclothymic Mood DO Lasts: ____yr+ (Adult) ____yr+ (Peds)

Answer 37

2yr+ (Adult) 1yr+ (Peds) ## Footnote Ss for half the time. Max: 2mo in b/w episodes

Question 38

Cyclothymic Mood DO Tx

Answer 38

NO FDA approved meds * #1 Mood Stabilizer * 2nd Gen "Atypical" Antipsychotics +/- Mood Stabilizer * CBT