Antidepressant Induced Mania
Manic symptoms within a few days of starting an antidepressant. New medication should be discontinued before adding new therapy.
Adjustment Disorder w/ Depressed Mood
Onset within 3mo of stressor. <5 of SIGECAPS. Distressed or Impaired. Tx: Psychotherapy
MDD
> 2 weeks of 5+ SIGECAPS, marked impairment.
Tx: Antidepressant + Psychotherapy
Bipolar Type I
Episodes of Depression and Mania
Maintenance: Lithium, Valproate. 2nd line Seroquel, Lamotragine.
ADHD
Must be from 2 different locations (Home/School)
MDD with Seasonal pattern
depressive symptoms plus carb craving onset in fall, improves in summer.
Tx: Antidepressants and bright light therapy
Light therapy can be considered as sole treatment for mild to moderate.
Delusional Disorder
1 delusion for more than 1 month
Ability to function otherwise
Tx: Antipsychotics & CBT
Anorexia nervosa vs Bulemia nervosa
The main difference is anorexics have well below normal weight, where bulemics have normal to above normal weights. Both may features restrictive/purging behaviors.
Body dysmorphic disorder
When the patient displays a preoccupation with perceived faults about their body but does not display behaviors that fall into eating disorder criteria.
SSRIs & CBT
Therapy Course in Bipolar
Bipolar is a life long illness. Those that have a severe course (Mutiple manic/depressive episodes, hx of suicide attempt) should remain on pharmacologic therapy as long as the medication does not cause significant side effects.
Selective Mutism
Refusal to speak in a specific setting for greater than 1 month. Will speak in other settings.
Depression plus sleep problems =
Mirtazepine
Neuroleptic Malignant Syndrome
Reaction to 1st and 2nd gen antipsychotics, Usually within first 2 weeks of treatment. Hyperthermia, autonomic instability, lead pipe rigidity, altered sensorium.
Elevated CPK and WBC
Tx: Supportive or Bromocriptine or amantadine if they do not respond to supportive measure after withdrawal of the offending agent.
Bipolar 1 vs 2
1: Mania (interrupts functionality) with or without depressive episodes
2: Hypomania (manic features that are milder and do not affect daily function) with at least 1 episode of MDD
Cyclothymic Disorder
2 or more years of fluctuating hypomania and depressive symptoms that do not meet criteria for other mood disorders.
Considerations when prescribing antidepressants
All patients with a history of depression should be screened for episodes of mania/hypomania due to increased risk of antidepressant-induced mania.
Specific Phobia tx
CBT with exposure
Generalized Anxiety Disorder
Excessive worry and anxiety for 6mo or more. 3 or more of the following: -Restlessness -Fatigue -Difficulty concentrating -Irritability -Muscle Tension -Sleep Disturbance
Significant distress/impairment
CBT & SSRI/SNRI
Treatment of MDD with psychotic features
Antidepressant + Antipsychotic, ECT can be considered if risk of suicide is high or patient is refusing to eat.
Panic Disorder
May present with symptoms of depersonalizations/derealization
Antisocial Personality Disorder
- Violation of others rights and social norms
- Impulsive, irritable, aggressive
- Irresponsible, liar, deceitful
- Lack of remorse
- 18 or older
- Evidence of conduct disorder as a kid
Postpartum blues
Onset in 2-3 days, typically resolves in 2 weeks. Mild depression, tearfulness, irritability.
Tx: Reassurance and monitoring
Postpartum depression
Onset within 4-6 weeks, moderate to severe depression symptoms: sleep disturbances, changes in appetite, low energy, psychomotor changes, guilt, difficulty with concentration, SI.
Antidepressants and psychotherapy
Postpartum psychosis
Onset days to weeks, delusions, hallucinations, thought disorganization, bizarre behavior.
Antipsychotics, antidepressants, mood stabilizers, hospitalization.
