MDD and bipolar II

Question 1

What is the role of psychotherapy and psychopharmacology?

Answer 1

Complementary–psychopharmacology outcomes are largely improved with psychotherapy

Question 2

What is transcranial magnetic stimulation?

Answer 2

A noninvasive method used to stimulate small regions of the brain. During a TMS procedure, a magnetic field generator, or “coil”, is placed near the head of the person receiving the treatment. The coil produces small electric currents in the region of the brain just under the coil via electromagnetic induction. The coil is connected to a pulse generator, or stimulator, that delivers electric current to the coil

Question 3

What is the role of ketamine in the treatment for depression? What is the MOA?

Answer 3

Rapid response

NMDA receptor antagonist

Question 4

What is the role of exercise in MDD?

Answer 4

Treatment, but not cure

Question 5

What is the black box warning for antidepressants?

Answer 5

Increase risk for suicidal ideation if young. Usually occurs in the first 2 weeks

Question 6

True or false: improvements in mood can be seen in the first week of antidepressant therapy

Answer 6

True, but smaller than full effect

Question 7

What is the MOA of duloxetine?

Answer 7

SNRI

Question 8

What is the difference in response vs remission in the treatment of MDD?

Answer 8

• Response = 50% reduction

- Remission = 100%

Question 9

Should you dose antidepressants according to severity of symptoms?

Answer 9

No

Question 10

What are the major TCAs?

Answer 10

Imipramine

Amitriptyline

Question 11

What is the MOA of venlafaxine?

Answer 11

SNRI

Question 12

What is the MOA of desvenlafaxine?

Answer 12

SNRI

Question 13

What is the MOA of levomilnacipran?

Answer 13

SNRI

Question 14

What is the MOA of fluoxetine?

Answer 14

SSRI

Question 15

What is the MOA of fluvoxamine?

Answer 15

SSRI

Question 16

What is the MOA of paroxetine?

Answer 16

SSRI

Question 17

What is the MOA of sertraline?

Answer 17

SSRI

Question 18

Which of the SSRIs can cause QTc prolongation?

Answer 18

Citalopram and escitalopram

Question 19

What is the MOA of SNRIs?

Answer 19

Increase 5HT and NE

Question 20

True or false: there is no such thing as a stronger or weaker antidepressant

Answer 20

True

Question 21

What is the MOA of vilazodone?

Answer 21

SSRI with 5HT1 binding properties

Question 22

What is the MOA of vortioxetine?

Answer 22

SSRI with multiple serotonin properties

Question 23

What is the effect of vilazodone and vortioxetine on weight?

Answer 23

Weight neutral

Question 24

What is the MOA of bupropion?

Answer 24

NE and dopamine reuptake inhibitor

Question 25

What is the MOA of mirtazapine? What is it known for?

Answer 25

Alpha 2 blocker and serotonin blocker Weight gain (good in cachectic patients)

Question 26

What is the MOA of trazodone?

Answer 26

Inhibition of 5HT2A receptors. Human and animal studies have demonstrated that inhibition of this receptor is associated with antianxiety, antipsychotic and antidepressant effects.

Question 27

What is the MOA of Quetiapine?

Answer 27

Atypical antipsychotic

Question 28

What is methylphenidate?

Answer 28

Ritalin (amphetamine)

Question 29

What is dextroamphetamine?

Answer 29

Adderall

Question 30

Which gender has an increased prevalence in bipolar disorder?

Answer 30

Neither--equally common

Question 31

What percent of patients who have had an episode of bipolar disorder will have another incidence?

Answer 31

90%

Question 32

True or false: there is no increase in the incidence of bipolar disorders in 1st degree relatives of patients with the disorder

Answer 32

False--increased

Question 33

What are the diagnostic criteria for bipolar disorder?

Answer 33

Requires the presence of manic or mixed episode--no depressive episode is required

Question 34

True or false: to be diagnosed with bipolar disorder, you do NOT need to have a depressive episode

Answer 34

True

Question 35

True or false: mania usually requires hospitalization

Answer 35

True

Question 36

Untreated episodes of mania usually last how long?

Answer 36

Few weeks to months

Question 37

What is the mean age of onset for bipolar disorder?

Answer 37

early 20s

Question 38

Do patients with manic episodes typically have insight into their disease?

Answer 38

no

Question 39

What usually precedes episodes of mania with bipolar disorder?

Answer 39

Psychosocial stressors

Question 40

What is a hypomanic episode?

Answer 40

Same s/sx as a manic episode, but less severe, and do not markedly impair functioning

Question 41

What is bipolar I disorder?

Answer 41

One or more manic or mixed episodes (no MDE required)

Question 42

What is bipolar II disorder?

Answer 42

At least one hypomanic episode and at least one depressive episode without any manic or mixed episodes

Question 43

What is cyclothymia?

Answer 43

2 years of fluctuating periods of hypomania and depressive symptoms that don't meet full criteria for a hypomanic or major depressive episode

Question 44

Can anti-depressants cause manic episodes in patients with bipolar disorder?

Answer 44

Classically, yes, but most of the time they just don't respond

Question 45

How efficacious is Li in the treatment of bipolar disorder?

Answer 45

Highly, but narrow therapeutic window

Question 46

What lifestyle change in indicated for bipolar treatment?

Answer 46

Sleep hygiene

Question 47

What is the treatment for manic episodes with bipolar?

Answer 47

Antipsychotics

Question 48

True or false: Li is neuroprotective

Answer 48

True

Question 49

What is the number 1 killer of bipolar patients?

Answer 49

CV disease

Question 50

What is the MOA of phenelzine?

Answer 50

MAOI

Question 51

What is the MOA of selegiline?

Answer 51

MAOI

Question 52

What are the diagnostic criteria for bipolar disorder? (7)

Answer 52

- Flight of ideas - Inflated self-esteem - Distractibility - Goal directed activity increased - Excessive pleasurable activities - Talkativity - Sleep needs decreased (FIDGETS)

Question 53

How many s/sx are needed from the criteria of bipolar disorder to qualify?

Answer 53

Three, but four needed if only irritable

Question 54

What non-pharmacotherapy treatment is recommended for bipolar disorder?

Answer 54

Good sleep hygiene