Mood d/o

Question 1

Hallmark of mammalian stress response

Answer 1

Inc HPA activity

20-40% outpx depressed

40-60% inpxs

Associated melancholia, pyschotuc, suicide

Question 2

Hormonal changes in depression

Answer 2

Inc cortisol
Inc CRH, AcTH NE
Dec serotonin
Dec in feedback inhibition
Dec somatostatin

*anxiety- inc somatostatin

Question 3

How to test feedback inhibition?

Answer 3

Dexa suppression test

Exog dexa IV 0.5-2.0mg
Normal- suppresion of cortisol in 24 hrs

Abn- inc cortisol and nonsuppreaiion

Question 4

% of pxs with depression that have thyroid abn

Answer 4

5-10%

8%

Reason withbthis- prob preacence of antibody to thyroid,
baseline
Inc TRH and inc TSH.

Question 5

Implication if blunted TSH response in TRH stimulation?

Answer 5

Blunted is less than 7mIU/ml

It means inc risk for relapse for mood d/o

Question 6

Implication of dec in sleep?

Answer 6

Dec response to psychotherapy

Inc recurrence and relapse

Question 7

Neurophysio sleep changes in depressed

Answer 7

Loss if sleep waves

Inc nocturnal awakening

Dec sleeping time

Dec REM latency

Question 8

Structural changes in depression

Answer 8

Hyperintensities on periventricular, bg, thalamus

Reduced size of hippocampus and caudate

• bipolar- ventricular enlargement, cortical atrophy, sulcal widening

Question 9

Pet changes in depressiom and mania

Answer 9

Depression- hypofrontality, dec in anterior brain metabolism

Dec in blood flow on left, mesocortocal/mesolimbic- in depression

Dec blood flow on right- mania

Question 10

Structure for goal directed and appetitive behaviors

Answer 10

Left prefrontal cortex

Right- avoidance, inhibitionbof appetitive pursuits.

Question 11

Acc vs PCC function

Answer 11

ACC point of integration of stimuli/attentional and emotional inputs.

PCC/ dorsal- cognitive

Question 12

Life event most often assoviated with development of depression

Answer 12

Losing parent before age of 11

Question 13

Envi stressor mostly assoc with depression

Answer 13

Losing a spouse

Question 14

Mood symp occur during preg or 4 weeks post partum

Answer 14

Peripartum onset

Question 15

How many % of women experience peripartum onset MDE

Answer 15

3-6%

Question 16

How many % postpartum depression start their symptom even before deluvery

Answer 16

50%

Question 17

Most associated with infanticide

Answer 17

Post partum mood with psychotic features

Question 18

Charac of postpartum mood with psychotic

Answer 18

1 in 500 or 1 : 1000 drluveries

Primigravud

Prior hx of depression/ bipolar 1

Question 19

For subsequent deluveries risk of recurrence of post partum moood with psychotic features is by %?

Answer 19

30-50%

Question 20

Coined the term mania and melancholia?

Answer 20

Hippocrtaes

Question 21

Depression is caused by black bile

Answer 21

Celsus

Question 22

Folie circulare

Answer 22

Alyernating moods of mania nad depression

Jules Flaret

Question 23

Coined term cyclothymia

Answer 23

Karl kahlbaum

Question 24

Diffrentiared manicdeoressive psychosis from dementia precox

Answer 24

Emil Kareaplin

Question 25

Difference of bipolar 2 vs 1

Answer 25

Bipolar 2 - depression+ hypomania - earlier age onset - more marital disruption - inc risk for attempt and completion of suicide

Question 26

Most common symptom of depression

Answer 26

Generalized psychomotor retardation Most common symptom of agitation- hand wringjng and hair Pulling Hallmark of manic- impaired judgement

Question 27

Grossly regressed depressed patients Hindi naliligo, mute, soling

Answer 27

Psychotic depression- although no hallu and delusions

Question 28

Triad of NMS

Answer 28

Rigidity Inc symp Nervous sys activation Hyperthermia Leukocytosis Inc CK Inc transaminases Metab acid Hypoxia

Question 29

Diffetentials NMS

Answer 29

Malugnant catatonia- also eith hyperthermia, do not resolve in withdrawal of antipsychotics Serotonin syn- hx use SSRI Malignant hyperthermia- use of anesthetics Use of Dopa antag- metoclopramide/ prochlorphenazine Wothdrawal of dopa agents- amantadine, baclofen

Question 30

TXT of NMS

Answer 30

Dec/discontinue antipsychotics Anticholinergucs Benz Amantadine EcT Dantrolene- muscle relaxant Bromocriptine- dopa agonist

Question 31

Side effects of MAOI

Answer 31

Hypertensive crisis - when taken with rich in tyramine (wine and cheese) Serotonin syn- SSRI, pseudoephedrine and meperidine. MAOI- phenelzine

Question 32

Bipolar 2 diff from Bipolar 1

Answer 32

Bipolar 2- full MDD plus hypomania * cyclothymia- milder form of bipolar 2 Younger onset, marital discord, suicidal attempts more chronic, longer depressive episodes, more freq mood ep and shorter interp later on

Question 33

Clinical featurrs predictive of bipolar

Answer 33

Early age of onset < 25 y/o depression with psychotic Rapid shif mood <3mos Recurrent deoression- 5x Atypical depression Refractory depression- faikure of 3 antidep from 3 diff classes Family hx bipolarity Hypomania with antidep Hyperthymic temperament Depressive mixed states

Question 34

How many % of MDD can switch into bipolar ?

Answer 34

5-10% Mean age 32y/o

Question 35

bipolar II vs cyclothymic

Answer 35

cyclothymic- minor depressive + hypomania (numerous ep, doest not meet full) 2 yrs if chil/ adol <1yr bipolar II- MDD + hypomania hypomania- atleast 4 days

Question 36

bipolar accdg to gender

Answer 36

bipolar equal in men and women women- hypomania, rapid cycler, mixed state, anxiety men- alcohol abuse