MH exam 2

decreased

increased

• -depressed mood and/or anhedonia QD x 2wks plus four or more of the following:
• 1) change in appetite, weight, sleep
• 2) fatigue
• 3)poor concentration/indecisiveness
• 4) agitation or retardation
• 5) feelings of worthlessness/guilt
• 6) s/i

• 1) catatonic features
• 2) melanchoic features
• 3) atypical features
• 4) Seasonal Affective D/O
• 5) postpartum onset
• 6) psychotic features

• -mood reactivity (mood brightens in respnse to external events, like someone visiting pt.)
• -significant weight gain and incr. appetite
• -hypersomina
• -leaden paralysis (feeling weighted down in extremeties)
• -extreme sensitivity to interpersonal rejection (causes significant occupational or social impairment)

• * delusions or hallucinations
• -mood congruent: content is consistent w/ typical depressive themes (eg. personal inadequacy, guilt, desease, nihilism, deserved punishment)

-mood incongruent: content not typical of depressive themes (e.g. thought insertion (someone is inserting thoughts into my brain), thought broadcasting (ppl can read my thoughts), delusions of control

• 1) low grade, rarely remitting depression
• 2) depression that lasts >1 year in children and >2 years in adults
• 3) may have atypical features

• Selective Serotonin Reuptake Inhibitors:
• -1st tx of choice
• -can cause serotonin syndrome
• -s/e: wt gain, sexual dysfunction

Celexa, Lexapro, Luvox, Paxil, Prozac, Zoloft

• - overabundance of serotonin in the CNS
• Symptoms:
• -confusion, diaphoresis, hyperreflexia, ataxia, myoclonus (brief, involuntary twitching of a muscle or a group of muscles), restlessness, shivering, tremor

-occurs when agents are used together w/ MAOI's or St. John's Wort, or other drug combos

they work on more than 1 NE

• Cymbalta (NE and SE)
• Effexor (NE and SE)
• Remeron (NE and SE)
• Wellbutrin (NE and DA)

• TCAs:
• -older, less commonly used bc of anticholinergic effects...caution use in elderly bc they are already dehydrated!

• (most generic names end in -ine) Sinequan, Anafranil, Elavil, Endep, Ludiomil, Norpramine, Pertrofane, Pamelor, Surmontil, Tofranil, Vivactil...
• S/E: anticholinergic!
• -dry mouth, blurred vision, constipation, orthostatic hypotension, sexual dysfunction, agranulocytosis, wt. gain/loss, tremor

• -used rarely
• -can cause hypertensive crisis
• -pt. must be on tyramine restricion diet
• -EMSAM- new transdermal patch, fewer restrictions

Nardil, Parnate, marplan, Emsam

• when meds prevent the breakdown of the monoamine it builds up, resulting in:
• -severe occipital or temporal HA
• -diaphoresis
• -mydriaisis (excessive pupil dilation)
• -nuchal rigidity
• -palpations
• -elevated BP

• avoid: beer/red wine, aged cheese, dry sausage, fava or italian beans, brewers yeast or Marmite extract, smoked fish, liver, sauerkraut
• avoid in large amounts: ripe avocado, yogurt, ripe bananas, soy sauce

Lithium, Tegretol, Depakote, Lamictal, (atipical antipsychotics like Zyprexa)

-therapeutic range = 0.05-1.5, draw serum levels 12 hours after last dose

-don't restrict fluid or salt and use caution w/ diuretis bc

-polyuria, polydipsia, muscle weakness, fine tremor, GI upset, diarrhea, nausea

• lethargy, impaired concentraion or confusion, coma, seizures, ataxia, twithching, coarse tremors, dysarthria, nustagmus, nephropathy, (2.5-3.5= very dangerous levels)
• -w/ chronic use= nephrogenic DI and chronic RF, hypothyroidism

• -OD
• -kidney disease
• -Na deficiency
• -strange/drastic diets
• -diuretics
• -fevers
• -gastroenteritis
• -dehydration

one or more manic or mixed episodes, may be accompanied by psychosis

one or more major depressive disorders w/ at least 1 hypomanic episode, psychosis is not present

• -at least 2 years of numerous hypomanic episodes and periods of depressive symptoms (pt. is cycling)
• -specifiers: "rapid cycling" = 4 or more episodes in 12 months, or seasonal pattern
• -either bipolar I or II can be mixed

• -psychotic features
• -truancy
• -antisocial behavior
• -drug use
• -school failure
• -possible long-standing behavioral problems (prodromal? {early s/sx of bipolar?})
• -mean onset of 1st manic episode: early 20s

• rapid onset, often occur after a significant stressor
• episodes last few wks to several months and end abruptly, often followed bya MDD episode