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Mood Disorders (Normal (:smiley: Mood up (Bipolar I (Path: Manic…
Mood Disorders
Normal
:smiley: Mood up
Bipolar I
Path: Manic Predominant (severe mania, sometimes w/ depression)
Pt: DIG FASTER
- thinks highly of themselves
- never sleep
- doing stuff, having fun (:unamused:)
- sex
- many projects they can't finish (or college classes)
- This is Mania
Distractability
Insomnia
Grandiosity
- 1 more item...
1st steps
- r/o stimulants (amphetamines, cocaine)
- r/o less severe Bipolar forms (BPII, Cyclothymia)
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Dysthymia
- mini chronic indolent MDD
Dx:
- Chronic depressed mood :cry: within 2yr or more
- Duration < 2mo at a time
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Bipolar II
- looks like MDD w/ a small bit of mania
- hypomanic episode ≥ 4 days
- (Uworld) Hypomania lacks psychosis
- Hypomania (never full mania)
- MD episode :cry:
:check::check: either is present? :warning:Automatically BP I #
:pencil2:if SSRI unmasks mania, could be BPII
- probably severe mania = BP I
- Combines 2 sections in DSM V: Depressive disorders & Bipolar
- There are other low yield disorders not covered in this video
- See the 2 disorders as on a spectrum, both extremes cause impaired productivity.
- MDD and Bipolar I
- All these diseases can present w/ varying degrees of psychosis. Mostly mood, some psychosis vs. Mostly psychotic, w/ some mood.
- Catatonia (waxy) is not a sign of Schizophrenia.
- Catatonia is more likely associated w/ depression and mood disorder.
- :warning:Commit most time to SIGECAPS, MDD, BP I, and what to do if SI is present
:pencil2:Dustyn doesn't cover timing much. So I included it below the disease title. They should look familiar.
What you should be doing when 1st evaluating MDDDx: r/o suicidal ideation. (can dx MDD w/o suicidal ideation)
- what you do in that moment depends on how close to suicide pt is.
- Pt w/ means & plan = hospitalized for their own safety
- Pt w/ SI but no means to carry out plan = high risk, Contract for safety :newspaper:
Maintains relationship and preserves pt rights.
- No SI, treat chronically = SSRI, SNRI
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:pencil2:Disregard any other antidepressants we've learned in the past. They aren't standard of care for MDD.
- f/u: wait 1 wk and increase dose
- increase until max tolerable dose
- Tx for 1-2 mo, then decide "Do you need another one?"
- Concurrent treatment w/ Psychotherapy
:stars: Best treatment: :zap::bed: Electroconvulsive therapy
- for refractory depression, catatonia, psychosis
- causes amnesia
- so much stigma against this therapy
Typical depression (Melancholic)
- everything decreased, except guilt/SI
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Lesser form of BPII
- usually no treatment
- The med student who studies ≥ 16hrs/day
- Get's good scores
- Has energy to go to parties
- No depression symptoms
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