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Mental Health > 2 - Mood disorders > Flashcards

2 - Mood disorders Flashcards

1
Q

Define mood/affective disorder:

A

Any condition characterised by distorted, excessive, or inappropriate moods or emotions for a sustained amount of time

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2
Q

Name the 2 types of unipolar mood disorders:

A

1 - Depression

2 - Dysthymia

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3
Q

Name the 2 types of bipolar mood disorders:

A

1 - Cyclothymia

2 - Bipolar affective

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4
Q

Define cyclothymia:

A

Mild periods of elation and depression, broken up by periods of normal mood.

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5
Q

Define dysthymia:

A

Chronic low mood not fulfilling the criteria for depression

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6
Q

What is the monoamine hypothesis?

A

Deficiency of monoamines (dopamine, noradrenaline, serotonin) causes mood disorders including depression and bipolar disorder

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7
Q

What are the risk factors for depression?

A
  • Family history
  • Lack of social support
  • F:M 2:1
  • PMH of depression
  • Physical co-morbidities
  • Low socioeconomic status
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8
Q

Depressive illness could be secondary to which physical conditions?

A
  • Hypothyroidism
  • Cushing’s disease
  • Addison’s disease
  • Hyperparathyroidism
  • Anaemia
  • Malignancy
  • Parkinson’s disease
  • Huntington disease
  • Multiple Sclerosis
  • Stroke
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9
Q

What kind of substance abuse is commonly linked to causing depression?

A
  • Alcohol
  • Cocaine
  • Amphetamines
  • Cannabinoids
  • Sedatives/hypnotics
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10
Q

If a patient presented 2 months after the loss of his wife, complaining of low mood, lack of energy/appetite/sleep and excessive guilt, what is the diagnosis?

A

Normal bereavement

= Reactions < 6 months

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11
Q

What are the core symptoms of depression?

A
  • Anhedonia
  • Continuous low mood for > 2 weeks (usually AM)
  • Lack of energy
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12
Q

What are the additional symptoms of depression?

A
  • Decreased appetite
  • Trouble sleeping - severe = EMW
  • Negative thoughts
  • Trouble concentrating
  • Loss of libido
  • Psychomotor retardation
  • Suicidal ideation
  • Excessive guilt
  • Hallucinations
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13
Q

What type of hallucinations are most commonly seen in depressive illnesses?

A

Auditory:

2nd person derogatory

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14
Q

What is the classification for mild depression?

A

2 core symptoms + 2 other symptoms

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15
Q

What is the classification for moderate depression?

A

2 core symptoms + 3/4 other symptoms

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16
Q

What is the classification for severe depression?

A

3 core symptoms + ≥4 other symptoms

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17
Q

What are the biological treatments for depression?

A
  • 1st line = SSRI ie Sertraline
  • 2nd = SNRI ie Venlafaxine
    Other:s
  • MAOI ie Phenelzine
  • NARI ie Reboxetine
  • TCA ie Amitriotylline
  • NASSA ie Mirtazepine
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18
Q

In what type of depression would you consider prescribing a MAOI such as Phenelzine?

A

Treatment-resistant or atypical

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19
Q

What is the MoA of MAOIs?

A
  • Inactivate monoamine oxidase

- Reduced oxidation of dopamine/serotonin, noradrenaline, tyramine

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20
Q

Which foods would you advise a patient starting on a MAOI to avoid? Why?

A

Tyramine-rich foods:

  • Marmite
  • Bovril
  • Aged/strong cheese
  • Cured/processed meat
  • Pickles/fermented food
  • Broad beans

= Risk of hypotensive reaction

21
Q

Which antidepressants would you avoid using if the patient had suicidal ideations? Why?

A
  • MAOIs
  • TCAs

= Toxic in overdose

22
Q

What is the 1st line antidepressant for children/adolescents?

A

Fluoxetine

23
Q

What is the MoA of SSRIs?

A
  • Inhibits neurotransmitter re-uptake pump on pre-synaptic membrane
  • Increases [neurotransmitter] available to bind to post-synaptic membrane
24
Q

If you are about to start a patient on aspirin + sertraline, what other type of drug must you add?

A

PPI ie Lansoprazole

25
Q

Why should an SSRI never be co-prescribed with heparin/warfarin?

A
  • SSRI inhibits serotonin uptake in platelets
  • Inhibit platelet aggregation
  • 3/4x risk of bleeding
26
Q

Which SSRIs should not be prescribed in long QT syndrome?

A
  • Citalopram

- Escitalopram

27
Q

The when should the effects of SSRIs on depression be clinically detectable?

A

4-6 weeks

28
Q

Name some common side effects of SSRIs:

A
  • Nausea
  • Dyspepsia
  • Diarrhoea
  • Constipation
  • Bloating
29
Q

Name some rare side effects of SSRIs:

A
  • Mania
  • Suicidal ideation
  • Tremor
  • EPSE
30
Q

How would an overdose of SSRIs present?

A

Serotonin syndrome:

  • Extreme agitation
  • Hostility
  • Muscle rigidity
  • Migraine
  • Diarrhoea
  • Fever
  • Seizures
  • Unconsciousness
31
Q

What medications can cause serotonin syndrome?

A
  • SSRIs
  • TCAs
  • Lithium
32
Q

Which antidepressants are safest in the elderly?

A

SSRIs

33
Q

What is the MoA of Reboxetine (NARI)?

A

NARI

- Highly specific NA re-uptake inhibitor

34
Q

What are some common ADRs of Reboxetine (NARI)?

A
  • Nausea
  • Dry mouth
  • Constipation
  • Tachycardia
  • Palpitations
    +++ many more
35
Q

What class of antidepressants are Venlafaxine and Duloxetine? What is the MoA?

A

SNRIs

- Prevent re-uptake of NA and 5-HT

36
Q

Why are SNRIs (Venlafaxine) preferred over TCAs (Amitriptyline)?

A

SNRIs do not block cholinergic receptors unlike TCAs, so less anti-cholinergic side effects

37
Q

What are some common side effects of SNRIs (Venlafaxine)?

A
  • Nausea
  • Bloating
  • Diarrhoea
  • Constipation
  • Dyspepsia
  • Sleep disturbance
  • ^BP
  • Dry mouth
  • Hyponatraemia
38
Q

What are the contraindications of SNRIs (Venlafaxine)?

A
  • ^ risk of arrhythmias

- uncontrolled hypertension

39
Q

What is the MoA of TCAs?

A

1) Inhibit NA re-uptake = ^[NA]
2) Reduce cholinergic neurotransmission
3) Suppress NA transmission at α-1 adrenoceptors

40
Q

What are some common side effects of TCAs?

A
  • Dry mouth
  • Urinary retention
  • Blurred vision
  • ^HR
  • Postural hypotension
  • Constipation
  • Impaired myocardial contractility
  • Sedation
  • Lowers seizure threshold
  • Impaired psychomotor performance
41
Q

What are the contraindications for TCAs?

A
  • Recent MI
  • Arrhythmias
  • Mania
  • Severe liver disease
  • Agranulocytosis
42
Q

What are the indications for using an NASSA such as Mirtazepine?

A

Depressed patient who would benefit from weight gain and suffers insomnia

43
Q

What are the main ADRs of Mirtazepine?

A
  • ^^ appetite + weight gain

- Sedation

44
Q

What are the psychological treatments recommended for the treatment of depression?

A
  • CBT
  • IPT
  • Counselling
  • Self-help groups
  • Physical activity
45
Q

What are the social treatments for depression?

A

Social support groups

46
Q

Define Mixed Affective State:

A

Mix or rapid alternation within hrs between hypomania/mania/depression

47
Q

What is the 2nd line drug treatment for depression?

A

SNRI:

  • Venlafaxine
  • Duloxetine
48
Q

What are the indications for ECT for depression?

A

Treatment-Resistant depression +

  • Suicidal ideation OR
  • Not eating/drinking

Mental Health (4 decks)

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