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2: Mood Disorders Flashcards

1
Q

What is a mood disorder

A

Group of psychiatric conditions where primary disturbance is in mood

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2
Q

What are the 4 categories of mood disorders

A
  1. Manic
  2. Hypomanic
  3. Major Depressive Disorder
  4. Mixed
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3
Q

Define a manic episode

A

Period >1W (or less if hospitalised) of persistently raised, elevated, expansile and irritable mood.

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4
Q

What is a hypomanic episode

A

Period >4d where individuals mood is elevated, expansile and irritable. But, not sufficient to cause pronounced impairment in social or occupational functioning.

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5
Q

What is major depressive disorder

A

> 2W where individual has depressed mood or loss of pleasure in activities

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6
Q

What is a mixed episode

A

Affective episode (2W) - characterised by rapid alternation in hypomanic, manic and depressive symptoms

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7
Q

Define unipolar depressive disorder

A

Persistently and pervasive low mood for 2 weeks, that is significantly different to normal

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8
Q

What is the time frame to diagnose unipolar depressive disorder

A

Symptoms persisting beyond 2W

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9
Q

In which gender is unipolar depressive disorder more common

A

Females (2:1)

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10
Q

What model outlines causes depression

A

Biopsychosocial model

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11
Q

What biological factors contribute to depression

A

Genetics: 45% concordance in monozygotic twins

Endocrine: high cortisol, low thyroid

Neurotransmitter: low 5-HT

Neuroanatomy: decrease density in pre-frontal cortex

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12
Q

What is theory describing serotonin deficiency in depression called

A

Monamine oxidase theory

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13
Q

What psychological factors have been linked to depression

A

Personality - neuroticism increases risk of depression

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14
Q

What are social factors that can cause depression

A

Adverse childhood events

Marital status

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15
Q

What is a social risk factor for depression in men

A

Rates of depression are higher in separated males

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16
Q

What is a mnemonic to remember ICD-10 criteria for depression

A

SIG E CAPS

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17
Q

What are the 10 symptoms of depression

A 
Sleep disturbance 
Interest loss 
Guilt or unworthiness 
Energy loss, Erection (libido) loss 
Cognitive decline
Appetite loss 
Psychomotor agitation 
Suicidal ideation
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18
Q

What is the ICD-10 criteria for depression

A

Individual must four (out of 10) or more of the following persisting for more than 2W:

  1. Anhedonia
  2. Loss of energy
  3. Low mood
  4. Appetite loss
  5. Insomnia and sleep disturbance
  6. Psychomotor retardation
  7. Libido
  8. Feelings guilt or unworthiness
  9. Reduced concentration
  10. Suicidal ideation
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19
Q

What are the 3 core symptoms of depression

A

Anhedonia
Low mood
Anergia (Low energy)

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20
Q

How is depression categorised

A

Into:

  • Mild
  • Moderate
  • Severe
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21
Q

What is required to define mild depression

A

4 Symptoms, 2 of which must be core symptoms

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22
Q

What is required to diagnose moderate depression

A

6 symptoms, 2 of which must be core symptoms

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23
Q

What is require to diagnose severe depression

A

7 symptoms, 3 of which must be core symptoms

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24
Q

What are 3 delusions associated with depression

A

Nihlistic
Cotard
Delusiosn of guilt

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25
Q

What is a nihilistic delusion

A

That the world is going to end

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26
Q

What is a cotard delusion

A

The the person is already dead or rotting on the inside

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27
Q

What is delusion of guilt

A

Everything is their fault eg. the next door neighbour cat died and it was their fault

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28
Q

What are two other symptoms of depression

A

Low self-esteem

Auditory hallucinations

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29
Q

What are 3 differential diagnosis for depression

A
  • Adjustment disorder
  • Bereavement
  • Hypothyroidism
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30
Q

what is seasonal affective disorder

A

When individuals experience symptoms of major depressive disorder in winter

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31
Q

what is major depressive disorder with psychosis

A

Symptoms major depressive disorder with psychotic hallucinations and delusions

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32
Q

Explain delusions and hallucinations in MDD with psychosis

A

Delusions and hallucinations are usually congruent with mood

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33
Q

What is dysthymia also known as

A

Persistent major depressive disorder

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34
Q

What is dysthymia

A

Symptoms of major depressive disorder persisting beyond 2-years

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35
Q

What is first line for investigating depression

A

Ask two questions, how often in past month have you felt bothered by:

  1. Feeling down or depressed?
  2. Little pleasure in things used to enjoy?
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36
Q

What two questions should people be asked to screen for depression

A
  1. Feeling down, depressed or hopeless

2. Little pleasure in something used to enjoy

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37
Q

If a person answer yes to either of the screening questions what is next line

A

PHQ-9 Questionnaire

HAD

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38
Q

In the PHQ9 what defines mild depression

A

5-10

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39
Q

In the PHQ9 what defines moderate depression

A

10-15

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40
Q

In the PHQ9 what defines moderately severe depression

A

15-20

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41
Q

In the PHQ9 what defines severe depression

A

20-27

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42
Q

What is a positive score in HAD

A

More than 11

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43
Q

What should all patient’s with depression receive during work-up

A

Risk assessment

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44
Q

What is offered for all cases of depression

A

Advice and Follow-up (in 2W)

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45
Q

What is offered for persistent sub-threshold depression symptoms or mild-moderate depression

A

Low intensity psychosocial intervention

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46
Q

What are the two low intensity psychosocial interventions

A

CCBT

Group-Based CBT

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47
Q

What is step 3 for moderate-severe depression

A

High intensity psychosocial intervention or medication

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48
Q

what is step 4 for severe depression, severe self-neglect or risk to life

A

Crisis service
ECT
Inpatient care

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49
Q

How is mild-moderate depression managed

A
  1. Advice and follow-up in two weeks

2. Low intensity psychosocial intervention

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50
Q

What advice is offered in mild-moderate depression

A

Sleep hygiene

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51
Q

What are two low-intensity psychosocial interventions

A

CCBT (Online-CBT)

Group-CBT

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52
Q

If individual does not improve on low intensity psychosocial interventions, what is offered

A

High intensity psychosocial intervention or medication

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53
Q

what are three criteria for antidepressants

A
  • Sub-threshold depressive symptoms persisting beyond 2-years
  • Mild depression not managed by low intensity psychosocial methods
  • Moderate - Severe depression
54
Q

what is first line medication for depression

55
Q

if an individual has chronic health problems, what SSRI should they be prescribed and why

A

Citalopram or Sertraline

- Fluoxetine has highest drug interactions

56
Q

what needs to be considered when giving SSRIs

A

Suicide risk

57
Q

what happens if an SSRI is ineffective

A

Trial another SSRI after 3-4W

58
Q

what is second-line medication for depression

59
Q

what is third-line medication for depression

60
Q

what is fourth-line medication for depression

A

Venlafaxine

61
Q

what is venlafaxine

62
Q

If switching one SSRI (citalopram, sertraline, escitalopram, paroxetine) to another SSRI what should be done

A

Stop one SSRI and start the next

63
Q

If switching fluoxetine to another SSRI, what should be done

A

Stop Fluoxetine, wait 4-7d, then start the next SSRI

64
Q

If switching SSRI (not fluoxetine) to TCA what is done

A

Gradually taper down SSRI and increase TCA

65
Q

if switching SSRI (not fluoxetine) to Venlafaxine what is done

A

Gradually taper down SSRI and increase TCA

66
Q

What is the risk of switching SSRIs

A

Serotonin Syndrome

67
Q

What are the 4 causes of serotonin syndrome

A
  • TCA
  • SSRI
  • Amphetamines
  • Ectasy
68
Q

What are three features of serotonin syndrome

A
  • Autonomic Symptoms
  • Altered mental status
  • Neuromuscular excitation
69
Q

What are the 3 symptoms of neuromuscular excitation

A

Myoclonus
Hypereflexia
Rigidity

70
Q

What is an autonomic symptom of serotonin syndrome

A

Hyperthermia

71
Q

How is serotonin syndrome managed

A

IV Fluids

Benzodiazepines

72
Q

How is seratonin syndrome managed if severe

A

Serotonin antagonists:

  • Chlorpromazine
  • Cyproheptadine
73
Q

What is used to treat severe depression

A

ECT

Crisis Resolution and Home treatment team

74
Q

When is ECT used

A

Severe life-threatening depression that needs urgent response

75
Q

What is CRHT

A

Crisis resolution and home treatment team

76
Q

If psychotic depression what may be used to treat

A

Anti-psychotics

77
Q

How does ICD-10 define bipolar affective disorder

A

Disorder characterised by two or more disturbances in mood. This can be classified as elevation in mood and energy (mania and hypomania) or depressive mood.

78
Q

How does DSM-V classify bipolar disorder

A

Into 5 distinct types

79
Q

What is type I bipolar disorder

A

Manic and depressive disorder

80
Q

What is type 2 bipolar disorder

A

Hypomanic and depressive disorder

81
Q

What is bipolar type 3

A

Cylothermia

82
Q

Define cyclothermia

A

persistent hypomanic symptoms that do not meet the diagnostic threshold and persistent depressive symptoms that do not meet the diagnostic threshold

83
Q

What is the average age of onset for bipolar disorder

84
Q

Describe aetiology of bipolar

A

Very strong genetic component (40-70%) concordance amongst twins

85
Q

What is the main risk factor for bipolar disorder

86
Q

What are 4 triggers for bipolar disorder

A
  • Traumatic childhood experience
  • Psychosocial stress
  • Sleep disturbance
  • Physical illness
87
Q

Define mania

A

Period >1W where individuals experience persistently abnormally and persistently raised, expansive, irritable mood

88
Q

Define hypomania

A

Period >4d where individuals experience elevated mood insufficient to cause impairment in their social or occupational functioning

89
Q

What is a mnemonic to remember symptoms of manic episode

90
Q

What are the symptoms of a manic episode

A 
Distractable
Irresponsible 
Grandoisity 
Flight of ideas 
Activity increase 
Sleep reduction 
Talkativeness
91
Q

Describe time-frame in the following

a. Mania
b. Hypomania

A

a. >1W

b. >4d

92
Q

Describe presentation of mania

A

Severe functional impairment, requires hospitalisation due to risk to self or others

93
Q

What symptoms can be present in mania

A

Psychotic symptoms

94
Q

Describe hypomania

A

Lesser version of mania

95
Q

How long does hypomania last

96
Q

Describe psychotic symptoms in hypomania

A

No psychotic symptoms

97
Q

What is a mnemonic to remember depressive symptoms

A

SIG E CAPS

98
Q

What are symptoms of depressive episode

A 
Sleep disturbance 
Interest loss in activities 
Guilt
Energy low, Erection (libido) loss 
Cognitive decline 
Appetite loss 
Psychomotor agitation 
Suicidal ideation
99
Q

Explain investigation for bipolar depressive disorder

A

Any individual who presents to HCP should be asked - within the past 4-days have you experienced any symptoms of persistently raised mood?

100
Q

What should happen to an individual if they have had episodes of hyper-excitability in the past 4-days

A

Specialist referral to psychiatric assessment unit

101
Q

What does a specialist assessment involve

A

Risk assessment

Psychiatric assessment

102
Q

Describe conservative measures to manage mania or hypomania

A
  1. Calming environment
  2. Recommend individual does not make any large life choices until post-recovery
  3. Refer to CMHT
103
Q

What is first-line medical treatment for mania or hypomania

A

Antipsychotic

104
Q

What antipsychotics are offered for mania in bipolar disorder

A

Olanzipine
Risperidone
Quetiapine

105
Q

What is second-line for manic episode in bipolar disorder

106
Q

What is third-line for mania in bipolar disorder

107
Q

If someone is on an antidepressant and has a manic episode, what should be done

A

Stop antidepressant and start antipsychotic

108
Q

if pharmacological measures are ineffective in manic episode of bipolar what is used

109
Q

When is ECT used

A

To induce rapid remission in symptoms

110
Q

What conservative measures are used to treat depressive episode in bipolar

A

High-intensity psychosocial intervention

111
Q

Name three high-intensity psychosocial interventions

A
  • Interpersonal therapy
  • CBT
  • Behavioural couples therapy
112
Q

What medical treatment is first-line for depressive episode in bipolar disorder

A

Fluoxetine and Olanzapine

113
Q

What is an alternative to fluoxetine and olanzapine in depressive episode of bipolar

A

Quetiapine

114
Q

When is third (/second-line) for depressive episode in bipolar

A

Lamotrigine

115
Q

What conservative measures are offered long-term for bipolar disorder

A

High-intensity individual and group psychological interventions to prevent relapses

116
Q

What is first-line long-term management for bipolar

117
Q

What is second-line long-term management for bipolar

A

Valproate

Or:
Olanzapine

Or:
Quetiapine

118
Q

What should individuals with bipolar be reviewed for annually

A
  • BMI
  • Weight
  • Cardiovascular profile: HbA1c, Lipid Profile
  • LFTs
119
Q

If on lithium, what 3 things should be checked

A

TFT
Renal Function
Calcium

120
Q

What two medications offered for bipolar are teratogenic during pregnancy

A
  • Valproate

- Lithium

121
Q

What medications are safe alternatives in pregnancy

A
  • Lamotrigine

- Olanzapine

122
Q

What drug for bipolar is contraindicated in breast feeding

123
Q

Explain risk of bipolar and what is done to address this

A

Increases risk of CVD (4-times) and diabetes (4-times0

: therefore monitor CVD risk factors annually in these patients

124
Q

What is grief

A

Period of grief, low mood and adaptation following a bereavement

125
Q

Define prolonged greif

A

Grief> 12m

126
Q

Define delayed grief

A

Onset of grief 2W after initial loss

127
Q

What are 4 risk factors for abnormal grief reaction

A
  • Women
  • Unexpected death
  • Problematic relationship
  • Poor social support
128
Q

Who outlined stages of grief

A

Kuber and Ross

129
Q

What is a mnemonic to remember Kuber-Ross stages of grief

130
Q

What are the Kuber Ross stages of grief

A 
Denial 
Anger 
Bargaining 
Depression 
Acceptance
131
Q

Explain how an individual may progress through stages

A

Individual may not progress through all stages, can progress through them in a non-linear fashion. If someone is stuck in a stage they may need assistance

132
Q

What can happen in denial stage of grief

A

Individual may experience pseudo hallucinations (visual and auditory). They can focus on objects that reminds them of their loved one and even prepare meals for them

Psychiatry (13 decks)

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