Abnormal mood Flashcards
Define euthymic?
- normal mood
Define hyperthymic?
- elevated mood
Define cyclothymic?
- variable mood
Define anhedonia?
- loss of enjoyment
Define stupor?
- absence of relational functions
- e.g. action and speech
Presentation of depression?
- facial expression reduced
- insight preserved
- 2nd person hallucinations
- Reduced rate of speech
Explain mood?
- prolonged prevailing state
- subjective
- how do you feel
Explain Affect?
- how the patients feelings change in relation to their environment
- objective
What is Cortard’s syndrome?
- nihilistic deliusions
- lost organs
- bloods
- body part
Observations seen in depression
- slower movements
- fiddling
- defeated posture
- exhausted
- worrying
- mood low
What is the main classification system used in the UK?
icd 10
in next year ICD 11
How is depression diagnosed?
- at least 2 weeks
- no hypomanic or mani symptoms to meet that diagnosis
2 out of 3 criteria for depression?
- depressed mood for that person
- loss of interest or pleasure
- decreased energy
Minimum score for moderate episode of depression
- 2 core
- 4 others
- minimum of 6
Minimum score for severe episode of depression?
- 3 core
- 5 others
- minimum 8 in total
What is bipolar 1
- at least 1 previous episode of mania + depression
What is bipolar 2
- current or past hypomanic episodes
- never met criteria for manic episodes
What is hypomania
- elevated to a degree abnormal to the individual
- for 4 consecutive days
- 3/7 additional symptoms
Additional hypomania symptoms
- increased activity
- increased talkative
- difficulty concentrating
- decreased need for sleep
- increased sexual energy
- mild spending spree
What is a manic episode
- elevated or irritable mood
- sustained for 1 week
- severe interference with daily functioning
- 3/9 additional symptoms
Additional symptoms of a manic episode
- increased activity
- pressure of speech
- flight of ideas
- loss of normal social inhibitions
- decreased need for sleep
- inflated self-esteem
- distractibility
- reckless behaviour
- marked sexual energy
Average onset of bipolar disorder?
late teens
early 20s
Bipolar 1 vs bipolar 2
- bipolar 2 more common - major depression to hypomania
- bipolar 1 - major depression to mania
Co-morbidities of bipolar disorder?
- Anxiety disorders
- Alcohol and drug misuse
- Personality disorder
- Eating disorder
- Schizophrenia
- Schizoaffective disorder
Which has the bigger proportion of depression, bipolar 1 or 2?
- bipolar 2 has a larger proportion of the time with depression
Which has the bigger proportion of depression, bipolar 1 or 2?
- bipolar 2 has a larger proportion of the time with depression
Most common mood disturbance in bipolar?
- depression
- causes the patient most issues
What is cyclothymia?
- cycling between hypomania and dysthymia
What is dysthymia?
- low mood
- persistent
- usually 2 years
- less severe than major depression
What is the mood spectrum?
- major depression
- dysthymia
- normal
- hypomania
- mania
What is an example of a self-rated scale for mood?
- IDS-30
What scaling system is used for ECT and is an observer rated scale?
- MADRS
- Montgomery-Asberg Rating scale
- good for ECT
- Observer rated
Often what is the first line pharmacological treatment for depression?
- sertaline
- mirtazapine
Side effect of mirtazapine?
- increased appetite
- increased weigh
Preventing relapse in depression
- 1st episode = continue antidepressants for 6mnths after full recovery
- 2nd episode = continue antidepressants for 1-2yrs after full recovery
- may require to be on antidepressants for life
Treatment of acute mania/hypomania in bipolar?
- stop antidepressants
- hospitalisation??
- antipsychotics = olanzapine, quetiapine
- others = lithium, valproate, carbamezpine
Treatment of acute depression in bipolar?
- anti-psychotics
- SSRIs (don’t give anti-depressants alone)
- ECT
- Lithium
Gold standard for bipolar maintenance?
- lithium
Side effect of SSRIs and SNRI?
- Falls in elderly
- hyponatraemia
What is ECT used for?
- depression
Explain ECT
- Bilateral bitemporal ECT
- 2 weekly
- 6-12treatments
- seizures last 15-30seconds
Side effects of ECT?
- Headaches
- memory impairment
CBASP vs CBT?
- CBASP like CBT but with more emphasis of the childhood
What are the 4 Ps of psychiatric factors?
- Predisposing
- Precipitating
- Prolonging
- Protective
What are the 2 functional differentiations in the brain?
- appetitive/approach
- aversive/deffensive
The appetitive differentiation of the brain mainly involves what neurotransmitter?
- dopamine
The aversive differentiation of the brain is mainly what neurotransmitter?
- serotonin
What is over secreted in depression? (endocrine)
- CRF
- Excess cortisol
- desensitisation of cortisol receptors
What is increased in blood works in depression?
- increased cytokines
What happens to the hippocampal volume in depression?
- reduction in hippocampal volume
What is the hippocampus connected to?
- prefrontal cortex (working memory, cognition, mood)
- amygdala (emotion and fear)
What are potential aetiological theories of depression?
- genetic
- monoamines reduced
- increased cortisol
- increased cytokines
- hippocampal atrophy
- reduced BDNF
What is BDNF?
- Brain derived neurotrophic factor
- involved in neogenesis
- BDNF reduced in depression
