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Abnormal mood Flashcards

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1
Q

what is adjustment disorder

A

getting over a significant life event (may present similar to depression but not depression)

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2
Q

how long does adjustment disorder last

A

<1 month from event

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3
Q

50% of mental health disorders start before the age of

A

14

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4
Q

50% of mood disorders start before the age of

A

30

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5
Q

risk factors for depression

A

significant life events - loss of primary caregiver <11yo

chronic illness - eg cancer, diabetes, stroke

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6
Q

typical age of onset of depression

A

10-20yo

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7
Q

what age does late onset depression occur in

what is it associated with

A

> 60yo

loneliness

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8
Q

are men or women more likely to get depression

A

women

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9
Q

which pathways are decreased in depression (2)

A

serotonin pathway

noradrenaline pathway

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10
Q

what is the neurotransmitter in the serotonin pathway that is decreased in depression

A

5-hydroxytrytamine (5-HT)

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11
Q

what part of the brain does the serotonin pathway innervate (and hence is less stimulated in depression)

A

amygdala

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12
Q

what chemical normally recycles serotonin and noradrenaline (and is hence a target for treatment of depression)

A

monoamine oxidase (MAO)

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13
Q

how do monoamine oxidase inhibitors (MAOi) work

A

decrease how much serotonin ad noradrenaline are recycled = increase conc of them = decrease depressive symptoms

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14
Q

what 2 (main) endocrine changes happen in depression

A

increased cortisol

large adrenal glands

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15
Q

what happens to hippocampal volume in depression

A

decreases

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16
Q

presentation of depression (things you must ask!)

A 
sleep disturbance = tiredness
suicidal ideation 
loss of appetite = weight loss 
amotivation - housebound?
anhedonia - loss of enjoyment in things previously enjoyable 
lack of concentration 
irritable 
psychomotor retardation - slowing of thoughts/movements

ask about delusions for ?psychosis
ask about manic symptoms for ?bipolar

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17
Q

what is initial insomnia

A

when you cant get to sleep for hours

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18
Q

what is middle/interrupting insomnia

A

when you wake in the middle of the night and cant get back to sleep

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19
Q

what is late insomnia

A

when you wake up several hours earlier than normal and cant get back to sleep

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20
Q

when is depression typically worse (what time of day)

A

worse in morning, better as day goes on

diurnal variation

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21
Q

what is loss of pleasure/joy in things previously enjoyable called

associated with depression

A

anhedonia

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22
Q

what is psychomotor retardation

associated with depression

A

slowing of thoughts/movements

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23
Q

what is it called when someone has depressive delusions (of worhlessness etc), 2nd person hallucinations (people telling them theyre useless), nilhistic delusions (walking corpse)

A

psychotic depression

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24
Q

what is a nilhilistic delusion

what syndrome is this characteristic of

A

the idea that their body is dying
that they are a walking corpse

coharts syndrome - in the elderly, rare

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25
Q

social history questions to ask in ?depression

A 
finances 
people at home (esp if suicidal)
sexual function 
upbringing 
recent traumatic event/change
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26
Q

describe the mental state examination (MSE) findings likely in someone with depression

A

appearance - disheveled, furrowed brow, reduced facial expression
behavior - difficult rapport, reduced eye contact
speech - slow, low, quiet, monotonous, unresponsive to Qs
emotion - low, depressed, flat, tearful, ‘empty’
perception - probs none
thoughts - normal form, slow/absent, negative content, pessimism, guilt, suicide
insight - usually yes, sometimes blame other things
cognition - slow, poor memory

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27
Q

walking corpse

elderly person

A

coharts syndrome

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28
Q

how long does depressive symptoms need to be present for diagnosis
what are the other 2 core symptoms included in diagnosis

A

> 2 weeks

loss of interest/pleasure
decreased energy

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29
Q

what must you rule out before you give antidepressants in ?depression

A

bipolar

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30
Q

mild depression criteria

A

2/3 core symptoms

2/7 additional symptoms

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31
Q

moderate depression criteria

A

2/3 core symptoms

4/7 additional symptoms

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32
Q

severe depression criteria

A

3/3 core symptoms

5/7 additional symptoms (suicidal ideation = severe)

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33
Q

treatment of mild depression

A 
NOT anti depressants 
exercise!!
hobbies, socializing
improve sleep
time off work 
online CBT
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34
Q

treatment of moderate depression

A

SSRI (antidepressant) and CBT

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35
Q

after how long could you consider anti depressants for mild depression

A

> 8 weeks

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36
Q

treatment of severe depression

A

psych referral
ECT
?detention

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37
Q

how long should you continue an antidepressant for once its started working (if first episode)

A

6-12 months after started working

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38
Q

how long should you continue an antidepressant for once its started working (if second episode)

A

12-24 months after started working

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39
Q

how long should you continue an antidepressant for once its started working (if third episode)

A

indefinitely - patient decides but recommend to continue low dose
be aware of side effects
patient probs will want to be on it

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40
Q

if after 6 weeks antidepressant isnt working, what do you do

A

increase dose

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41
Q

if increased dose of antidepressant isn’t working what do you do

A

change drug

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42
Q

first line antidepressant for depression

A

SSRIs

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43
Q

second line antidepressant for depression

A

diff SSRI

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44
Q

first line SSRI choice for depression

A

citalopram

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45
Q

indication for fluoxetine for depression (as first line)

A

<18yo

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46
Q

SSRIs used for depression (4)

A

citalopram
sertraline
paroxetine
fluoxetine

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47
Q

indication for sertraline for depression (first line)

A

cardiac problems

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48
Q

what do you do if citalopram is ineffective

A

try diff SSRI - fluoxetine, paroxetine, sertraline

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49
Q

what do you need to monitor if you give citalopram

A

ECG for QT prolongation

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50
Q

if someone on antidepressants starts feeling better and just stops medication then starts getting headaches, sweaty, needle like sensation in head and anxiety, what has happened

A

discontinuation syndrome (bc stopped taking drug)

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51
Q

SNRI example

A

venlafaxine

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52
Q

when are SNRIs used in depression

A

fourth line

after
SSRI
diff SSRI
SSRI + mirtazapine

53
Q

indication for mirtazapine in depression

A

insomnia
poor appetite

bc SEs are weight gain and sedation

54
Q

what is bad about SNRIs (venlafaxine)

A

SEs are worse than SSRIs

55
Q

alternative antidepressant options after SSRI/diff SSRI/mirtazepine/SNRI

A

tricyclics (TCAs)
monoamine oxidase inhibitors (MAOi)
lithium carbonate - last line

56
Q

alternative to antidepressants in severe depression

A

ECT (electroconvulsive therapy)

57
Q

indications for ECT (electroconvulsive therapy) in severe depression

A

suicide risk
not eating
patients choice - past good experience from it

58
Q

how many treatments are involved in ECT therapy for severe depression
over what time

A

9 treatments
2 per week
lasts 4.5 weeks

59
Q

alternative to antidepressants in someone that doesn’t want to take drugs (eg side effects), or childhood abuse

mild/moderate depression

A

CBT

psychoeducation

60
Q

which herbal remedy do people take for depression but you should discourage (hence ask if theyre taking it)

A

st johns wort (hypericum perforatum)

61
Q

side effects of CBT

A

headache
tooth damage (given block)
memory/cognitive problems

62
Q

does bipolar or depression have a higher suicide risk

why

A

bipolar

bc the change between mania and depression (the highs and lows) is so drastic

63
Q

psychotic symptoms after birth

A

puerperal psychosis

note diff from post natal depression

64
Q

how many people get post natal depression

how many people et postnatal blues

A

10%

75%

= important to differentiate

65
Q

how long does post natal depression usually last

A

1-4 weeks after birth

66
Q

how long does baby blues usually last `

A

3-10days after birth

67
Q

differences in treatment of baby blues and post natal depression

A

baby blues - reassurance

post natal depression - counselling (mild), antidepressants and CBT (moderate), mother baby unit admission (severe)

68
Q

what medication can trigger bipolar disorder

A

SSRIs

69
Q

what causes bipolar disorder

A

multifactorial - genetic and environmental

70
Q

bipolar I

A

mania and depression

71
Q

bipolar II

A

hypomania and depression

72
Q

cyclothymia

A

mild bipolar

cycling of mood lots of times per day

73
Q

mixed affective disorder

A

major depressive episodes and mania/hypomania at same time/during same day

74
Q

do people with bipolar usually have insight

A

nah

75
Q

hypomania vs mania

which is abnormal for the individual but DOESNT interfere with their normal function

A

hypomania

76
Q

MSE findings for mania

A

appearance - bright colours
behavior - inappropriate, reckless, loss of normal inhibitions
speech - pressured, uninterruptable, puns ,rhyming
emotion - elated, irritable
perception - probs no hallucinations, maybe delusions
thoughts - increased flow, tangential, flight of ideas (NOT knights move), grandiosity
insight - probs nah
cognition - ? depends robs don’t know

77
Q

differences between mania and hypomania (5)

A

mania has; (hypomania doesn’t)

psychosis
flight of ideas
grandiosity 
interferes with their normal function
requires hospitalisation
78
Q

what must you ALWAYS ask in bipolar

A

suicidal ideation

79
Q

what is speech like in MSE of mania

A

uninterruptable
use of puns (words with same sounds)
use of rhymes

80
Q

if you ?mania as part of bipolar, what endocrine condition do you need to rule out

A

hypo/hyperthyroidism

81
Q

what drugs do you need to stop ASAP if diagnosis of bipolar

why

A

antidepressants

can cause a manic episode - dangerous!

82
Q

what is the only exception to not giving antidepressants in bipolar

A

bipolar depression

give fluoxetine (SSRI) with antipsychotic SHORT TERM, alongside antipsychotic (not alone

83
Q

first line class of antipsychotics for bipolar

A

atypical second generation antipsychotics

84
Q

second line class of antipsychotics for bipolar

A

typical first generation antipsychotics

85
Q

example of first line antipsychotic for bipolar (atypical second generation antipsychotics )

A

olanzepine
quetiapine
risperidone

86
Q

example of second line antipsychotic for bipolar (typical first generation antipsychotics )

A

haloperidol

87
Q

side effects of atypical second generation antipsychotics (eg olanzepine) (3)

A

weight gain
sedation
prolonged QT syndrome

88
Q

side effects of typical first generation antipsychotics (eg haloperidol)

A

extra pyramidal side effects (EPSE)

89
Q

how do you treat extra pyramidal side effects (EPSE) if the occur when taking haloperidol

A

procyclidine

90
Q

last line antipsychotic for bipolar (after olanzepine and haloperidol)

A

clozapine

91
Q

if antipyschotics (olanzepine, haloperidol then clozapine) are ineffective then what would you add on

who needs to do this

A

lithium carbonate

psychiatrist, not GP

92
Q

what must you do if you start someone on lithium

A

check lithium levels regularly

93
Q

what is the gold standard long term treatment for bipolar

A

lithium

94
Q

side effects of lithium

A

hypothyroidism (need to check TFTs)
dry mouth, salty taste
diabetes - polydipsia, polyuria
tremor

95
Q

alternative to lithium if antipsychotics alone are ineffective in bipolar

A

sodium valproate

96
Q

non drug treatments of bipolar

A

ECT - ?hospitalization

CBT

97
Q

how long do antidepressants take to work

A

weeks-months - warn patients!

98
Q

how long should you trial an antidepressant for before changing it

A

6 months

99
Q

are antidepressants addictive

A

no

this is sometimes why people aren’t keen, just reassure them

100
Q

how do SSRIs work

A

selective serotonin reuptake inhibitors = increases conc of serotonin at synaptic cleft = decreases depressive symptoms

101
Q

SSRI examples (4)

A

fluoxetine
citalopram
sertraline
paroxetine

102
Q

which SSRI is first line (for anything)

A

citalopram

103
Q

side effect of citalopram

A

long QT syndrome

104
Q

what do you use in patients with cardiac problems instead of citalopram (as causes long QT)

A

sertraline

105
Q

side effects of SSRIs

A

nausea
headache
worsened anxiety
sexual dysfunction

106
Q

what happens if you just stop taking a SSRI all of a sudden

A

discontinuation syndrome = need to warn patient not to!

107
Q

which age group shouldn’t get SSRIs

why

A

<25s

increases risk of suicide

108
Q

how do SNRIs work

A

selective noradrenaline reuptake inhibitors = increases conc of noradrenaline at synaptic cleft = decreases depressive symptoms

109
Q

SNRI examples (2)

A

duloxetine, venlafaxine

110
Q

why aren’t SNRIs used much

A

side effects worse than SSRIs eg insomnia (need to take it in the morning)

111
Q

how do tricyclics (TCAs) work

A

prevent reuptake of serotonin and noradrenaline = increase conc and presynaptic terminal = decreases depressive symptoms

112
Q

are TCAs used much

why

A

no

side effects not great - dry mouth, falls, cognitive impairment, postural hypotension

but good as an antidepressant if willing to tolerate SEs

113
Q

tricyclic examples (3)

A

imipramine
amitriptyline
clomipramine

114
Q

which group of people are contraindicated tricyclics (if you give must be low dose)

why

A

elderly

increased risk of falls and cognitive impairment

115
Q

if someone has ?dementia and is on amitriptyline (tricyclic) what should you do

A

take them off amitriptyline to see if it resolves

116
Q

which antidepressants are monoamine reuptake inhibitors

A

SSRIs
SNRIs
tricyclics

117
Q

which antidepressants aren’t monoamine reuptake inhibitors

A

monoamine oxidase inhibitors (MAOi)

118
Q

example of monoamine oxidase inhibitors (MAOi)

A

phenelzine

moclobemide

119
Q

how do monoamine oxidase inhibitors work (MAOi)

A

monoamine oxidase usually breaks down serotonin and noradrenaline
so MAOi = stops break down happening = increases conc of serotonin and noradrenaline = decreases depressive symptoms

120
Q

side effects of monoamine oxidase inhibitors (MAOi) (3)

A

hypertensive crisis
postural hypotension
insomnia

121
Q

what do you need to avoid if you are taking a monoamine oxidase inhibitor

what foods contain this (5)

what can it cause if you don’t avoid these foods

A

tyrosine

avoid; red wine, cheese, yeast products, gravy, caffiene

= HYPERTENSIVE CRISIS

122
Q

when are MOAi used in depression

A

last line, in SSRI/SNRI/tricyclic resistant depression

123
Q

why isn’t MOAi (monoamine oxidase inhibitors) used earlier on in treatment pathway for depression if they are better than the other antidepressants

A

hard compliance! need to avoid red wine, cheese, yeast etc
needs to carry a MAOi card
restrictions with medication also

124
Q

which antidepressant drug isn’t a monoamine oxidase inhibitor, SSRI, SNRI or tricyclic (hence is an atypical antidepressant)

A

mirtazapine

125
Q

how does mirtazapine work

A

blocks alpha2, 5-HT2, 5-HT3

126
Q

side effects of mirtazapine

A

weight gain

sedation (may be good)

127
Q

when would you use mirtazapine in depression

A

alongside SSRI/SNRI

128
Q

amitriptyline mechanism

A

inhibits monoamine reuptake in presynaptic membrane

J Psych (14 decks)

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