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Psychiatry > Affect & Depression > Flashcards

Affect & Depression Flashcards

1
Q

What is the prevalence of depression?

A

Around 2-5% (1 in 5)

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2
Q

Who is depression most common in- males or females?

A

F2:M1

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3
Q

What are the core symptoms of depression?

A

Anhedonia, low mood (may have diurnal variation and be worse in the morning) and reduced energy

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4
Q

How long do symptoms need to be lasting for in order to diagnose depression?

A

2 weeks and NOT secondary to the effects of drug/alcohol misuse, organic illness or bereavement.

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5
Q

What are the ICD-10 criteria for depression?

A

Low mood, loss of interest, reduced energy levels, sleep disturbance, change in appetite, reduced concentration, reduced sex drive, loss of confidence, guilt feelings and suicidal thoughts.

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6
Q

How many of the criteria do you need to diagnose depression?

A 
Mild= 2 core and 2 other
Moderate= 2 core and 3 other
Severe= 3 core and 4 other
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7
Q

What is BAD?

A

Bipolar affective disorder

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8
Q

What is the mean age of onset of BAD?

A

21 years

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9
Q

Who is BAD more common in?

A

Equal between males and females.

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10
Q

What is the prevalence of BAD?

A

1%

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11
Q

What are the genetic associations of BAD in twins?

A

Mz 79% Dz 19%

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12
Q

What are the ICD-10 criteria for a manic episode?

A

Elated mood, irritable, labile, increased energy, overactivity, distractibility, reduced NEED for sleep, poor concentration, constant change of plans, inflated self-esteem, grandiosity, overfamiliarity, disinhibition, reckless behaviour, overspending, increase in sex drive, racing thoughts or flight of ideas.

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13
Q

What is BAD according to ICD-10?

A

It is one episode of mania with or without depression and one episode of hypomania with depression. (recurrent episodes of mania to diagnose BAD). The text book says 2 or more episodes of depression and mania or hypomania.

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14
Q

What is hypomania?

A

A lesser degree of mania.

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15
Q

What is the monoamine hypothesis of depression?

A

This suggests that mania results from increased levels of noradrenaline, serotonin (5HT) and dopamine and it has been observed that drugs such as cocaine and amphetamines can exacerbate mania.

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16
Q

What is the evidence behind this?

A

Reserpine ( a former anti-hypertensive drug) depletes brain MA and this can cause depression.

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17
Q

How do anti-depressants work?

A

They inhibit the uptake or breakdown of monoamine (MA).

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18
Q

What is the onset of action of antidepressants?

A

Biochemically they rapidly block NAd or 5HT uptake but clinical improvement takes up to 4-6weeks.

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19
Q

What are the three mode of actions of antidepressants?

A

Monoamine re-uptake inhibitors, receptor antagonists, monoamine oxidase inhibitors.

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20
Q

Name the 5 types of MA re-uptake Inhibitors?

A

TCAs, SSRIs, NARI, SNRIs and NaSSa

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21
Q

What type of anti-depressant is citalopram?

A

SSRI

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22
Q

Venlafaxine?

A

SNRI (N N)

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23
Q

Lofepramine?

A

TCA

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24
Q

Mirtazapine?

A

Noradrenaline and specific serotonin antidepressant (NaSSa)

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25
Q

Reboxetine

A

Noradrenaline re-uptake inhibs….. (R R)

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26
Q

Amytriptyline?

A

TCA

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27
Q

Fluoxetine?

A

SSRI (5HT)

28
Q

What are the side effects associated with NaSSa?

A

Sedative and weight gain

29
Q

What must you do before issuing Venlafaxine?

A

Check BP, ECG

30
Q

What is NICE first line for depression?

A

SSRIs, side effects GI problems and half life varies. also safe in overdose

31
Q

What are the side effects of TCAs?

A

Toxicity in overdose, except lofepramine. Its an anti-cholinergic so arrhythmias, sedation

32
Q

What are the side effects of SSRIs?

A

Agitation, nausea/loss of apetite, indigestion, diarrhoea, constipation, loss of libido, erectile dysfunction, dizziness, dry mouth, blurred vision, sweatiness, headaches

33
Q

What do mono-amine oxidase inhibitors do?

A

They prevent the degradation of mono amines in the pre-synaptic cleft

34
Q

Why are MAOIs rarely used?

A

They are poorly tolerated and monoamine oxidase breaks down tyramine in your gut so if you eat tyramine you won’t be able to break it down and there is potential for a hypertensive crisis.

35
Q

What does tyramine do?

A

Tyramine leads to hypertensive crisis by increasing the release of norepinephrine (NE), which causes blood vessels to constrict (through binding to alpha-1 adrenergic receptors)

36
Q

What foods contain tyramine?

A

Cheese, pate, alcohol

37
Q

What is an arbitrary inference?

A

Drawing a conclusion in the absence of evidence..everyone in this library hates me

38
Q

What is overgeneralistion?

A

One student gave me a dirty look, everyone in this library hates me

39
Q

What is dichotomous thinking?

A

All or nothing thinking, e.g. if he doesn’t come see me today he doesn’t love him.

40
Q

Magnification/mimisation?

A

Over or underestimating an event.

41
Q

What is catastrophic thinking?

A

Expecting a disaster to strike,

42
Q

What is personalisation?

A

Relating independent external events to oneself. Someone just left the library, it must be because they hate me.

43
Q

What are the core features of depression?

A

Depressed mood, loss of interest & enjoyment and fatiguability (loss of energy)

44
Q

What are somatic features of depression?

A

Sleep disturbance, early morning waking, morning depression, loss of apetite/libido, anhedonia and agitation or retardation.

45
Q

What is the difference between dysthymia and mild chronic depression?

A

Dysthymia is a mild chronic depressive symptoms not as severe as mild depressive disorder.

46
Q

If dysthymia develops into depression, what is it called?

A

Double depression

47
Q

What is the ICD 10 criteria for a mild depressive episode ?

A

At least two of depressed mood, loss of interest and energy plus at least two other symptoms for a minimum period of 2 weeks.

48
Q

How does ICD 10 class a moderate depressive episode?

A

At least 2 of core plus three preferably 4 of others. Present to an intense degree.

49
Q

How does ICD 10 class a severe depressive episode?

A

Considerable distress of agitation, unless retardation is a marked feature. Psychotic symptoms may be present and are usually mood congruent.

50
Q

What percentage of patients are antidepressants effective in?

A

Over 60% of patients

51
Q

What is defined as treatment resistant depression?

A

When a pt fails to respond to two drugs of same class of different class,

52
Q

Why have SSRIs replaced TCAs as first line?

A

Safety in overdose, lesser need for dose titration.

53
Q

Which anti-depressants should be avoided in suicidality?

A

Avoid TCAs and MAOIs

54
Q

Who else should TCA’s be avoided in?

A

Elderly and physically ill pts. Also may promote ‘rapid cycling’ in bipolar disorder.

55
Q

Which antidepressants can be used in pregnancy?

A

SSRI fluoxetine, and the TCAs nortripyling, amitriptyline and imipramine in pregnancy.

56
Q

Which antidepressants can be used in breast feeding?

A

SSRIs paroxetine or sertraline.

57
Q

What is rapid cycling?

A

Refers to four or more episodes of mania, hypomania and/or depression in a period of one year.

58
Q

Which SSRIs inhibit cytochrome p450?

A

Fluoxetine, fluvoxamine and paroxetine.

59
Q

What does discontinuation syndrome consist of?

A

Headache, dizziness, shock-like sensations, paraesthesia, GI symptoms, lethargy, insomnia and change in mood (depression/anxiety/agitation). Frequently paroxetine. This does not mean anti-depressants are addictive!!

60
Q

Just a recap but what are the symptoms of serotonin syndrome?

A

Agitation, confusion, nystagmus, myoclonus, tremor, seizures, hyperpyrexia, autonomic instability.

61
Q

What symptoms does 5-HT2 blockade cause?

A

Weight gain and sexual dysfunction.

62
Q

How does the patient die in a hypertensive crisis?

A

Of a subarachnoid hemorrhage (well can result in). Due to tyramine in their diet.

63
Q

How long after stopping a MAOI can you start a TCA or an SSRI?

A

2 weeks

64
Q

How long do manic episodes usually last for?

A

About 6 months and rarely last for more than a year except in the elderly.

65
Q

What is the difference between mania and hypomania?

A

No psychotic features in hypo and NO MARKED impairment of social functioning

Psychiatry (24 decks)

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