Affective Disorder's Flashcards
What are affective disorders?
Illnesses where the main feature is excessively high (e.g mania) or low mood (e.g depression)
What neurochemical theories are there for depression?
Monoamine hypothesis (depression results from a deficiency in brain monoamine neurotransmitters):
- Noradrenaline (affects mood and energy)
- Serotonin (affects sleep, appetite, memory and mood)
- Dopamine (affects psychomotor activity)
What are the core symptoms of depression (3)?
- Low mood
- Anergia (low energy)
- Anhedonia (inability to feel pleasure from normally pleasurable activities)
What is the core symptoms-related diagnostic criteria for depression? (2)
At least 2 core symptoms
At least 2 weeks of symptoms
What are the cognitive symptoms of depression?
Worthless
Helpless
Hopeless
What are the biological symptoms of depression?
- Altered sleep
- Initial insomnia
Early morning wakening (waking at least 2 hours earlier than normal)
Hypersomnia is possible (may coexist with hyperphagia) - Reduced appetite
- Reduced libido
- Constipation, aches and pains and dysmenorrhoea
What are the psychotic symptoms of depression?
Occur in severe depression:
Auditory hallucinations
Visual hallucinations
Delusions: often nihilistic and persecutory
Describe 4 subtypes of depression
Seasonal Affective Disorder: presents predictably with low mood in the winter. Usually reversed biological symptoms of overeating and oversleeping
Atypical Depression: no seasonal variation but shows reversed biological symptoms and may retain mood reactivity
Agitated Depression: depression with psychomotor agitation (instead of retardation) such as restlessness and pacing
Depressive Stupor: wen psychomotor retardation is so profound that the person grinds to a halt, hey become mute and stop eating, drinking or moving
Give some differentials for depression
Physical/organic causes (e.g. hypothyroidism, MS)
Adjustment disorder (unpleasant but mild affective symptoms follow a life event, but do not reach the severity needed to diagnose depression)
Normal sadness
Bereavement
BPAD/schizoaffective disorder/schizophrenia
Substance misuse
Postnatal depression/puerperal illness
Dementia
Give some investigations for depression
- Collateral history
- Physical examination
- Blood tests
TFT
FBC (anaemia causes fatigue)
Glucose and HbA1c (DM can cause fatigue) - Rating scales to monitor severity and treatment response (e.g. PHQ-9 questionnaire)
What is the treatment for mild depression?
- Referral to supportive counselling/community mental health teams (home treatment)
- Advice on; sleep hygiene, exercise, self-help
- Access to CBT & counselling
- Social stressors intervention (e.g time off work, refuge from abusers, debt advice etc)
What are the principles of CBT (cognitive behavioural therapy), a type of psychological treatment?
- Identification of NATs (negative automatic thoughts)
- Influencing thought and behaviour, to improve mood
Examples of NATs that will be challenged in CBT: - Generalisations - ‘always messing up everything’
- Distorted beliefs - ‘no one cares about me/wants to spend time with me’
CBT can introduce behavioural experiments (e.g inviting friends over to dinner)
–> building up a set of more realistic beliefs
Describe psychodynamic psychotherapy for depression
- Identifying transferences (application of unconscious templates of relationships, derived from the past, to new situations)
- Allows pt to recognise hidden beliefs
- -> can re-evaluate based on current reality
What classes of drugs can be given for depression, and what is the main aim of action?
SSRIs, SNRIs, TCAs
- Aim to increase overall level of monoamines at the synapse (can lead to downregulation of serotonin and central beta-adrenergic receptors –> 4-6 week delay in antidepressant effects)
- Indicated for moderate-severe depression, in combination with psychotherapy
Give examples of SSRIs used in depression and some side effects
Fluoxetine, sertraline, paroxetine, fluvoxamine, citalopram, escitalopram
- Nausea and vomiting
- Appetite/weight change
- Anxiety and agitation
- Insomnia, tremor, dizziness
- Headache
- Sweating
Give examples of SNRIs used in depression and some side effects
Venlafaxine, duloxetine Side effects are same as SSRIs but also… - Constipation - Hypertension - Raised cholesterol
Give examples of TCAs used in depression and some side effects
Amitriptyline, clomipramine, imipramine, lofepramine, dosulepin Side-effects: - Tachycardia, arrhythmias - Dry mouth - Constipation - Urinary retention - Postural hypotension - Nausea - Weight gain
What are some important considerations of taking antidepressants?
- Lower seizure threshold (careful in epilepsy)
- Avoid in mania/hypomania
- Do not drink alcohol (increased sedation), do not drive if feeling drowsy
- Onset of action is delayed
Stopping:
- Discontinuation symptoms (flu-like, electric shock sensations, headache)
Therefore should be withdrawn over a few weeks
- Serotonin syndrome (giving 2 antidepressants at once) –> life threatening
Give some other treatments for depression
Augmentation: lithium, thyroxine
ECT (electroconvulsive therapy)
Light therapy (for seasonal affective disorder)
Differentiate between mania and hypomania
Manic episode: symptoms should last at least a week and prevent work and ordinary social activities
Hypomania: less severe symptoms that do NOT entirely disrupt the patient’s ability to function
Give some core symptoms of mania
- Mood, energy and enjoyment are elevated
- Raised mood can range from cheerfulness to elation and uncontrollable excitement, through irritability and aggression
- Labile mood
- Pt indulges in many new activities
Give some cognitive symptoms of mania
- Inflated self-esteem and confidence
- Belief they are; gifted, attractive, creative, intelligent and extremely special
- Thoughts race
- Concentration dissolves
- Despite being very distractible, the patient may feel that they can think more clearly than ever
- Speech becomes pressured and topics change rapidly (flight of ideas)
Give some biological symptoms of mania
- Reduced sleep
- Voracious appetites for food and sex
- Reckless, disinhibited behaviour
- Tendencies to; spend excessively, drive recklessly or gamble their money
- Drugs or alcohol become new interests and make the patient more disinhibited
Give some psychotic symptoms of mania
- Grandiose delusions: optimism develops (e.g fame, special powers)
- Persecutory delusions: pt believes other are jealous of them
- Auditory hallucinations
