Affective Disorders Flashcards
Unipolar and BPAD definition
Unipolar = depression episodes
BPAD = mania OR mania and depression episodes
Aeiology of BPAD and depression: genetics, lifetime prevalence and female:male ratio
- Heritability = depression (35-50%), BPAD (80-90%)
- Lifetime prevalence = depression>BPAD
- Female:male = depression (2:1), BPAD (1:1)
polygenic
depression can occur without an obvious trigger (e.g. strong FHx)
Childhood and life experience: depression, mania triggers
Childhood -> depression
- abuse/neglect
- institutionalisation -> tx resistance
life experience -> depression
- unemployment
- lack of confident relationships
- lower SES
- social isolation
- loss
life experience -> mania
- -ve and +ve life events
triggers of manic episodes
- childbirth, sleep deprivation, flying across time zones
childhood maltreatment consequences
recurrent + persistent depressive episodes
increased bPAD severity + comorbidity w/ more frequent relapses + suicide attempts than in children w/o childhood abuse
Behavioural and cognitive theories of depression
learned helplessness = depressed people learn they cant change their situation, leading them to give up
self, world, future -> -ve thoughts -> worthless/guilty, hopeless, hopeless
Psychoanalytical theories of depression
early experiences (especially quality of earlky relationship)
superego bullies ego into despair
mania considered an unconscious self-defence against depression by denying vulnerability
Neurochemical theories of depression
what medication can cause depression
Monomamine hypothesis (deficiency of brain monoamine NTs)
- serotonin (H-HT) = mood, sleep, appetite, memory
- NA = mood, energy
- DA = psychomotor activity and motivation
anti-depressants increase 5-HT and NA levels
riserpine (adrenergic blocking agent for hypertension depletes monomamines)
neurochemical theories for mania
what medications treat mania
monoamine overactivity
- bromocriptine (dopamine agonist)
- L-dopa
- amphetamine
- cocaine
- anti-depressants
tx for mania = anti-psychotics (dopmaine receptor antagonists)
glutamate overactivity can result in mania -> mood stabilisers decrease glutamate activity
neuroendocrine abnormalities -> depression
high cortisol
- hippocampal damage and reduction in serotonin
- linked to CVD and diabetes (chronic conditions and depression link)
neuroanatomical abnormalities theory for depression
Left anterior cingulate cortex abnormality -> DBS potential treatment for severe treatment-resistant depression
classification of depression: cog, bio, psychotic
mild, moderate, severe, severe w/ psychotic sx
Symptoms:
- 2 of low mood, interest or energy almost daily for two weeks alongside other sx
Cognitive sx
- worthlessness, unconfident, unworthy
- guilty, hopeless about future
- helpless to improve situation
- struggle concentrating, slow think
- pseudodementia when old
Biological sx
- altered sleep (insomnia, early morning wake aka wake up 2 hours before usual)
- reduced appetitie -> weight loss, low libido (hypersomnia/hyperphagia)
- constipation, aches, pains
Psychotic
- halucinations and delusions (mood congruent)
- 2nd person, derogatory
- nihilistic, persecutory, guilt related
Mild depressive episode
- 2 or 3 of above symptoms usually present. Patient usually distressed by these but will probably be able to continue with most activities
Moderate depressive episode
- 4 or more of above sx usually present and pt likely to have great difficulty in continuing with ordinary activities
Severe depressive episode w/o psychotic sx
- several of above sx marked and distressing (loss of self-esteem, worthlessness, guilt), suicidal thoughts and acts common, somatic sx usually present
Severe depressive episode with psychotic sx
- as previous but with presence of hallucinations, delusions, psychomotor retardation, or stupor
- may/may not be mood congruent
- so severe that ordinary social activities are impossible
- danger to life from suicide, dehydration, starvation
DDx for depression
Organic
- hypothyroidism, hypoactive delirium, addison disease, dementia, neurodegenrative disorders
sadness/bereavement = normal responses to upsetting events or losses
adjustment disorder = mild affective sx after stressful event, not severe enough to diagnose depression
dysthymia = chronic low mood for more days than not, lasting years, but not continuous enough to diagnose depression
BPAD = recurrent mood episodes, with at least one hypomanic/manic episode
substance abuse = can cause/mask depression
postpartum depression
burnout = exhaustion, disengagement, and reduced productivity in response to chronic work stress
- tx = addressing work porblems
- committed, conscientious, compassionat people are at highest risk
Bereavement: normal stages
numbness
pining
depression
recovery
prolonged grief disorder response characteristics (4)
prolonged = >6 months without any relief
extremely intense = longing for deceased or persistent preoccupation, with intense emotional pain
exceeds expected social, culutral, or religious norms for their context
significantly impairs functioning
Ix for depression
Bedside:
- full set obs
- collateral hx
- rating scales (PHQ-9)
- cognitive assessment
Bloods:
- TFTs
- FBC
- Glucose/HbA1c (diabetes causes fatigue)
- VitD and B12
- Calcium (hyperparathyroidism can cause depression)
Radiology
- CT/MRI head to exclude suspected cerebral pathology
Mx: 1st line SSRIs for moderate-severe depression
examples, benefits, common side effects and good to know
citalopram, escitalopram, fluoxetine, fluvoxamine, paroxetine, sertraline
- paroxetine = very short half life so delaying tablet can cause discontinuation sx
benefits:
- less side effects
- safer in overdose
how to take
- 1-2 weeks to take effect
- 6-9 months after recovery to prevent relapse
- suicidal thoughts so safety net
- NOT for hypomania/mania hx as ‘switching’
common side effects:
- N+V
- dyspepsia, diarrhoea
- anxiety/agitation
- insomnia
- tremor
- headache
- sweating
- sexual dysfunction
- GI bleeding
- hyponatraemia
Good to know:
- enhances 5-HT neurotransmission
What is St Johns wort used for?
mild depression
but induces enzymes, increasing metabolism of drugs (e.g. contraceptive pill)
comparison of anti-depressents (TCAs)
TCAs = amitiptyline, clomipramine, imipramine, lofepramine
- anticholinergic side effects: blurred vision, dry mouth, constipation, urinary retention, arrhythmia, postural hypotension, sedation, sexual dysfunction
- CARDIOTOXIC so infrequently used
‘switching’
people who respoind too well to antidepressants may be switching from depression to mania (undiagnosed BPAD)
Stopping and swapping in depression: discontinuation sx and serotonin syndrome
discontinuation sx = flu-like, electric shock, dizzy, headache, vivid dreams, irritable
serotonin syndrome (multiple antidepressants) = restlessness, sweating, myoclonus, confusions, fits
Tx resistance to antidepressants
medication concordance and diagnosis revied before considering a higher dose, different medication, or different of antidepressants
augmentation strategies with depression
lithium
SGAs = lower dose than for psychosis
T3
combining 2 antidepressants
ECT for depression
w/ GA + muscle relaxant
for life-threatining, tx resistant depression
-> generalised tonic-clonic seizure
Side effects:
- acute = achy, tired, sick, confused
- long term = memory loss from just before ECT (use lower dose, unilateral electrodes)
rTMS
no anaesthetic
few side effects
light therapy
for SAD
exercise
C25K and parkrun = increases activity while connecting people with others though shared, achievable challenges
CBT
individual/groups
goal orientated, here and now
8 - 24 weeks
behavioural activation first step
- next step is to activate behaviours AND thoughts
Negative automatic thoughts (NATs): generalisation and minimisation
- discussion and behavioural experiments to challege distorted beliefs
relapse prevention
Psychodynamic therapy
over a year or 16-20 weeks
transference (past experiecne cause them to behave unconsciously in certain ways)
draw from unconscious and articulate and evaluate them
IPT and MBCT
IPT
- unresolved loss, role transitions, relationship conflicts, and social skills deficits
MBCT
- mindful awareness aka notice what happening externally and within mind and body at any particular moment
- mindful meditation practce and reduces risk of relaspe in recurrent depressive disorder
Social interventions
psychoeducation
support groups
exercise, diet, sleep hygiene
problem solving for social stressors
CMHTs (e.g. home treatment/crisis teams, care coordinators)
Prognosis of depression
50% have second depressive episode
recurrence risk increases with each episode
average episode lasts 8-9 months, 2-3 months with tx
depression w/ psychotic sx worse prognosis but responds better to ECT
15% die by suicide (severe and w/ psychotic sx highest risk)
Sleep hygiene: tips for a good night’s sleep
Hypomania criteria
Hypomania (F30.0) = mood elevated to a degree that is out of character for individual (collateral hx) and sustained for at least 4 days in a row (NOT severe enough for disruption of work result in social rejection, no psychotic features, no require admission – mania more severe)
- Not as extreme as mania (hypomania -> moderate mania -> severe mania)
- Has been at least one other affective episode in the past
At least 3 of the following present:
- Increased activity, restlessness
- Increased talkativeness (pressured speech)
- Difficulty concentrating, distractibility
- Decreased need for sleep (don’t feel tired when wake up from sleep)
- Increased sexual energy (may have promiscuity)
- Mild spending sprees (often thing they don’t need with money they don’t have)
- Increased sociability
mania criteria: with and without psychotic sx
Mania = impaired functioning (social, occupation), or needs hospitalisation + presence of psychotic symptoms
more than a week
BPAD criteria
At least 2 episodes, one must be hypomania/mania/mixed (other can be depressive) with complete recovery between 2 episodes
Mania lasts 1w-4m, depression longer (6 months)
Distributed evenly between genders
First episode <30 years, peak at 15-19 years
Length of time to diagnosis >10 years as misdiagnosed depression/mania seen as ‘good days’
50% attempt suicide (half tend to complete)
remission = no mood disturbance for last several months
BPAD DSM-V classification
BPAD risk factors and aetiology
Depression vs mania
mania core sx:
elated/irritable
energetic
new activities, contacts
DDx for BPAD
organic = delirium, intoxication (e.g. amphetamines, cocaine), dementia, frontal lobe damage, cerebral infection (e.g. HIV), myoxedema amdness (hyperactivity in extreme hypothyroidism)
schizoaffective disorder = psychotic and affective sx evolve simultaneously
emotionally unstable personality disorder = labile mood and impulsivity can mimic mania, but will be persistent traits, not episodic sx
perinatal disorders
ADHD = more persistent and develops earlier
Ix for BPAD
bedside
- collateral hx
- physical examination
bloods
- FBC, TFTs, CRP/ESR for infection/autoimmune/thyroid pproblems
- HIV tests
- urinary drug screen
- lumbar puncture
radiology
- CT/MRI head for intracerebral causes if indicated (e.g. abrupt symptoms, change in consciousness, focal neurological signs)
BPAD mx: medications
Acute mania with agitation = IM therapy w/ neuroleptic or BDZP (e.g. Lorazepam, aripriprazole). May need urgent admission to a secure unit.
Acute mania without agitation = anti-psychotic (e.g. olanzapine but alternatives include haloperidol, risperidone and quetiapine)
Acute depression = SSRIs (e.g. citalopram)
Acutely patients may lack insight and will refuse admission to hospital. May need to contact mental health services for them to apply for a section 2.
Chronic:
- 1st line: Lithium monotherapy (0.6-1.2 mmol/L) initially, then add other drugs like anti-psychotics (lithium takes 2 weeks to work)
- SSRIs like citalopram in depressive episodes but caution as can cause mania (add mood stabilisers as cover)
- 2nd line: sodium valproate (if lithium fails), has teratogenic effects particularly in women of childbearing age. DO NOT start sodium valproate in primary care to treat BPAD and not until anti-psychotics have been tried.
BPAD aka acute mx of hypomania and mania: other things to consider regarding medications and holistic
stop exacerbating meds (e.g. antidepressants, steroids, dopamine agonists)
limit access to drugs and alcohol where possible
monitor food and fluid intake to prevent dehydration
consider a short course of benzodiazepines/hypnotics
start/optiminising mood stabilising medication
- SGA or
- mood stabiliser or
- mood stabiliser plus SGA for severe sx/poor response
rarely, considering ECT (e.g. life-threatening overactivity and exhaustion despite medication)
Comparison of mood stabilisers
lithium takes 2 weeks to work
triggers of lithium toxicity
electrolyte changes due to low-salt diets, dehydration, diarrhoea, and vomiting
drugs interfering with lithium excretion (e.g. NSAIDs, thiazide diuretics, ACE inhibitors)
overdose
lithium toxicity management
stop lithium and transfer for medical care (rehydration, dialysis)
Mild-moderate: resuscitation with 0.9% IV normal saline
Severe: haemodialysis for severe lithium toxicity (>2 mmol/L) if neuro symptoms or renal failure are present
neuro signs of lithium toxicity
coarse tremor (fine tremor in therapeutic levels), hyperreflexia, acute confusion, polyuria, seizure, coma
withdrawing medication in BPAD
slowly and cautiously if symptom-free for a sustained period
BPAD relapse prevention strategies through psychoeducation
identify relapse indicators (early warning indicators) = insomnia, increased energy
relapse prevention strategies:
- daily routine
- sleep hygiene
- healthy lifestyle
- limiting excessive stimulation/stress
- addressing substance misuse
- medication changes
CBT for BPAD
reduces relapse frequency and duration and number of inpatient admissions
informs wellness recovery action plan (WRAP) = to identify triggers and relapse indicators, agreeing a mx plan for future episodes
social interventions
family therapy
IPSRT = IPT + stbailsiing sleeping, waking, eating and exercise times support biological rhythms which regulat mood
BiPolar UK support group
share WRAP to OH staff as stress levels, travel and unsocial hours may affect recovery
Depression hx tips
don’t say ‘i know how you feel’
avoid platitudes
don’t give quick fixes
don’t say ot’s OK
don’t fear the tear
slow down
have hope ‘there are lots of effective tx to help you get better’ ‘it’s really common to feelhopeless when you’re depressed; as you recover that will change’
how to ask core sx in depression
mood
- how have you been feeling recently?
- more anxious/snappy?
- which bit of the day feels the worse/do you dread the most?
anergia
- how are your energy levels at the moment?
- how’s it affecting you? (screen work/studies/childcare etc.)
anhedonia
- can you enjoy things like you used to?
how to ask cognitive sx in depression
worthlessness
- how do you see yourself as a person?
- can you think of anything you are proud of?
- how would you compare yourself to other people?
guilt
- why do you think you’ve had a hard time recently?
- do you blame yourself for these problems?
- do you worry that you’ve let people down?
helplessness
- what do you think would help?
- what about your family, friends, or the doctors, do you think they would help?
hopelessness
- how do you see the future?
- is it ever so bad you feel life isn’t worth living?
how to ask biological sx in depression
sleep
- how’s your sleep been lately?
- which part of the night is the problem?
- how does that affect your energy levels?
appetite
- what’s your appetite been like recently?
- has your weight changes? how much roughly?
- clothes baggy or tight?
- can you be bothered or find the energy to cook for yourself?
libido
- when people feel low, they can lose their sex drive. has that been a pproblem for you?
how to ask psychotic sx and risk in depression
hallucinations
- have you seen or heard anything recently that seemed strange or frightening?
- do people talk to you?
delusions
- are you worried that people have turned against you?
- do you worry you’ve done anything unforgiveable?
- is your body working properly? is any part failing, dying or rotting?
risk
- have you felt so bad, you wanted to harm yourself in some way?
- are you eating and drinking enough?
- are you looking after yourself? washing, dressing, cleaning?
- have you had any thoughts of suicide?
Mani hx tips
Closed question, echo, summary, redirection, comment on behaviour
avoid mirroring
point out inappropriate behvaiour, saying why -> warn you have to end interview if behaviour continues -> leave
- that’s not OK, I’m here to talk to you, if you do it again, we’ll stop the the interview, you’re making me feel uncomfortable, we can talk another time, thank you
Mania hx core, cognitiv, biological and psychotic symptoms
risk and impulsivity
Mood, energy, interest
cognitive
- self worth = how do you seee youself as a person?
- optimism/hope = you seem such a positive person. Where do you see yourself in a month/year?
- concentration/thoughts = how’s your concentration? you have so many ideas, where do they come from?
Biological
- sleep = how’s your sleep been lately?
- libido = have you noticed any changes in your sex drive?
Psychotic
- do you pick on things other people can’t see or hear?
- talents/powers, mission/special purpose, people jealous of you?
Risk/impulsivity
- done anything you wouldn’t usualluy do
- any trouble recently
- have you had moments of wanting to harm or kill yourself?
Next steps: affective disorders
preparation
look at notes
gain team member’s views
contact GP for background, including psych history and how he’s been coping prior to admission
check causes of delirium: ix results stool chart (constipation?), drug chart (recent changes, anticholinergic medications)
Next steps: affective disorders
management
pros and cons of moving to nursing home
bereavement = empathy, normalisation, recruitment of family/friends/faith leaders. Call them if they don’t know pt is in hospital
- bereavements support from social support and counselling
delirum = ix fully and tx underlying medical cause(s)
- dementia only diagnosed after delirium is treated and with a clear history of decline
- contact liason psychiatry (mental health team in the hospital) to further assess dementia and advise on ongoing mx
depression mild/moderate
- appropriate blood test
- depression rating scale
- psych therapy
- consider cardiac saftery before starting antidepressants
- OH assessment on functional ability -> inform RA and POC
- follow-up by GP or an older adult CMHT depending on response to treatment
depression severe
- specialist review and mx by liason psychiatry. They may recommend admission to a psychiatric ward
Stepped Care Model for depression
mild-moderate depression mx
Do not routinely consider medication unless:
- past hx of moderate or severe depression
- sx’s have been present for a long time (>2 years)
- symptoms persist despite other interventions
- NOTE: do NOT recommend St. John’s wort but warn patients about uncertainty in dosing and drug interactions
Moderate-severe depression mx
complex-severe depression mx
depression mx summary
stopping antidepressants
Stopping Antidepressants: should be done over a period of 4 weeks
PACES tips for depression
Explanation = persistently low mood that impacts on day to day functioning
- very common (each year, 1 in 4 people suffer a mental health problem)
address social needs
explain the role of psychological therapy (CBT - talking therapy based on the principle that thoughts, mood and behaviour are intertwined)
explain the role of medication (takes a number of weeks to work, follow-up in 1 or 2 weeks, warn about side-effects)
advise about the crisis resolution and home treatment team
support = mind.co.uk, samaritans
Mood stabilisers
3 main drugs
lithium and toxicity (presentation, triggers, mx)
Mood stabiliser
- even out extreme highs of mania and profound lows of dpression
- more effective against mania
- lithium, sodium valproate, carbamazepine
Lithium
- 0.6 - 1.0 mmol/L
- toxic 1.2 +
- check levels 1 week after starting/changing dose and monitor weekly until steady therapeutic level achieved
- monitored every 3 months from then on
- U+Es and LFTs monitored every 6 months (can cause renal impairment and hypothyroidism)
valproate and carbamazepine
mood stabilisers and pregnancy
Mood stabilisers are teratogenic
Risk of harm should be weighed against harm of manic relapse
- Lithium - Ebstein’s anomaly
- Valproate + carbamazepine - spina bifida
Women of childbearing age should be given contraceptive advice and prescribed a folate supplement** **if using valproate
Closely monitor the foetus if medications are used in pregnancy
antipsychotics and anticonvulsants
antipsychotics
- olanzapine
- usually atypical (e.g. olanzapine, risperidone, quetiapine) as fewer side effects
- typical (chlorpromazine, haloperidol)
anticonvulsants
- lamotrigine is 2nd line for prophylaxis in BPAD type II
Acute tx of mania/hypomania
Stop all medications that may induce symptoms (e.g.anti-depressants, drugs of abuse, steroids and dopamine agonists)
Monitor food and fluid intake to prevent dehydration
If treatment free:
- Give an antipsychotic and a short course of benzodiazipines (diazepam, lorazepam)
If already on treatment
- Optimise the medication
- Check compliance
- Adjust doses
- Consider adding another agent (e.g. antipsychotic as well as mood stabiliser)
- Short-term benzodiazepines may help
ECT may be used if patients are unresponsive to medication
Long term tx of BPAD
depression mx in BPAD
mood stabilisers are the main stay
other drugs may be added when sx arise or when facing stress that could precipitate relapse (e.g. antipsychotics or benzodiazepines)
depression in BPAD
- diffcult as antidepressents can cause a switch to mania
- SO, antidepressants given with mood stabiliser or antipsychotic
- 1st line = fluoxetine + olanzepine/quatiapine
- 2nd line = lamotrigine
- monitor closely for signs of mania and immediately stop antidperessants if signs are present
- medications can be cautiously withdrawn if patient is symptom-free for a sustained period
BPAD psychological treatment and social interventions
BPAD mx summary
BPAD PACES Tips
consider admission and section if at risk
explain diagnosis = condition where patients have a tendency to experience the extremes of emotion for variable lengths of time
explain importance of controlling it = both extremes can lead to making certain decisions and taking risks that you would otherwise regret
explain that there are medications available (helps balance the chemicals in the brain)
advise about crisis resolution team and Samaritans
Definitions of Mania and BPAD
BIO Mx for BPAD: summary
Summary of Mania Questions
Severity of depression
Factors necessitating admission
self neglect
risk of suicide/self-harm
risk to others
poor social support
psychotic symptoms
lack of insight
tx resistant depression
Atypical depression: risk factors, co-morbidities and clinical features
RFs: female, young age
Co-morbidities: higher rates of anxiety, somatisation disorder, alcohol/drug misuse
Clinical features:
- low mood but no anhedonia
- extreme fatigue
- reversed diurnal variation in mood
- hypersomnia: excessive sleeping (10+ hours a day, at least 3 days a week, for at least three months)
- hyrerphagia: excessive eating w/ weight gain (>3kgs in 3 months)
- interpersonal rejection sensitivity
- leaden paralysis: feelings of heaviness in limbs (1hr/day, 3days/week, at least months)
Dysthymia
Chronic low grade depressive
5% UK, more in females
Clinical features:
- Depressed mood (>2 years)
- reduced energy and fatigue
- appetite increased/reduced
- insomnia/hypersomnia
- low self esteem
- poor concentration
- difficulty making decisions
- thoughts of hopelessness
less severe than depression, more chronic course, low remission ate, on average may last 5 years
SAD (seasonal affective disorder)
low mood with change in season (sunlight hits pineal gland → decreases melatonin synthesis → increased 5HT synthesis)
increased appetite including ‘carbohydrate craving’
mx:
- simple measures = light therapy (specialised SAD lights)
- pharmacological = antidepressants (SSRIs), propanolol
Difference between hypomania and mania
functional impairment
4 days vs 7 days
Secondary mania
secondary to a physical cause
- organic brain damage (especially right hemisphere), more common in elderly
- medication: L-Dopa and corticosteroids
- illicit drugs: stimulant or other street drugs induced mania, if mood state significantly outlasts the drugged state then a diagnosis of BPD can be made
- Hyperthyroidism: hypomanic, agitated depressed
What is likely to be the prevalence of bipolar disorder in a psychiatric inpatient ward
2% (1.5% if general population)
BPAD biopsychosocial
SSRI consultation
Common side effects: headache, GI (nausea, diarrhoea/constipation), sleep distrubance/vivid dreams, sexual dysfunction, hyponatraemia, GI bleeding
Serotonin syndrome: common but potentially lethal in 0.1% patients treated; psychological sx, neurological sx including myoclonus and autonomic sx.
Discontinuation syndrome: especially with SSRIs with short half life e.g. paroxetine. Experience ‘flu-like’ sx, ‘electric shocks’, trouble sleeping, GI effects, anxiety.
Suicidality: potential association (small evidence in adolescence) but every patient should be warned, given safe netting advice and be reviewed regularly.
Duration: once well its recommended at the same dose for 6 months and for 2 years for those at greater risk of relapse e.g. multiple recent episodes or significant history
Which of the following is a coresymptom of depression according to the ICD criteria?
A.Sleep disturbance
B.Diminished appetite
C.Reduced self confidence
D.Ideas or acts of self harm or suicide
E.Reduced energy or fatigue
E
Which of the following is correct?
A.Moderate Depression = 2 core symptoms + 3 other symptoms
B.Mild Depression = 3 core symptoms + 1 other symptoms
C.Moderate Depression = 3 core symptoms + 2 other symptoms
D.Severe Depression = 2 core symptoms + 4 other symptoms
E.Mild Depression = 2 core symptoms + 3 other symptoms
A
A 35 year old woman presents to her GP asking for a sick note. She has been struggling at work as a teaching assistant for the last 2 months ; she struggles to concentrate for long periods and has no energy to run around after the children. She feels guilty as a result and thinks she is no good as a teacher or a human. She comes home from work and cannot face going to her jazzercise class or for dinner with friends. She tells the GP that she had similar symptoms a year ago, and also for the two years preceding this, always during the Christmas term at school.
Seasonal Affective Disorder
Depression secondary to hypothyroidism
Dysthymia
Bipolar Affective Disorder Type I
Atypical Depression
RANK THESE
SAD
Depression 2o to hypothyroidism
Atypical depression
Dysthymia
BPAD Type 1
A 34 year old South Asian woman presents with a two month history of elated mood, increased energy and increased productivity in her marketing business. Her mother has a history of anxiety and her father has a history of bipolar affective disorder.
Which of the following is the most influential factor in her presentation.
BPAD = FHx
Depression = gender + ethnicity
A patient presents with a 3 day history of elated mood, increased restlessness, decreased need for sleep, overfamiliarity and a bill for £150 on Asos.com. There are no grandiose delusions. A similar episode occurred 6 months ago and resolved spontaneously after 6 days. They are managed with enhanced visits by their CC in the community.
BPAD Type 2 hypomania episode
