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Psychiatry > Affective Disorders > Flashcards

Affective Disorders Flashcards

1
Q

Unipolar and BPAD definition

A

Unipolar = depression episodes

BPAD = mania OR mania and depression episodes

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2
Q

Aeiology of BPAD and depression: genetics, lifetime prevalence and female:male ratio

A
  • 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)

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3
Q

Childhood and life experience: depression, mania triggers

A

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
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4
Q

childhood maltreatment consequences

A

recurrent + persistent depressive episodes

increased bPAD severity + comorbidity w/ more frequent relapses + suicide attempts than in children w/o childhood abuse

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5
Q

Behavioural and cognitive theories of depression

A

learned helplessness = depressed people learn they cant change their situation, leading them to give up

self, world, future -> -ve thoughts -> worthless/guilty, hopeless, hopeless

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6
Q

Psychoanalytical theories of depression

A

early experiences (especially quality of earlky relationship)

superego bullies ego into despair

mania considered an unconscious self-defence against depression by denying vulnerability

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7
Q

Neurochemical theories of depression

what medication can cause depression

A

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)

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8
Q

neurochemical theories for mania

what medications treat mania

A

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

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9
Q

neuroendocrine abnormalities -> depression

A

high cortisol

  • hippocampal damage and reduction in serotonin
  • linked to CVD and diabetes (chronic conditions and depression link)
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10
Q

neuroanatomical abnormalities theory for depression

A

Left anterior cingulate cortex abnormality -> DBS potential treatment for severe treatment-resistant depression

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11
Q

classification of depression: cog, bio, psychotic

mild, moderate, severe, severe w/ psychotic sx

A

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
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12
Q

DDx for depression

A

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
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13
Q

Bereavement: normal stages

A

numbness

pining

depression

recovery

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14
Q

prolonged grief disorder response characteristics (4)

A

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

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15
Q

Ix for depression

A

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
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16
Q

Mx: 1st line SSRIs for moderate-severe depression

examples, benefits, common side effects and good to know

A

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
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17
Q

What is St Johns wort used for?

A

mild depression

but induces enzymes, increasing metabolism of drugs (e.g. contraceptive pill)

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18
Q

comparison of anti-depressents (TCAs)

A

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
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19
Q

‘switching’

A

people who respoind too well to antidepressants may be switching from depression to mania (undiagnosed BPAD)

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20
Q

Stopping and swapping in depression: discontinuation sx and serotonin syndrome

A

discontinuation sx = flu-like, electric shock, dizzy, headache, vivid dreams, irritable

serotonin syndrome (multiple antidepressants) = restlessness, sweating, myoclonus, confusions, fits

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21
Q

Tx resistance to antidepressants

A

medication concordance and diagnosis revied before considering a higher dose, different medication, or different of antidepressants

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22
Q

augmentation strategies with depression

A

lithium

SGAs = lower dose than for psychosis

T3

combining 2 antidepressants

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23
Q

ECT for depression

A

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)
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24
Q

rTMS

A

no anaesthetic

few side effects

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25
Q

light therapy

A

for SAD

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26
Q

exercise

A

C25K and parkrun = increases activity while connecting people with others though shared, achievable challenges

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27
Q

CBT

A

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

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28
Q

Psychodynamic therapy

A

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

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29
Q

IPT and MBCT

A

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
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30
Q

Social interventions

A

psychoeducation

support groups

exercise, diet, sleep hygiene

problem solving for social stressors

CMHTs (e.g. home treatment/crisis teams, care coordinators)

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31
Q

Prognosis of depression

A

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)

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32
Q

Sleep hygiene: tips for a good night’s sleep

A
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33
Q

Hypomania criteria

A

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
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34
Q

mania criteria: with and without psychotic sx

A

Mania = impaired functioning (social, occupation), or needs hospitalisation + presence of psychotic symptoms

more than a week

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35
Q

BPAD criteria

A

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

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36
Q

BPAD DSM-V classification

A
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37
Q

BPAD risk factors and aetiology

A
38
Q

Depression vs mania

A

mania core sx:

elated/irritable

energetic

new activities, contacts

39
Q

DDx for BPAD

A

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

40
Q

Ix for BPAD

A

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)
41
Q

BPAD mx: medications

A

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.
42
Q

BPAD aka acute mx of hypomania and mania: other things to consider regarding medications and holistic

A

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)

43
Q

Comparison of mood stabilisers

A

lithium takes 2 weeks to work

44
Q

triggers of lithium toxicity

A

electrolyte changes due to low-salt diets, dehydration, diarrhoea, and vomiting

drugs interfering with lithium excretion (e.g. NSAIDs, thiazide diuretics, ACE inhibitors)

overdose

45
Q

lithium toxicity management

A

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

46
Q

neuro signs of lithium toxicity

A

coarse tremor (fine tremor in therapeutic levels), hyperreflexia, acute confusion, polyuria, seizure, coma

47
Q

withdrawing medication in BPAD

A

slowly and cautiously if symptom-free for a sustained period

48
Q

BPAD relapse prevention strategies through psychoeducation

A

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
49
Q

CBT for BPAD

A

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

50
Q

social interventions

A

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

51
Q

Depression hx tips

A

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’

52
Q

how to ask core sx in depression

A

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?
53
Q

how to ask cognitive sx in depression

A

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?
54
Q

how to ask biological sx in depression

A

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?
55
Q

how to ask psychotic sx and risk in depression

A

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?
56
Q

Mani hx tips

A

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
57
Q

Mania hx core, cognitiv, biological and psychotic symptoms

risk and impulsivity

A

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?
58
Q

Next steps: affective disorders

preparation

A

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)

59
Q

Next steps: affective disorders

management

A

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
60
Q

Stepped Care Model for depression

A
61
Q

mild-moderate depression mx

A

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
62
Q

Moderate-severe depression mx

A
63
Q

complex-severe depression mx

A
64
Q

depression mx summary

stopping antidepressants

A

Stopping Antidepressants: should be done over a period of 4 weeks

65
Q

PACES tips for depression

A

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

66
Q

Mood stabilisers

3 main drugs

lithium and toxicity (presentation, triggers, mx)

A

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)
67
Q

valproate and carbamazepine

A
68
Q

mood stabilisers and pregnancy

A

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

69
Q

antipsychotics and anticonvulsants

A

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
70
Q

Acute tx of mania/hypomania

A

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

71
Q

Long term tx of BPAD

depression mx in BPAD

A

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
72
Q

BPAD psychological treatment and social interventions

A
73
Q

BPAD mx summary

A
74
Q

BPAD PACES Tips

A

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

75
Q

Definitions of Mania and BPAD

A
76
Q

BIO Mx for BPAD: summary

A
77
Q

Summary of Mania Questions

A
78
Q

Severity of depression

A
79
Q

Factors necessitating admission

A

self neglect

risk of suicide/self-harm

risk to others

poor social support

psychotic symptoms

lack of insight

tx resistant depression

80
Q

Atypical depression: risk factors, co-morbidities and clinical features

A

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)
81
Q

Dysthymia

A

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

82
Q

SAD (seasonal affective disorder)

A

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
83
Q

Difference between hypomania and mania

A

functional impairment

4 days vs 7 days

84
Q

Secondary mania

A

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
85
Q

What is likely to be the prevalence of bipolar disorder in a psychiatric inpatient ward

A

2% (1.5% if general population)

86
Q

BPAD biopsychosocial

A
87
Q

SSRI consultation

A

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

88
Q

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

A

E

89
Q

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

90
Q

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

A

SAD

Depression 2o to hypothyroidism

Atypical depression

Dysthymia

BPAD Type 1

91
Q

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.

A

BPAD = FHx

Depression = gender + ethnicity

92
Q

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.

A

BPAD Type 2 hypomania episode

Psychiatry (11 decks)

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