Affective Disorders Flashcards
What are the ICD 11 definition of a single depressive episode?
Depressed mood or deminished interest almost all day, every day for >2 weeks
AND
Biological Symtpoms
* difficulty concentrating,
* changes in appetite or sleep
* psychomotor agitation or retardation
* and reduced energy or fatigue
Thoughts
* feelings of worthlessness or excessive or inappropriate guilt
* hopelessness,
* recurrent thoughts of death or suicide,
No other psychiatric diagnosis (recurrent depression, bipolar etc)
What are the criteria for diagnosing recurrent depressive disorders?
At least 2 depressive episodes, separated by several months of wellness
Does mood in depression fluctuate throught the day?
Yes - usually diurnal fluctuation with mornings worse
What is psychomotor retardation?
Slowing of thought and movements associated with depression
What are the typical characteristics of psychotic symptoms in Depression?
Usually in moderate - severe depression
1. Mood congruent (e.g. audistory 2nd person “You’re worthless” common, visual uncommon)
- Nihilistic dilusions, persecutory or guilt related
Hallucinations/Catatonia
What are organic differential diagnosis of depression?
- Hypothyroidism
- hypoactive delirium
- Addisons disease
- Vitamin D Deficiency
- Dementia / other neurodegenerative disorders
What are psychiaric differential diagnosis in depression?
- Sadness/bereavement (normal response)
- Adjustment disorder(mild affective symptoms after a stressful event)
- Dysthymia (chronic low mood for more days than not, lasting years but not enough to diagnose depression)
- BPAD
- Substance misucse
- Postpartum depression
- Bornout
- Schizoaffective disorder
What investigations should be done before the diagnosis of depression?
- Collateral History
- Physical exam
Blood - Baseline
* TFT, FBC (anaemia), HbA1c (fatigue Diabetes), Vitamin D and B12, Calcium), CRP (LFT, U&E)
Specific
* HIV, syphillis serology, magnesium
Asessments
* Cognitive assessment (Dementia/pseudo dementia)
* Rating scales for depressive symptoms (only support MSE) - PHQ9 / HADS
* CT/MRI brain (if clinically indicated)
What is the 1 year prevalence and lifetime prevalence of unipolar depression?
- One year: 5.3%
Lifetime: 13-16%
What is the mean age of onset of depression?
~30 years
What are the dignnostic critteria for mild, moderate and severe depression (ICD 10 i think)
- mild: 2 core + 2 other symtoms
- moderate: 2 core +3+ other symptoms
- severe: 2 core + 4 other symptoms
What are symptoms of atypical depression?
- increased appetite
- increased sleep + fatigue
- leaden paralysis
What is Dysthymia?
Chronic low grade depressive symptoms >2 years
What is Seasonal affective disorder?
Low mood related to season, responds to light therapy
Explain the Monoamine theropy of depression
States that depression is caused by low levels of serotonin and CNS monoamines (good pharmacological evidence), but also need to consider psycholgical and social factors
Which medications can cause depression?
Medications:
* antihypertensives (beta blockers, methyldopa, calcium channel blockers)
* steroids
* Histamine H2 blockers
* sedatives, muscle relaxants
* retinoids, chemotherapy agents, sex hormones e.g. oestrogen etc,
* psychiatric medications.
Which factors require admission in depression?
- Self neglect
- Risk of suicide/ self harm
- Risk to others
- poor social support
- Psychotic symptoms
- Lack of insight
- Treatment resistant
What are the Indications and managemnet for the in NICE step 4 for treating depression?
Step 4:
Severe deperssion at risk of self harm
1.Consider Medication, High intensity psychological therapy and / or electtroconvulsion therapy
Involve specialist services, consider inpatient care
What are features of mania?
Core symptoms
* Euphoria
* Irritability
* Expansive mood
PLUS: increased activity
> 7 days OR severe enough for hospital admission
Additional
* Increased talkativeness/pressure of speech
* Flight of ideas
* increased self-esteem/ grandiosity
* Decreased need for sleep
* Distractability
* impulsive, reckless behaviour
* Increased sexual drive, sociability or goal directed activity
What are the diagnostic criteria of BPAD?
- At leastt 2 episodes of mood disturbance
- One of them is hypoamanic/ manic
What is the difference between BPAD type 1 and BPAD type 2?
Type 1: Mania +/- depression
Type 2: Hypomania +/- depression
What are the characteristic features of hypomania
- > 4 days
- Decreased degree of functional impairment compared to mania
- All symptoms just at a lesser extent
(Usually no inpatient care needed)
What is the prevalence and epidemiolgoy of BPAD?
- 1.5% prevalence
- Mean age of onset ~18-21
- 10% of patients who begin with a depressive episode will develop mania within 10 years
- Higher incidence in upper social class
- no difference in ethnicities and relatives
- 7x incidence if relatives BPAD
Why is the risk of suicide higher in the first 2 weeks after starting antidepressant?
Because SSRI have different effects at different points in time: first increase energy (but not suicidal thoughts) to people have the energy to commit suicide
