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Year 5 Psych > Affective Disorders > Flashcards

Affective Disorders Flashcards

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1
Q

What are the ICD 11 definition of a single depressive episode?

A

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)

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2
Q

What are the criteria for diagnosing recurrent depressive disorders?

A

At least 2 depressive episodes, separated by several months of wellness

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3
Q

Does mood in depression fluctuate throught the day?

A

Yes - usually diurnal fluctuation with mornings worse

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4
Q

What is psychomotor retardation?

A

Slowing of thought and movements associated with depression

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5
Q

What are the typical characteristics of psychotic symptoms in Depression?

A

Usually in moderate - severe depression
1. Mood congruent (e.g. audistory 2nd person “You’re worthless” common, visual uncommon)

  1. Nihilistic dilusions, persecutory or guilt related

Hallucinations/Catatonia

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6
Q

What are organic differential diagnosis of depression?

A
  1. Hypothyroidism
  2. hypoactive delirium
  3. Addisons disease
  4. Vitamin D Deficiency
  5. Dementia / other neurodegenerative disorders
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7
Q

What are psychiaric differential diagnosis in depression?

A
  1. Sadness/bereavement (normal response)
  2. Adjustment disorder(mild affective symptoms after a stressful event)
  3. Dysthymia (chronic low mood for more days than not, lasting years but not enough to diagnose depression)
  4. BPAD
  5. Substance misucse
  6. Postpartum depression
  7. Bornout
  8. Schizoaffective disorder
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8
Q

What investigations should be done before the diagnosis of depression?

A
  1. Collateral History
  2. 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)

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9
Q

What is the 1 year prevalence and lifetime prevalence of unipolar depression?

A
  1. One year: 5.3%
    Lifetime: 13-16%
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10
Q

What is the mean age of onset of depression?

A

~30 years

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11
Q

What are the dignnostic critteria for mild, moderate and severe depression (ICD 10 i think)

A
  • mild: 2 core + 2 other symtoms
  • moderate: 2 core +3+ other symptoms
  • severe: 2 core + 4 other symptoms
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12
Q

What are symptoms of atypical depression?

A
  • increased appetite
  • increased sleep + fatigue
  • leaden paralysis
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13
Q

What is Dysthymia?

A

Chronic low grade depressive symptoms >2 years

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14
Q

What is Seasonal affective disorder?

A

Low mood related to season, responds to light therapy

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15
Q

Explain the Monoamine theropy of depression

A

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

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16
Q

Which medications can cause depression?

A

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.

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17
Q

Which factors require admission in depression?

A
  • Self neglect
  • Risk of suicide/ self harm
  • Risk to others
  • poor social support
  • Psychotic symptoms
  • Lack of insight
  • Treatment resistant
18
Q

What are the Indications and managemnet for the in NICE step 4 for treating depression?

A

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

19
Q

What are features of mania?

A

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

20
Q

What are the diagnostic criteria of BPAD?

A
  1. At leastt 2 episodes of mood disturbance
  2. One of them is hypoamanic/ manic
21
Q

What is the difference between BPAD type 1 and BPAD type 2?

A

Type 1: Mania +/- depression
Type 2: Hypomania +/- depression

22
Q

What are the characteristic features of hypomania

A
  • > 4 days
  • Decreased degree of functional impairment compared to mania
  • All symptoms just at a lesser extent

(Usually no inpatient care needed)

23
Q

What is the prevalence and epidemiolgoy of BPAD?

A
  • 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
24
Q

Why is the risk of suicide higher in the first 2 weeks after starting antidepressant?

A

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

25
Q

What are non-psychiatric differentials for a manic episode?

A
  • Organic Brain Damage (more common in elderly)
  • Levo-dopa and corticosteroids
  • illicit drugs
  • Hypothyroidism (“myxoedema madness- paradoxical)
26
Q

What is the managmement and follow up of a mild depressive episode?

A

Nice Step 1

Active monitoring
1. Psychological interventions (psycho-education)
2. Safety-netting for suicidal thoughts

Follow up

27
Q

What is the management of a moderate depressive episode or sub-threshold depression resistant to step 1 interventions?

A

NICE Step 2:
Sub-threshold depression resistant to step 1
interventions; mild to moderate depression

  1. Consider medication (with propper councelling)
  2. And/or low-intensity psychological therapies (self-help, group physical activity, computerised (BT) or group CBT.
28
Q

When would you do NICE Step 3 for depression?

A

STEP 3: Subthreshold; mild/ moderate depression
resistant to step 2 interventions; severe depression

Consider medication and/ or high intensity osycholozical therapiel
(c8l., interpersonal therapy or behavioural activat on)

29
Q

What is a mixed episode in BPAD?

A

Rapid alteration between manic and depressive symptoms on most days for at least 2 weeks

30
Q

What are psychiatric differentials for BPAD?

A
  • Schizoaffective disorders (psychotic and affective symptoms evolve simultaneously)
  • Emotionally unstable personality disorder
  • Perinatal disorders
  • ADHD
31
Q

What invesitgations would you do in a patient with BPAD presenting with Mania?

A
  • collateral history
  • Physical exam
  • Bloods: FBC; TFT, CRP. ESR, other depending on histroy
  • CT/MIR head (if indicated)
  • LP if suspected encephalitis
32
Q

How is an acute episode of mania managed?

A
  1. Risk reduction: usually in-patient admission under MHA needed
  2. Medical
    * Stop exacerbating medications (e.g. antidepressant, steroids etc)
    * Start either Second-Generation anti-psychotic OR Mood Stabelizer OR Combination of both
    * Consider short course of hypnotics/ Benzodiazepines
33
Q

What is the prognosis for BPAD?

A

Manic episodes: abrupt onset + general shorter
Depressive episodes 2 weeks - 5 months

Complete recovery between episodes
15% suicide rate

34
Q

What psychological interventions would you consider in a patient with BPAD?

A
  1. Psychoeduction
  2. CBT
  3. Social Interventions (Family therapy, interpersonal and social rhythm therapy)
35
Q

What risk asessment questions should be considered in a patient with mania?

A
  • Emplyment
  • Relationship
  • finance
  • driving
  • sexual activity
  • alcohol/drugs
36
Q

A patient with suspected Bipolar Affective Disorder presentes to the GP in an acute episode. What is the management plan?

A

Refere to Secondary care. In meantime: Risk:

  1. Risk asessment: For depression: usual deperessive screen, for mania
  2. Urgent Mental Health Asessment if: mania or severe depression

While awaiting asessment
1. don’t start antipsychotics without psychiatric review
2. Talk to psychiatirc constultantt re decreasing antidepressants
3. Tell the patient to stop driving

37
Q

What support networks can you offer to a patient with non-acute BPAD?

A
  1. Offer Psychological Interventions
  2. Refere to: Bipolar UK, Mind and Rethink (information and self-help groups)
  3. Supported employment programms offering
38
Q

What is the pharmacological management of Mania 2nd to BPAD in Secondary Care?

A

Step 1: oral antipsychotic trial (haloperidole, olanzapine, quietapine, risperidone)
Step2: Swith to one of the other mentioned antipsychotics
Step 3: Add Lithium or Sodium Valporate (not in pre-menopausal women)

39
Q

What is the pharmacological treatment of a patient with BPAD presenting with depression?

A
  • Quetiapine alone, or
  • Fluoxetine combined with olanzapine, or
  • Olanzapine alone, or
  • Lamotrigine alone.
40
Q

What is the plan for health reviews for people with BPAD?

A

Asessment at least annually or more frequently if there are any concerns

41
Q

What medications are associated with depression?

A

Most common:
1. Beta blockers
2. Benzos
3. hormonal
4. Anti-parkison drugs

42
Q

How long should an episode of depression be treated with SSRIs?
1. a first episode of depression
2. A recurrent episode of depression

A
  1. at least 6 months
  2. at least 2 years

Year 5 Psych (11 decks)

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