Affective Disorders Flashcards
What are the core depressive symptoms?
Low mood
Anhedonia
Anergia
Cognitive Sx of depression?
Helplessness Hopelessness Worthlessness Pessimistic Suicidal thoughts Poor concentration, attention and memory
Somatic Sx of depression?
Loss of libido Reduced appetite, weight loss Distorted sleep, EMW DVM Psychomotor retardation
How long must symptoms of depression be present for?
2 weeks at least
What are the 9 DSM 5 criteria for depression?
Low or irritable mood for most of day nearly every day Anhedonia Anergia Reduced appetite or weight loss not intentional Sleep disturbance Psychomotor agitation or retardation Feelings of worthlessness or guilt Poor concentration Thoughts of death or suicidal thoughts
What are the DSM 5 diagnostic criteria for major depressive disorder?
At least 5 of the 9 symptoms present during same 2 weeks period, with at least 1 either low mood or anhedonia
Symptoms causing clinically significant functional impairment or distress
Not attributable to substance misuse or medical conditions
How are depressive episodes split based on severity?
Moderate = 5 or more symptoms Severe = 7 or more symptoms of which at least a few are severely impacting on life
What are the exceptions to treating depression medically?
If currently mild but previously had severe episodes
Dysthymia (2 years plus)
Suggested treatment of moderate-severe depression?
SSRI e.g. Sertraline, citalopram is first line
If not effective try another SSRI or SNRI
Alternatives include mirtazapine, moclobomide, reboxetine, lofepramine
Medical management that might be considered in very severe depression?
Venlaxafine or older TCA
What is the recommended treatment duration for an isolated episode of depression?
6m
What is the recommended treatment duration for recurrent depressive disorder?
2 years plus
What is refractory depression?
Depression that has failed to respond to at least 2 antidepressants
Treatment options for refractory depression?
Antidepressant plus CBT Lithium augmentation Venlafaxine/older TCA SSRI plus NaSSa (mirtazapine) Augmentation with atypical antipsychotic Phenelzine/selegeline patches ECT
Features of depression with psychosis?
Often mood congruent delusions and hallucinations
Psychomotor retardation
Stupor
Loss of insight
What is dysthymia?
Chronic subthreshold depression for at least 2 years
Can have superimposed depressive episodes
Often hard to treat as improvements are small
What is cyclothymia?
Repeated and persistent instability of mood characterised by numerous depressive and mildly elated episodes, neither of which meet criteria for depression or hypomania respectively (in length or severity)
Common where there is FH of BPAD
What is hypomania?
Persistent mildly elated mood alongside other symptoms, which usually doesn’t significantly interfere with everyday life or function
Symptoms of 9 Sx of mania besides mood?
Increased self esteem Flight of ideas Pressured speech Increased activity Increased libido Distractibility Decreased need for sleep Disinhibition Reckless behaviour
How many and for how long must Sx be present for to distinguish between hypomania and mania?
At least 3/9 symptoms alongside elevated/irritated mood for at least:
4 days for hypomania
7 days for mania plus functional impairment
Management options for acute manic episode?
Atypical antipsychotics e.g. Risperidone, quetiapine, olanzapine
Typical antipsychotic e.g. Haloperidol
Lithium or valproate
With which type of episode do most BPAD present? What suggests increased likelihood of BPAD?
Depressive episode, often several of these before first mania
Earlier onset or increased severity, plus FH, suggest BPAD more likely
What psychotic symptoms may occur in mania?
Mood congruent hallucinations often 2nd person auditory
Grandiose delusions
Flight of ideas or physical activity so significant to become incomprehensible or to neglect self
What is the difference between BPAD 1 and 2?
1 = classic, mania 2 = only hypomania
