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Psych Y5 > Affective Disorders > Flashcards

Affective Disorders Flashcards

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1
Q

What are the core depressive symptoms?

A

Low mood
Anhedonia
Anergia

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2
Q

Cognitive Sx of depression?

A 
Helplessness
Hopelessness
Worthlessness
Pessimistic
Suicidal thoughts 
Poor concentration, attention and memory
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3
Q

Somatic Sx of depression?

A 
Loss of libido
Reduced appetite, weight loss
Distorted sleep, EMW
DVM
Psychomotor retardation
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4
Q

How long must symptoms of depression be present for?

A

2 weeks at least

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5
Q

What are the 9 DSM 5 criteria for depression?

A 
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
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6
Q

What are the DSM 5 diagnostic criteria for major depressive disorder?

A

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

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7
Q

How are depressive episodes split based on severity?

A 
Moderate = 5 or more symptoms
Severe = 7 or more symptoms of which at least a few are severely impacting on life
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8
Q

What are the exceptions to treating depression medically?

A

If currently mild but previously had severe episodes

Dysthymia (2 years plus)

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9
Q

Suggested treatment of moderate-severe depression?

A

SSRI e.g. Sertraline, citalopram is first line
If not effective try another SSRI or SNRI
Alternatives include mirtazapine, moclobomide, reboxetine, lofepramine

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10
Q

Medical management that might be considered in very severe depression?

A

Venlaxafine or older TCA

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11
Q

What is the recommended treatment duration for an isolated episode of depression?

A

6m

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12
Q

What is the recommended treatment duration for recurrent depressive disorder?

A

2 years plus

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13
Q

What is refractory depression?

A

Depression that has failed to respond to at least 2 antidepressants

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14
Q

Treatment options for refractory depression?

A 
Antidepressant plus CBT 
Lithium augmentation
Venlafaxine/older TCA 
SSRI plus NaSSa (mirtazapine)
Augmentation with atypical antipsychotic
Phenelzine/selegeline patches
ECT
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15
Q

Features of depression with psychosis?

A

Often mood congruent delusions and hallucinations
Psychomotor retardation
Stupor
Loss of insight

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16
Q

What is dysthymia?

A

Chronic subthreshold depression for at least 2 years
Can have superimposed depressive episodes
Often hard to treat as improvements are small

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17
Q

What is cyclothymia?

A

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

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18
Q

What is hypomania?

A

Persistent mildly elated mood alongside other symptoms, which usually doesn’t significantly interfere with everyday life or function

19
Q

Symptoms of 9 Sx of mania besides mood?

A 
Increased self esteem
Flight of ideas
Pressured speech
Increased activity
Increased libido
Distractibility
Decreased need for sleep 
Disinhibition
Reckless behaviour
20
Q

How many and for how long must Sx be present for to distinguish between hypomania and mania?

A

At least 3/9 symptoms alongside elevated/irritated mood for at least:
4 days for hypomania
7 days for mania plus functional impairment

21
Q

Management options for acute manic episode?

A

Atypical antipsychotics e.g. Risperidone, quetiapine, olanzapine
Typical antipsychotic e.g. Haloperidol
Lithium or valproate

22
Q

With which type of episode do most BPAD present? What suggests increased likelihood of BPAD?

A

Depressive episode, often several of these before first mania
Earlier onset or increased severity, plus FH, suggest BPAD more likely

23
Q

What psychotic symptoms may occur in mania?

A

Mood congruent hallucinations often 2nd person auditory
Grandiose delusions
Flight of ideas or physical activity so significant to become incomprehensible or to neglect self

24
Q

What is the difference between BPAD 1 and 2?

A 
1 = classic, mania 
2 = only hypomania
25
Q

What features suggest atypical depression?

A

Weight gain
Increased sleep need
Irritability rather than low mood

26
Q

Management of acute depressive episodes in BPAD?

A

SSRIs often ineffective and not necessarily recommended due to rebound mania but can use fluoxetine plus olanzapine
Quetiapine
Lamotrigine
Lurasidone

27
Q

What must be given alongside antidepressants in BPAD?

A

Mood stabiliser e.g. Lithium

28
Q

Long term medical management of BPAD?

A

Lithium first line but not for use in acute depression
Add valproate, CBZ if lithium ineffective
Atypical antipsychotics e.g. Aripiprazole
Lamotrigine

29
Q

Becks cognitive triad of depression?

A

Negative views about world
Negative views about self
Negative views about the future

30
Q

Medical causes of depression?

A 
Addison's
Cushing
Hypothyroidism
Hypercalcaemia
Folate deficiency
Cancer
PD
Stroke etc.
31
Q

Medications that can induce depression?

A 
OCP and other hormonal treatment
Steroids
B blockers
Digoxin
LDopa
32
Q

When is depression more likely to be severe/psychotic in terms of age?

A

Later life e.g. 50-70

33
Q

3 things that help differentiate depression from normal low mood?

A

Duration (2 weeks plus)
Intensity
Other symptoms

34
Q

What degree of EMW is often considered significant?

A

At least 2 hours earlier than normal

35
Q

What degree of weight loss may be considered significant in depression?

A

At least 5% of body weight in 1 month unintentionally lost

36
Q

3 common self report scales used to assess depression?

A

PHQ-9
Hospital anxiety and depression (HAD) scale
Becks depression inventory

37
Q

Management options for mild-moderate depression?

A

Watchful waiting, review within couple of weeks

Low intensity psychotherapy e.g. CBT, psychodynamic psychotherapy

38
Q

What side effects of medical treatment should be warned about for moderate or worse depression?

A

Initial worsening of anxiety Sx
Increased energy before suicidal thoughts go and mood improves - careful about this
SEs e.g. Akathisia

39
Q

3 major indications for ECT?

A

Severe or psychotic depression
Treatment resistant mania
Puerperal psychosis

40
Q

Medical cause of mania?

A 
Steroids
LDopa
FH
Hyperthyroidism
Drugs - cocaine, amphetamines
41
Q

What is rapid cycling BPAD?

A

At least four cycles in a year e.g. 2 depressions 2 manias

42
Q

How long do manic episodes tend to last?

A

2 weeks - 4/5 months

43
Q

What is a mixed episode in BPAD?

A

Manic symptoms and depressive symptoms often co-morbid during same episode

Psych Y5 (13 decks)

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