Affective Disorders Flashcards
What is the prevalence of depression?
Very common.
2-5% about 1 in 5 people.
Female:Male 2:1
What are the 3 core symptoms of depression?
Anhedonia - inability to derive pleasure
Anergia - reduced energy
Low mood - may be diurnal, worse in morning
How long do you have to have depression to make a diagnosis?
At least 2 weeks.
NOT secondary to the effects of: drug/alcohol misuse, organic illness and bereavement.
Depression in ICD-10
- Low mood
- Loss of interest
- Reduced energy levels
- Sleep disturbance
- Change in appetite
- Reduced concentration
- Reduced sex drive
- Loss of confidence
- Guilt feelings
- Suicidal thoughts
How do you judge the severity of depression according to the ICD-10? Mild, moderate and severe.
Mild: 2 core and 2 other.
Moderate: 2 core and 3 other.
Severe: 3 core and 4 other.
What is the prevalence of bipolar affective disorder?
What is the mean age of onset?
What is the aetiology of BAD?
1%
Female:Male 1:1
Mean age of onset - 21
Genetic - MZ:DZ 79% : 19%
Life events
Manic episode in ICD-10
- Elated mood, Irritable mood, lability
- Increased energy levels, over activity
- Distractibility, reduced concentration, constant change of plans
- Reduced need for sleep
- Inflated self-esteem, grandiosity
- Overfamiliarity, disinhibition
- Reckless behaviour, overspending
- Increase in sex drive
- Racing thoughts or flight of ideas
- Psychotic symptoms
What are the two types of bipolar affective disorder?
One Mania with or without Depression
Hypomania with Depression
What is the mechanism of action in depression?
Monoamine (MA) Theory of Depression
• Depression associated with decrease in brain NAd (Noradrenaline)
and/or 5HT (serotonin)
Evidence:
• reserpine depletes brain MA and can cause depression
• antidepressants inhibit uptake or breakdown of MA
What are the three types of antidepressants?
Monoamine reuptake inhibitors
Receptor antagonists
Monoamine oxidase inhibitors
What are the 5 main types of monoamine reuptake inhibitors and an example of each?
Tricyclics (older):
Amitryptyline (toxic in overdose), Lofepramine
Selective serotonin reuptake inhibitors:
Fluoexetine, Citalopram (1st line as safe in overdose)
Noradrenaline reuptake inhibitors:
Reboxetine
Serotonin noradrenaline reuptake inhibitors:
Venlaxafine (causes CVS problems)
Noradrenaline and specific serotonin antidepressant:
Mirtazapine (sedative and weight gain)
What are the common side effects of SSRIs?
- Agitation
- Nausea/loss of appetite
- Indigestion/diarrhoea/constipation
- Loss of libido/erectile dysfunction
- Dizziness/dry mouth/blurred vision/sweatiness/headaches
Why are monoamine oxidase inhibitors rarely used?
•MAOIs are rarely used due to poorer tolerability and interactions and diet restrictions •Monoamine oxidase breaks down tyramine in your gut. •If you eat tyramine containing food- cheese redwine bovril and many more •Potential for hypertensive crisis
How long should you typically give patients antidepressants for?
6-9 months.
If multiple episodes consider for at least 2 years.
What are the indications for Lithium?
- Mania: treatment and prophylaxis
- Bipolar Affective Disorder
- Recurrent depression
- Aggressive or self mutilating behaviour
What are the baseline investigations before administering Lithium?
- Physical and weight
- U/E’s, renal function, TFT’s, Ca2+
- ECG
- Pregnancy test?
What should you monitor in patients taking Lithium?
• Lithium has a therapeutic window • Li levels (3/12 when stable) • Renal, Thyroid, Ca2+, wt. and ECG • Avoid drugs which reduce Li excretion e.g. ACE, NSAID’s, diuretics esp. thiazide
What are the early and late side effects of Lithium?
Early:
Dry mouth, metallic taste, nausea, fine tremor, fatigue,
polyuria, polydipsia
Late:
Diabetes insipidus, hypothyroidism, arrhythmias, ataxia,
dysarthria, weight gain
What are the causes, levels, symptoms and management of Lithium toxicity.
Causes: drugs (NSAID, diuretics), renal failure, UTI,
dehydration
Levels : may occur if Li >1.5 but treat symptoms not just
levels
Symptoms:
Early: blurred vision, anorexia, nausea, vomiting, diarrhoea,
coarse tremor, ataxia, dysarthria
Late: confusion, renal failure, delirium, fits, coma, death
Management: medical emergency
Stop lithium, give fluids and start diuresis / dialysis; treat cause
What is the rate of success of ECT in regards to depression?
70-80%
What does NICE recommend for mild to moderate depression?
Low intensity psychological intervention NOT medication:
Advice
Self help CBT
Group CBT
Structured Group Physical Activity Programme
What does NICE recommend for moderate to severe depression?
Combination of antidepressant and high intensity psychological intervention.
Usually CBT or IPT.
What are the short and mid-long term biological interventions for depression?
Short - Exercise, ECT
Long - Antidepressants, antipsychotics, mood stabilisers
What are the short and mid-long term psychological interventions for depression?
Short - Exercise, behavioural activation, problem solving, self help/computer base CBT, psycho-education, CBT/IPT
Long - CBT/IPT, psychoanalysis (if CBT and IPT refused), other psychological therapies
What are the short and mid-long term social interventions for depression?
Short - Housing, financial support, exercise, socialisation
Long - Improve social networks, increase daily activities, employment, housing, finances
