Affective Disorders Flashcards
How do you define depression?
A emotional state of persistently feeling low
It is thought to be due to a lack of monoamines
What are the ICD classifications of depression?
At least 2 of feeling low, anhedonia and low energy for at least 2 weeks
How do you define mild, moderate and severe depression?
Mild: 2 core symptoms and 2 other but no functional limitation
Moderate: 2 core and 3-4 others
Severe: 3 core and 4+ others
Severe and Psychotic
How do you treat depression?
Treat with support - watch and wait CBT SSRI 1st line - Sertraline 50mg Psychotic/Severe - antipsychotic or mood stabiliser can be used ECT - severe, life-threatening
Types of anti-depressants?
Examples?
SSRI - Sertraline, Citalopram, Paroxetine SNRI - Venlafaxine, Duloxetine NARI - Reboxetine TCA - Amytriptiline NaSSA - Mirtazapine
What are some symptoms of mania?
Elevated mood or anger
Increased impulsivity, speech
Loss of inhibition
How do you define hypomania?
Symptoms of mania
Last for fewer than 4 days
Don’t affect function
SSRI side effects
GI - nausea, constipation
Headaches
Agitation and bad thoughts
TCA side effects?
ANS side effects - dizzy, dry mouth, headache
Sexual Dysfunction
SNRI side effects?
NaSSA side effects? Example
Appetite and weight gain, Low Na+, High BP
Mirtazapine: Weight gain, sedation, confusion
What is Bipolar Affective Disorder?
Manic Depression
Condition where the patient suffers from severe mood changes
What is Bipolar I?
What is Bipolar II?
What is Rapid Cycling BP?
Cyclothermia?
At least one instance of mania lasting more than one week
At least one instance of hypomania lasting more than one week
Both of these also have to have depressive episodes
Where there are more than 4 episodes in a year
Where there is rapid fluctuations of mood over 2 years but not severe enough to be BPAD
What are some symptoms of mania?
Elevated mood or anger
Increased impulsivity, speech, energy, self-esteem
Loss of inhibition, lack of sleep
Psychotic - Grandiose or persecutory delusions, auditory hallucinations
How do you define hypomania?
3+ Symptoms of mania
Last for more than 4 days
Don’t affect function
Medical DDx linked to depression?
Medications?
Diabetes (tiredness)
Hypothyroidism
Anaemia
Beta Blockers
What are the risk factors for Bipolar?
Young
Equal in Genders
Black Afrocaribbean (more likely to be psychotic and manic)
Low SE Status
FHx
(Rapid cycling is more common in females)
What is the prevalence of depression?
Bipolar?
16% lifetime risk
3-4%
What is Beck’s Triad?
Having a negative view of themselves, the future and the world
Other symptoms of depression?
Biological: Loss of appetite, loss of libido, early morning waking, diurnal variation of mood, weight loss
Cognitive: feeling helpless, worthless, thoughts of suicide, self harm, social isolation, poor attention, hypochondriasis
Psychotic: Nihilistic, persecutory delusions
What is Beck’s Triad?
Having a negative view of themselves, the future and the world
How do you treat Bipolar Disorder?
Acute Mania: Antipsychotic (+ Sedative if needed)
Depression: Antidepressant and mood stabiliser
Long term: Mood Stabiliser
How do you treat Bipolar Disorder?
Acute Mania: Antipsychotic (+ Sedative if needed)
Depression: Antidepressant and mood stabiliser
Long term: Mood Stabiliser
What is self harm?
Parasuicide?
Suicide?
Intentional act of harm inflicted on oneself which is not intended to be fatal
Surviving an attempt to take ones life
Intentionally taking ones life
Risk factors for suicide?
Middle Aged Men Isolated High or Low SE status Previous Attempt Bereavement Access to methods
Risk factors for self harm?
Young Females EUPD or Dissocial PD Low SE status Hx of trauma Unemployed Single Substance Misuse
Risk factors for self harm?
Young Females EUPD or Dissocial PD Low SE status Hx of trauma Unemployed Single Substance Misuse
Why don’t we use TCAs as much any more?
Not safe in overdose
Have more ANS side effects
Name some Mood Stabilisers?
Lithium Carbonate
Sodium Valproate
Lamotrigine
Carbamezapine
What are some side effects of Lithium?
Leukocytosis Increased Urine and Thirst Tremor Hypothyroidism Increased Weight Underactive Memory Mums (Teratogenic)
What are the signs of lithium toxicity?
Gross Tremor
Vomiting
Cognitive Impairment
Restlessness
Levels 0.4-1.2mmol/L
Over is unsafe
Side effects of Sodium Valproate?
Ataxia Liver Failure Pancreatitis Reversible Hair Loss Oedema Appetite Teratogenic, Tremor Encephalopathy
What do you need to monitor with lithium?
Renal U&Es
Thyroid Function
