Affective Disorders Flashcards
What is the aetiology of affective disorders?
Strong genetic element Female In 30s Higher social classes (bipolar) lower social classes (depression) Medicinal non compliance Hypothyroid, cancer, syphilis, HIV, MS, Diabetes, Cushings, Addisons Viral infections BBs, steroids, methyldopa Sleep disturbance Post child birth Chronic pain FH
What are the risk factors
Divorce Unemployment Lack of family support Childhood sexual abuse Not working outside the home Lack of confiding relationships
What is needed to diagnose Mania?
One week of elevated mood with intense irritability, increased activity and energy and Hallucinations or delusions causing major disruption to life
What are the other signs of hypomania?
Exaggerated optimism Sexual overactivity Dangerous driving Reckless spending Inflated self esteem Heightened sensory awareness Rapid speech and thinking Less sleep Absence of awareness
What is needed for a diagnosis of hypomania?
Managed in the community
4 days of elevated or irritable mood with 3 other symptoms
What are the 3 Types of BIpolar Affective Disorder?
- Manic
2. Hypomanic
What is needed for a diagnosis of depressive disorder?
3 core symptoms, 2 of which have been present every day for 2 weeks for mild depression and more for more advanced.
What are the core symptoms of depression?
- Pervasive Low Mood
- Anhedonia
- Decreased Energy
What are other symptoms of depression?
Reduced concentration Feelings of guilt and worthlessness Reduced self esteem Self harm thoughts Hopelessness about the future Decreased sleep or no apetite Retardation of speech and movement Psychotic symptoms- nihilistic/delusional/hypochondriac Diurnal variation Lack of emotional expression Loss of libido
What is cyclothymia?
Mild bipolar
Mood swings rapidly
What is dysthymia?
Persistent depression
Chronic low mood
What scale is used to measure Post Natal Depression?
Edinburgh Score
What are risk factors for postnatal depression?
Family history Older age Poverty Single mother Unwanted pregnancy Poor relationship with own mother Poor support
When does post natal depression require admission?
Thoughts of harm to self or baby
What is the treatment pathway for depression?
- Education
- Low intensity psychotherapy, sleep hygiene, CBT, self help
- CBT/IPT, medication
- ECT and MDT
What investigations are needed for depression?
TFT Cr LFT Lipid profile Alcohol screen Prolactin ECG Urine
Name some SSRIs
Sertraline
Citalopram
Fluoxetine
Paroxetine
Which SSRI is best to use in paediatrics (over 17s)?
Fluoxetine
Which SSRI shouldnt be prescribed in patients with cardica issues and why?
Citalopram
Long QT
What is the mechanism of SSRIs?
Increases the amount of free serotonin in synapses
Name some SNRIs
Venlafaxine
Duloxetine
What is the mechanism of SNRIs?
Increase the amount of serotonin and noradrenaline in synapses.
Name a Monoamine Oxidase Inhibitor
Phenelzine
Tranylcyromine
What are the dietary limitations for patients on MAOIs and why?
Aged cheese Red wine Beer Smoked fish Anything with tyramine in it which is a vasoconstrictor and causes a hypertensive crisis.
