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Psychiatry exam 2018 > Affective disorders > Flashcards

Affective disorders Flashcards

1
Q

Two types of affective disorder

A

Depressive and manic state

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2
Q

Criteria of depressive episode (DSM V - 9 criteria)

A

1) Depressed mood
2) Loss of interest or pleasure (anhedonia)
3) Significant weight loss or weight gain
4) Insomnia, or hypersomnia
5) Psychomotor agitation or retardation
6) Fatigue, or loss of energy
7) Feeling of worthlessness, or excessive or inappropriate guilt
8) Diminished ability to think or concentrate, or indecisiveness
9) Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation

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3
Q

Psychopathological symptoms in depression

A
  • Hypoprosexia
  • Monoideism
  • Self-accusation
  • Loss of perspective
  • Feeling of worthlessness
  • Anhedonia
  • Dysthymia
  • Dysphoria
  • Irritability
  • Anxiety
  • Hypobulia
  • Anergia
  • Retarded psychomotorium
  • Agitation
  • Psychotic symptoms
  • Holothym delusions
  • Hallucinations
  • Suicidal thoughts
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4
Q

Hypoprosexia

A

Defective fixing of attention

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5
Q

Monoideism

A

State of prolonged absorption in a single idea

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6
Q

Anhedonia

A

Loss of interest/pleasure

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7
Q

Dysthymia word meaning

A

Depressed mood

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8
Q

Hypobulia

A

Lowered ability to make decisions or to act

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9
Q

“-thymia”

A

Emotion, mood or state of mind

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10
Q

Holothym delusions

A

Delusions connected with emotional state

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11
Q

Somatic symptoms of depression

A
  • Sleep disorder
  • Weight loss
  • Sexual dysfunction
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12
Q

2 main types of depression, based on behavioural symptoms

A

1) Melancolic type

2) Agitated type

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13
Q

Diagnostic criterias of manic episode (DSM V - 8 criteria)

A
  • Hyperthymia or irritability (one of them is necessary for the diagnosis)
    + 3 or more of:
  • Inflated self-esteem or gradiosity
  • Decreased need for sleep
  • More talkative than ususal or pressure to keep talking
  • Flight of ideas or subjective experience that thoughts are racing
  • Distractibility
  • Increase in goal-directed or psychomotor agitation
  • Excessive involvement in pleasurable activities that have a high potential for painful consequences
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14
Q

Psychopathological symptoms in manic episode

A
  • Hyperthymia
  • Irritability
  • Logorrhea
  • Flight of ideas
  • Secunder incherentia
  • Grandiosity
  • Delusions
  • Accelerated psychomotorium
  • Agitation
  • Hyperbulia
  • Loss of critical sense
  • Hyperprosexia
  • Loss of insight
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15
Q

Bipolar I definition

A
  • There are manic and depressive phases

- Between them, in most cases are euthym episodes

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16
Q

Bipolar II definition

A

There are hypomanic and depressive epoisodes in the anamnesis

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17
Q

Cyclothymia definition

A
  • Intensive affective fluctuation and change in the activity

- Affective changes doesn’t reach clinical level

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18
Q

Unipolar depression definition

A

Only depressive episodes, no mania

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19
Q

Dysthymia definition

A
  • In most cases, affective symptoms doesn’t reach the criteria of depression
  • In many cases, dysthymia is based on personality disorder
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20
Q

How can we classify affective disorders?

A

Based on suspected etiology: endogenous, reactive, organic

Based on the progress: bipolar-unipolar, the disease takes place in phases, or is persistent

Bases on intensity: minor, major

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21
Q

Differential diagnosis of depressive symptoms

A

1) Somatic diseases and drug effect

2) Psychiatric disorder
- Bipolar disorder
- Dysthymia
- Anxiety disorders
- Drug, or alcohol abuse
- Schizoaffective disorder
- Schizophrenia

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22
Q

Differential diagnosis of manic symptoms

A

1) Somatic diseases and drug effect

2) Psychiatric disorders
- Bipolar disorder
- Schizoaffective disorder
- Drug, or alcohol abuse
- Schizophrenia

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23
Q

Therapy of a depressive episode

A

1) Every depressive episode should be treated
2) Mild depressive episode: psychotherapy
3) Moderate and severe: antidepressant medication

24
Q

Antidepressant medication principles

A
  • Affecting serotonin, NE, DA systems of CNS
  • Effect builds up in 2-4 weeks
  • Continue treatment for at least 6-12 months after recovery
  • In recurrent depression, profylactic antidepressive therapy is needed long-term
25
Q

SSRIs advantages (3)

A
  • Well tolerated
  • Low toxicity
  • Effective also in anxiety disorders
26
Q

SSRIs SEs (5)

A
  • Nausea, vomiting
  • Diarrhea
  • Headache
  • Sleep disorder
  • Sexual disorder
27
Q

SSRIs names

A
  • Fluoxetine
  • FLuvoxamine
  • Sertraline
  • Citalopram
  • Escitalopram
  • Paroxetine
28
Q

Dual action antidepressants examples

A
  • SSNRIs: Venlafaxine, duloxetine
  • NA+DA: Buproprion
  • Alpha 2 R inhibitor + serotonin antagonist: Mirtazapine
29
Q

SSNRIs advantaged use

A
  • Good when there´s psychomotor retardation and anergia

- Duloxetine can be useful in depression with psychosomatic symptoms

30
Q

Bupropion when extra effective

A
  • Anhedonia

- Psychomotor retardation

31
Q

Bupropion serious SEs

A
  • Can intensify psychotic symptoms

- Can provocate epileptic seizure

32
Q

Mirtazapine when extra effective + 2 common SE

A

When anxiety and insomnia symptoms are present

- SE: weight gain, sedation

33
Q

Tricyclic and tetracyclic antidepressants

A
  • Both serotonergic and NA
  • Rarely used due to SEs and toxicity
  • Clomipramine (tricyclic), Mianserine (tetracyclic)
34
Q

Tricyclic and tetracyclic SEs

A

AntiACh: dry mouth, accomodation problems, glaucoma, tachycardia, urine retention, obstipation, delirium, memory

Anti-histamine: sedation, weight gain

Alpha-1 R inhibition: orthostatic hypotonia, reflex tachycardia, sedation

35
Q

Trazodone

A
  • Serotonin reuptake inhibitor and atg of 5-HT2A/2C

- Beneficial when insomnia, agitation and anxiety symptoms

36
Q

Moclobemid

A
  • RIMA (reversible MAO-A inh)
  • Used in atypical depression
  • SE: serotonin SY
37
Q

Reboxetine

A
  • Selective NA reuptake inhibitor

- Used when anergia, psychomotor retardation are present

38
Q

Agomelatin

A
  • Agonist on melatonin R´s, atg on 5-HT2C R´s

- Effective when insomnia

39
Q

Tianeptin

A
  • Helps serotonin reuptake

- Effective when anxiety and ethyl abuse / dependency present

40
Q

Most common psychotherapeutic approaches in depression

A
  • Cognitive-behavioural therapy
  • Person-centered therapy
  • Short dynamic therapy
  • Interpersonal therapy
41
Q

Indications electroconvulsive therapy

A
  • Therapy-resistant depression
  • Severe retarded psychomotorium
  • Stupor
  • Nutrition negativism
  • High suicide risk
  • Bad somatic state
42
Q

Electroconvulsion safe?

A

It is safe during pregnancy and in elderly

43
Q

How often do we commonly use ECT?

A

2-3 times a week, 6-10 times totally

44
Q

Advantages ECT

A
  • Shorter therapy

- Also effective in therapy-resistant depressions

45
Q

Other possible therapies of depression

A
  • Sleep deprivation
  • Light therapy
  • Augmenting medication
46
Q

Main principles bipolar disorder therapy

A
  • All patients need sustained drug therapy
  • Base of therapy is mood stabilizers
  • Need both acute phase therapy and phase-prophylactic therapy (classic mood stabilizers and SGAs)
47
Q

Can antidepressants be used in depression in bipolar disorder?

A

Yes, but only combined with mood stabilizers

48
Q

Therapy of manic episode in bipolar disorder

A
  • Continue mood stabilizers (lithium, valproate, lamotrigine, carbamazepine)
  • First line: SGAs (olanzapine, quetiapine, aripiprazole)
  • If agitation: add benzo´s (clonazepam)
  • *Antidepressants are CI!
49
Q

Mood stabilizers

A
  • Lithium
  • Valproate
  • Carbamazepine
  • Lamotrigine
50
Q

Lithium function

A
  • Mood stabilizer
  • Antimanic and phase-prophylactic effect
  • Narrow TI
  • Eliminated only through kidney
  • SE: tremor, weight gai, hypothyreosis, diabetes insipidus
51
Q

Lithium TI + toxic effects

A

Blood level 0,6 - 1,0 mmol/l

- Loss of consciousness, tremor, diarrhea, nausea and kidney failure

52
Q

Valproate functions

A
  • Mood stabilizer + antimanic effect

- CI in age of pregnancy

53
Q

Carbamazepine functions

A
  • Mood stabilizer + antimanic effect

- Inductor of cytochrome system (drug interactions)

54
Q

Lamotrigine

A
  • Mood stabilizer + effective in preventing depressive episodes (esp. bipolar II)
  • Fast dose-elevation can cause SJS
55
Q

45 year old bipolar patient with symptoms: tremor, diarrhea, anxiety. First 2 steps?

A

1) Estimate suicidal risk and find out if overdosed on some medication
2) Urgent Lithium blood level control

56
Q

30 year old bipolar patient with depressive symptoms. Talks about acoustic hallucinations and guilt delusions. Possible treatment?

A
  • Antipsychotics
  • Phase-prophylactics
  • Anxiolytics
  • Antidepressants

Psychiatry exam 2018 (9 decks)

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