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Year 4 Psychiatry > Affective disorders > Flashcards

Affective disorders Flashcards

1
Q

For a patient in a severe catatonic state on a background of depression, what is the first line treatment?

A

Benzodiazepines and ECT

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2
Q

According to ICD-10, how long do depressive symptoms have to last for, for it to be termed a depressive episode?

A

2 weeks

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3
Q

What is the triad of classic symptoms of depression?

A
  1. Low mood
  2. Anhedonia
  3. Anergia
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4
Q

What is anergia?

A

Reduced energy levels

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5
Q

In addition to the triad of depressive symptoms, what are the other symptoms commonly associated with depression? (8)

A
  1. Reduced concentration and attention
  2. Decreased self-esteem and confidence
  3. Feelings of guilt and worthlessness
  4. Bleak and pessimistic views of the future/hopelessness
  5. Less sleep/waking up very early
  6. Diminished appetite and weight loss or weight gain
  7. Psychomotor agitation or retardation
  8. Marked loss of libido
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6
Q

What additional symptoms may someone experience during a severe depressive episode?

A

Psychotic symptoms

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7
Q

What screening questions are useful to ask when a patient presents with low mood/suspected depression?

A

“In the past month have you often felt down, depressed or hopeless?”

Same as above, but “little interest or pleasure in doing things”

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8
Q

If a first-degree relative has a major depression, what is the % risk of you developing a major depression too? (and compared to what % of the general population?)

A

15% (5% in the general population)

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9
Q

What is the monoamine hypothesis with regards to depression? …which neurotransmitters are involved?

A

The monoamine hypothesis of depression suggests that depression results from the depletion of the monoamine neurotransmitters noradrenaline, serotonin and dopamine.
Other hypotheses are that there is a change in their receptors’ function as opposed to the actual levels of them.

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10
Q

Which nuclei are responsible for releasing serotonin?

A

Raphe nuclei

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11
Q

What functions in the body is the neurotransmitter

serotonin associated with/responsible for? (7)

A
  1. Mood
  2. Anxiety
  3. Sleep
  4. Appetite
  5. Sexuality
  6. Vomiting
  7. Regulation of body temperature
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12
Q

In which endocrine disorders does depression commonly occur in? (4)

A
  1. Cushing’s
  2. Addison’s
  3. Hypothyroidism
  4. Hyperparathyroidism
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13
Q

Why do people with depression have endocrine abnormalities and how has this been proven?

A

50% of depression sufferers fail to respond to the dexamethasone suppression test - it is thought to be due to a disturbance of the hypothalamic-pituitary-adrenal axis

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14
Q

What are the organic causes of depression? (in terms of systems)

A
  1. Neurological = stroke, Alzheimer’s, Parkinson’s, Huntington’s, MS, epilepsy
  2. Endocrine = Cushing’s, Addison’s, hypothyroidism, hyperparathyroidism
  3. Metabolic = Iron deficiency, B12 deficiency, hypercalcaemia, hypomagnesaemia
  4. Infective = influenza, infectious mononucleosis, hepatitis, HIV
  5. Neoplastic
  6. Drugs = L-dopa, steroids, beta-blockers, opioids, alcohol
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15
Q

What is SAD?

A

Seasonal affective disorder is a depressive disorder that recurs every year at the same time go year and may be marked by an increase in sleep and carbohydrate craving. There is usually complete summer remission and, occasionally, summer hypomania or mania.

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16
Q

What types of thinking are associated with depression, they are known as Beck’s cognitive distortions or thinking errors of depression?

A
  1. Arbitrary interference; drawing a conclusion in the absence of evidence
  2. Overgeneralisation; drawing a conclusion on the basis of a single incident
  3. Selective abstraction; focussing on a single event to the detriment of others
  4. Personalisation; relating independent events to onself
  5. Dichotomous thinking; all or nothing thinking
  6. Magnification/minimisation
  7. Catastrophic thinking
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17
Q

What is arbitrary inference?

A

Drawing a conclusion in the absence of evidence e.g. the whole world hates me

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18
Q

What is overgeneralisation?

A

Drawing a conclusion on the basis of a single incident e.g. my nephew did not come to visit me - the whole world hates me

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19
Q

What is selective abstraction?

A

Focussing on a single event to the detriment of others e.g. she gave me an annoyed look three days ago (even though she spent an hour talking to me this morning)

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20
Q

What is personalisation?

A

Relating independent events to oneself e.g. the nurse went on holiday because she was fed up of looking after me

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21
Q

What is dichotomous thinking?

A

All or nothing thinking e.g. if he doesn’t come to see me today then he doesn’t love me

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22
Q

What is magnification/minimisation?

A

Over- or under- estimating the importance of an event

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23
Q

What is catastrophic thinking?

A

Exaggerative the consequences of an event or situation e.g. the pain in my knee is getting worse. I’m probably going to end up in a wheelchair. Then i won’t be able to go to work and pay the mortgage, so I’ll lose my house and end up living on the streets

24
Q

What are the core symptoms of depression? (3)

A
  1. Low mood
  2. Anhedonia
  3. Anergia
25
Q

What are the psychological symptoms of depression? (4)

A
  1. Poor concentration
  2. Poor self-esteem
  3. Guilt
  4. Pessimism
26
Q

What are the somatic symptoms of depression? (7)

A
  1. Sleep disturbance
  2. Early morning wakening
  3. Morning depression
  4. Loss of appetite and weight loss
  5. Loss of libido
  6. Anhedonia
  7. Agitation or retardation
27
Q

What is mild depression?

A

It is the commonest form of depression, the patient often complains of feeling depressed and tired all the time, and sometimes also of feeling stress or anxious. There are none of the somatic features of depression, and although suicidal thoughts can occur, self-harm is uncommon

28
Q

What is moderate depression?

A

Classic textbook description - many if not most of the clinical features of depression are present to such an intense degree that the patient finds it difficult to fulfil his or her social obligations. Somatic features are present and anhedonia is characteristic. Suicidal ideation is common and may be acted upon.

29
Q

What is severe depression?

A

Exaggerated form of moderate depression characterised by intense negative feelings and psychomotor agitation or retardation. Psychomotor retardation may occur and in some cases require ECT. Psychotic symptoms may present, often they are delusions of guilt, delusions of poverty.

30
Q

What is the paradox associated with severe depression and antidepressant treatment?

A

The severe depression results in such low levels of energy and psychomotor retardation, but when given antidepressants, their motivation and energy starts to return, they may be more motivated to act on suicidal thoughts/ideas.

31
Q

What is dysthymia?

A

It is characterised by mild chronic depressive symptoms the are not sufficiently severe to meet the criteria for mild depressive disorder. It has sometimes been regarded as ‘depressive personality’, genetic studies suggest that it is in fact a chronic, mild form of depressive disorder.

32
Q

What is the ICD-10 criteria for mild depression?

A

At least two of the three core features of depression, with at least two of the other symptoms (psychological/somatic) for a minimum period of 2 weeks (none of the symptoms should be present to an intense degree)

33
Q

What is the ICD-10 criteria for moderate depression?

A

At least two of the three core features of depression and at least four of the other symptoms for a minimum of two weeks. Several symptoms are likely to be present to an intense degree.

34
Q

What is the DSM-IV criteria for major depressive episode? (9)

A

5 or more of the following symptoms have been present for the same two-week period and represent a change from previous functioning, at least one of the symptoms is either depressed mood or loss of interest/pleasure:

  1. Depressed mood most of the day, nearly every day
  2. Markedly diminished interest or pleasure in all, or almost all, activities most of the day
  3. Significant weight loss or weight gain or decrease/increase in appetite
  4. Insomnia or hypersomnia
  5. Psychomotor agitation or retardation
  6. Fatigue or loss of energy
  7. Feelings of worthlessness or excessive or inappropriate guilt
  8. Diminished inability to think or concentrate
  9. Recurrent thoughts of death, suicide
35
Q

What are the differential diagnoses for depression? (9)

A
  1. Adjustment disorder
  2. Bereavement
  3. SAD
  4. Dysthymia
  5. Bipolar disorder
  6. Schizoaffective disorder
  7. Generalised anxiety disorder
  8. PTSD
  9. Eating disorder
36
Q

What is important to tell patients when starting them on antidepressants

A
  1. Although they are not a solution to all the problems that may be co-existing/coinciding, they can lift your mood and give you a better chance of addressing them
  2. Antidepressants are effective in over 60% of patients, but it can be 10-20 days before you start to notice an effect, better sleep is often the first sign of improvement
  3. Antidepressants may have troublesome side effects, but these tend to resolve in the first mont of treatment
  4. Antidepressants should not be stopped suddenly once treatment is established
37
Q

What are the three main indications for ECT?

A
  1. Severe depression
  2. Mania
  3. Schizophrenia
38
Q

What are the contraindications for ECT?

A
  1. Cardiovascular disease
  2. Raised ICP
  3. Epilepsy and other neurological conditions
  4. Cervical spine disease
39
Q

What are the common side effects associated with ECT?

A
  1. Headache
  2. Muscle aches
  3. Nausea
  4. Confusion
  5. Temporary memory impairment
  6. Side effects of anaesthesia
40
Q

What are the characteristics of mania?

A

Hyperactive, with racing thoughts, resulting in pressured speech which is high volume and difficult to interrupt.
They are often full of grandiose and unrealistic plans which they begin to act upon and then abandon to move onto the next. They often engage in reckless and impulsive behaviour for example driving recklessly, taking illegal drugs, spending vasts amounts of money or engaging in sexual activity with near-strangers.

41
Q

What is the common psychotic feature of mania?

A

Delusions - of grandeur and of exaggerated self-importance

42
Q

What is hypomania?

A

It is very similar to mania, the mood is elevated, expansive or irritable but in contrast to mania, there are no psychotic features and no marked impairment of social functioning.

43
Q

What is the response rate of lithium in BAD?

A

75%

44
Q

What is the therapeutic range for lithium?

A

0.4-1mmol/L

45
Q

When does lithium toxicity occur?

A

Beyond 1.5mmol/L and is characterised by GI disturbances such as anorexia, nausea, vomiting and diarrhoea; nystagmus, coarse tremor, dysarthria, ataxia and in severe cases LOC, coma and death

46
Q

Initially when started, when should serum lithium levels be monitored?

A

12 hours post-dose

47
Q

Until the patient is stabilised, how frequently should serum lithium levels be monitored?

A

5-7 day internals

48
Q

Once a patient is stabilised on lithium, how frequently should their serum lithium levels be monitored?

A

3-4 monthly

49
Q

In addition to the serum lithium, what else needs to be monitored too?

A

Thyroid (as it can enlarge the thyroid gland)

Renal function

50
Q

What is the risk of using ECT to treat a patient with bipolar disorder in a depressive episode?

A

It might switch them to a manic episode

51
Q

How many symptoms are present for someone to be diagnosed with mild depression?

A

4 symptoms

52
Q

What does Becks cognitive triad of depression describe?

A

Types of negative thought:

  1. Negative view of oneself
  2. Negative view of the world
  3. Negative view of the future
53
Q

What are the somatic syndrome features of a depressive episode? (8)

A
  1. Anhedonia
  2. Decreased emotional reactivity
  3. Early morning wakening
  4. Diurnal variation
  5. Psychomotor retardation
  6. Decreased appetite
  7. Weight loss (>5% in 1 month)
  8. Reduced libido
54
Q

How many biological symptoms must be present for the depressive episode to constitute somatic syndrome too?

A

4 of 8

55
Q

What is atypical depression?

A

It is characterised by reverse neurovegetative biological symptoms; hyperphagia, weight gain and hypersomnia.

56
Q

What type of disorder is atypical depression associated with?

A

SAD

Year 4 Psychiatry (14 decks)

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