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4th year psych > Affective disorders > Flashcards

Affective disorders Flashcards

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1
Q

Aetiology depression (molecular)

A

Decreased availability of monoamine neurotransmitters plus hypercortisolaemia in severe –> Decrease in BDNF (brain derived neurotrophic factor) which promotes neurogenesis.

Dysfunctional limbic system and related areas

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2
Q

What are the monoamine neurotransmitters?

A

Noradrenaline and serotonin

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3
Q

Risk factors for depression

A

Genetics/gene - environment interaction

PMH treatment with interferons (cytokines)

Physical illness

Medications e.g. steroids, isotretinoin

Female

LT alcohol or drugs

History of abuse, childhood stress, parental loss

Poor resilience/catastrophising

Recent adverse life events (housing, financial, employment, relationships etc)

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4
Q

three cardinal signs of depression

A

Low mood

Anhedonia

Anergia (low energy)

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5
Q

Diagnostic criteria for depression (ICD-10)

A

2 or more of the three main symptoms for 2w or more

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6
Q

What are the three affective disorders?

A

Bipolar

Mania

Depression

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7
Q

ICD-10 criteria for mild/mod/severe depression?

A

Mild: 2 core and 2 other

Moderate: 2 core and 3 other

Severe: 3 core and 4 other

But also depends on freq and number of sx, degree of distress and interference with ADLs

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8
Q

What other sx do you get in depression?

A

Decreased: concentration, self esteem, sleep, appetite

guilt, wortheless

Hopeless

Self-harm

Psychomotor retardation or agitation

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9
Q

How might an older person’s profile of sx differ in depression?

A

More biological sx than mood

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10
Q

What three things do depressed people have depressed thoughts about? What is this known as?

A

Self

World

Future

Beck’s cognitive triad

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11
Q

What diurnal variation might you get in depression?

A

Mood worse in am

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12
Q

Depressive retardation may be similar to

A

Flat affect chronic schizophrenia

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13
Q

Differentials for depression

A

Normal sadness

Schizophrenia (for psychotic depression)

Alcohol/drug withdrawal

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14
Q

Management of depression

A

Mostly primary care

Treat co-morbs and substance misuse in all

Self help, exercise, computer CBT

CBT/interpersonal therapy

Mod/severe: psych therapy and antidepressant

Could augment the antidepressant

Severe: ECT

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15
Q

What would indicate psych referral in depression?

A

Severe, unresponsive, bipolar, recurrent, high suicide risk

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16
Q

How long does depression normally last?

A

3-8m

20% >2y

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17
Q

What percent of depression recurs? What about if it was severe?

A

50% (80% severe)

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18
Q

Do recurrent episodes of depression tend to be similar?

A

no get worse so prophylaxis is good

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19
Q

Lifetime suicide risk in severe depression

A

15%

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20
Q

Severe depression is associated with _____ disease

A

Cardiac

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21
Q

what is hypomania?

A

Less severe mania, no psychosis

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22
Q

ICD-10 criteria for bipolar diagnosis?

A

At least 2 episodes, including at least one hypomanic/manic

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23
Q

Onset of bipolar age?

A

Early 20s

24
Q

How genetic is bipolar?

A

at least 60% inherited

25
Q

What is the neurophysiological basis for bipolar?

A

Abnormal hypothalamic pituitary adrenal axis

MRI- smaller prefrontal lobes, enlarged amygdala and globus pallidus.

Hypothyroid involved in 25% rapid cycling

26
Q

What, earlier in life, can lead to abnormal hypothalamic pituitary adrenal axis dysfunction (in bipolar)

A

prolonged psychosocial stressors in childhood

27
Q

Two things that might induce mania in bipolar?

A

Post-partum

Sleep deprivation

28
Q

How does mania present?

A

Elated mood

Irritable

Psychomotor agitation

Decreased need for sleep

High self esteem

Disinhibited

Pressured speech, flight of ideas

Mood-congruent delusions and hallucinations, usually auditory

29
Q

What is rapid cycling bipolar defined as?

A

at least 4 episodes per year

30
Q

Do people with bipolar have insight?

A

Often no

31
Q

Median duration of manic episode in bipolar?

A

4m

32
Q

Median duration of depressive episode in bipolar?

A

6m

33
Q

Differentials in a manic episode?

A

Substance abuse e.g. cocaine

Due to endocrine/epilepsy/medication

Schizophrenia/schizoaffective disorder

Personality disorder

ADHD (although high mood is rare)

34
Q

Most effective LT treatment for bipolar?

A

Lithium

35
Q

How would you start someone on lithium for biploar including monitoring

A

125mg-1g PO BD

Check U&Es, ECG, TFTs

Adjust dose until plasma level 0.6-1 mmol/L

First check on day 4-7. 12h after they’ve taken it.

Check weekly until they are stable for 4w, then monthly for 6m then 3 monthly

Check TFT and U&E at 6m

Warn signs toxicity

36
Q

progressively increasing lithium levels could indicate what

A

nephrotoxicity

37
Q

SEs lithium

A

Hypothyroid

nephrogenic diabetes insipidus

toxicity

38
Q

What are the signs of lithium toxicity

A

Worsening vision

D&V

Hypokalaemia

Ataxia

Tremor

Dysarthria

Coma

39
Q

Can you stop lithium cold turkey?

A

No taper over 2-4w or else it will induce mania in 50%

40
Q

Second line treatment for bipolar?

A

Anticonvulsants: semisodium valproate (±lithium) or olanzapine or quetiapine

41
Q

Can you prescribe an antidepressant in bipolar?

A

Must also have a mood stabiliser. Stop the AD at onset of acute manic episode

42
Q

How would you treat episodes of mod/severe depression in bipolar?

A

Quetiapine, olanzapine, lamotrigine

Olanzapine and fluoxetine combination

43
Q

Prognosis for a single manic episode?

A

90% have manic/depressive recurrence. Frequency and severity tend to increase for 4/5 episodes then plateau.

44
Q

Bipolar increases risk of what

A

Premature mortality, only partially explained by suicide rate of 10%

45
Q

What is cyclothymia?

A

Chronic mood fluctuation over 2y of depression and hypomania but not severe enough to be diagnosed)

30% will develop full bipolar

46
Q

What is mood like in mania

A

Irritable

Euphoric

Labile

47
Q

What is cognition like in mania?

A

Grandiose, flight of ideas, low concentration, confused, lack insight

48
Q

What is behaviour like in mania?

A

Rapid speech

hyperactive

reduced sleep

hypersexuality

extravagance

49
Q

Psychotic symptoms in mania?

A

Delusions and hallucinations

50
Q

Causes of mania

A

Bipolar

Physical- infection, hyperthyroid, SLE, TTP, stroke, hyponatraemia, ECT

Drugs- amphetamines, cocaine, antidepressants, catopril, steroids, procyclidine, L-dopa, baclofen

51
Q

Which antidepressant especially increases risk of mania?

A

Venlafaxine

52
Q

Management of first presentation of mania?

A

Ask about infection, drug use, FHx psch

CT head, EEG, drug screen

53
Q

Treatment for mod/severe mania

A

Olanzapine 10mg PO or semisodium valproate

54
Q

SEs olanzapine

A

Weight gain and glucose desensitivity.

55
Q

Symptoms of mania in primary care management?

A

Urgent referral to CMHT

4th year psych (15 decks)

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