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Phase 2 Psychiatry > Affective Disorders > Flashcards

Affective Disorders Flashcards

1
Q

Describe the ICD-10 criteria for Bipolar disorder

A

2+ episodes of depression and mania/hypomania

  • in the absence of mania/hypomania, diagnosis = recurrent depressive disorder
  • in the absence of depressive episodes, diagnosis is either bipolar or hypomania
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2
Q
  1. What gender is affected more by bipolar?
  2. what is the mean age of onset?
  3. In which SES group is prevalence highest?
A
  1. both genders affected equally
  2. 21
    • first episode of mania after 50 is unusual and should lead to investigation of organic cause
  3. higher SES groups
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3
Q

Which neurotransmitters are implicated in the aetiology of bipolar disorder?

A

NA, DA and 5-HT

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4
Q

Define the following classifications of bipolar disorder:

  1. Bipolar Disorder type I

2. Bipolar Disorder type II

A
  1. at least one manic or mixed episode

2. never had a full manic episode; at least 1 hypomanic episode and at least one major depressive episode

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5
Q

Describe clinical features of Mania

A
  • elevated mood
  • increased energy
  • thought disorder - racing thoughts, flight of ideas, pressured speech
  • increased self esteem
  • reduced attention, distractability
  • Tendency to engage in behaviour that has serious consequences
  • Marked disruption of work, usual social activities, and family life
  • may display psychotic symptoms such as grandiose ideas, persecutory delusions
  • Preoccupation with thoughts and schemes may lead to self-neglect, to the point of not eating or drinking, and poor living conditions.
  • total or partial loss of insight

must last >1 week

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6
Q

Describe clinical features of hypomania

A
  • mildly elevated, expansive or irritable mood
  • increased energy and activity
  • marked feelings of well-being, physical and mental efficiency
  • increased self esteem
  • sociability
  • talkativeness and over-familiararity
  • increased sex drive
  • reduced need for sleep
  • difficulty in focussing on one task alone
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7
Q

How does hypomania differ from mania?

A
  • shorter time
  • less severe
  • no psychotic features
  • less disability
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8
Q
  1. Name 5 other psychiatric differentials for bipolar disorder
  2. name 4 organic differentials for bipolar disorder
A 
1. schizoaffective disorder
   schizophrenia
   cyclothymia
   ADHD
   drug use - alcohol, amphetamines, cocaine, hallucinogens
  1. organic brain disease of the frontal lobes
    endocrine disorders - hyperthyroid, cushing’s
    SLE
    sleep deprivation
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9
Q
  1. How is an acute manic episode managed? (3)

2. What are the 3 main pharmacological options for long term management?

A 
1. sedative (e.g. diazepam)
   neuroleptic (e.g. haloperidol)
   atypical antipsychotic (e.g. olanzapine)
  1. lithium
    valproate
    carbamazepine
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10
Q
  1. How long does lithium treatment need to be taken for?
  2. How is lithium excreted?
  3. Which organ function needs to be monitored during lithium therapy? (2)
A
  1. at least 3 years
  2. unchanged by the kidneys (therefore plasma concentration can be affected by renal function)
  3. renal function
    thyroid function (can cause hypothyroidism)
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11
Q

Why should antidepressants be used conservatively in the management of bipolar disorder?

A

they have the potential to induce mania (manic switch) or rapid cycling

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12
Q

What is meant by the terms:

  1. attempted suicide
  2. parasuicide
  3. deliberate self harm
A
  1. an act of intentionally trying to kill oneself, with the primary aim of dying, but failing to do so
  2. an act that looks like suicide but does not result in death. Can be tantamount to attempted suicide, or a means of help seeking
  3. the act of intentionally inuring oneself, irrespective of the actual degree of injury sustained.
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13
Q

Out of deliberate self harm and suicide, which is more common in:

  1. men?
  2. women
A
  1. suicide

2. deliberate self harm

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14
Q
  1. In which gender is suicide more common in?
  2. How is suicide affected by age?
  3. Name other sociodemographic risk factors for suicide
A
  1. men
  2. rate is highest in males aged 25-44; rate increases with age
3. single/widowed/separated
    unemployment/insecure employment
    lower SES
    poor levels of social support - elderly, prisoners, immigrants, bereaved
    recent life crisis
    victim of physical or sexual abuse
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15
Q

Name some clinical risk factors for suicide

A
  • hx of deliberate self harm
  • hx of mental disorder - alcohol dependence, schizophrenia, depression
  • physical illness (particularly if terminal or disabling)
  • fam hx
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16
Q

What questions are important to ask when assessing a patient’s suicide risk?

A
  • was there a clear precipitant/cause for the attempt?
  • was the act premeditated or impulsive?
  • did they leave a suicide note?
  • had the patient taken steps not to be discovered?
  • did the patient make the attempt in strange surroundings?
  • would the patient do it again?
17
Q

What are the absolute indications for a psychiatric referral following a suicide attempt?

A
  • clinical depression
  • psychotic illness
  • clearly pre-planned suicidal attempt that was not intended to be discovered
  • persistent suicidal intent (more detailed plans)
  • violent method used
18
Q

What other factors could indicate a referral to psychiatry following a suicide attempt?

A
  • alcohol/drug misuse
  • patients <45, especially if male, and young adolescents
  • fam hx of suicide
  • those with serious physical disease
  • those living alone or otherwise unsupported
  • major unresolved crisis
  • persistent suicide attempts
  • patients giving you a cause for concern
19
Q

Name reasons that a person may perform deliberate self harm

A
  • express and relieve bottled up tension/anger/emotion
  • feel more in control of a seemingly desperate life situation
  • punish oneself for being a “bad person”
  • combat feelings of numbness
  • distract oneself from other pain
20
Q

Name risk factors for repeated parasuicide

A
  • hx of suicide attempt
  • hx of trauma
  • poor global functioning
  • hx of psychiatric disorder/undergoing psychiatric treatment
  • alcohol/drug abuse/dependece
  • PERSONALITY DISORDER
  • unemployment
  • unmarried status
  • interpersonal conflict
21
Q

Name risk factors for repeated deliberate non fatal self harm

A
  • hx of self harm
  • hx of psychiatric disorder/psychiatric treatment
  • personality disorder
  • alcohol/drug use/dependence
  • living alone
22
Q

How is a person who has performed self harm managed:
1. Acutely?

  1. In the long term?
A
  1. sensitive and compassionate approach
    see patient individually
    examine physical injuries
    assessment of emotional/mental state and risk
    address any safeguarding concerns
    refer to A&E if physical state is considered high risk
    consider referral to secondary mental health services
  2. harm minimisation techniques
    development of alternative coping strategies
    psychological intervention
    crisis team involvement
    management of other mental/physical health problems
    prevent access to any means of self harm where possible
23
Q

Which personality disorder is associated with repeated acts of deliberate self harm?

A

Borderline personality disorder

24
Q
  1. What is the prevalence of depression in primary care?
  2. What is the prevalence of depressive symptoms in the general population?
  3. How is the prevalence of depression affected by age?
  4. In which gender is the prevalence of depression higher?
A
  1. 10-15%
  2. ~30%
  3. increases with age
  4. females
25
Q
  1. Which 3 neurotransmitters are implicated in depression?
  2. What is the normal role of these neurotransmitters?
  3. How are they affected in depression?
A
  1. DA, NA and 5-HT (monoamines)
  2. NA - sleep/wakefulness, eating behaviour and attention
    DA - motivation
    5-HT - mood, sleep/wakefulness, emotional behaviour and sexual function
  3. deficiency of monoamines
26
Q
  1. Which personality traits are associated with a predisposition to depression?
  2. Name other environmental factors which may predispose an individual to depression
A
  1. neuroticism and obsessionality

2. adverse life events - loss of loved one, neglect, sexual abuse, divorce, unemployment etc

27
Q
  1. What are the 3 core symptoms of depression?

2. What are the 7 associated symptoms of depression?

A
  1. low mood; anhedonia; fatiguability
2. disturbed sleep
    poor concenctration
    low self confidence
    appetite changes
    suicidal ideation
    psychomotor agitation/retardation
    guilt/self blame
28
Q

What is the ICD-10 classification of:

  1. Mild depression
  2. Moderate depression
  3. Severe depression
A
  1. 2 core symptoms + 2 associated symptoms
  2. 2 core symptoms + 3 associated symptoms
  3. 3 core symptoms + 4+ associated symptoms
29
Q

What is the characteristics of psychotic features in depression?

A

mood congruent (i.e. have a depressive theme)

30
Q

What are the clinical features of atypical depression?

A
  • mood reactivity - mood brightens to positive events
  • increased appetite
  • increased sleep
  • interpersonal rejection sensitibity
31
Q

How may a patient with LD present with depression?

A
  • loss of interest
  • change in behaviour
  • reduced energy
  • slowed activity
  • loss of appetite
  • self harming/challenging behaviours
32
Q
  1. Which antidepressants are preferred in mixed anxiety-depression
  2. which antidepressants should be avoided if there is a high suicide risk?
A
  1. SSRIs

2. TCAs and MAOIs

33
Q
  1. Name examples of SSRIs
  2. Name examples of TCAs
  3. Name examples of SNRIs
A
  1. sertraline, fluoxetine, paroxetine, citalopram
  2. amitryptiline, imipramine
  3. venlafaxine, duloxetine
34
Q

What is the MOA of mirtazepine?

A

Enhances noradrenergic and serotinergic neurotransmission but has no significant effect on the reuptake of monoamines

35
Q

When is ECT indicated for depression?

A
  • treatment of choice in severe, life-threatening depressive illness, particularly when psychotic symptoms
  • essential treatment with the patient is dangerously suicidal and when a rapid resolution is required
36
Q

What is dysthymia?

A

mild chronic depressive symptoms that are not sufficiently severe to meet the criteria for mild depressive disorder.

Phase 2 Psychiatry (11 decks)

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