Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Y4 Psychiatry > Affective Disorders > Flashcards

Affective Disorders Flashcards

1
Q

What are the main types of affective disorder?

A

Depression

Mania

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Women are __?__ as likely as men to develop depression.

A

twice

F:M 2:1

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is the prevalence of depression?

A

5%

remember, prevalence is the proportion of the population with a disease at any given time

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is the lifetime rate of depression?

A

20%

That is, 20% of people will experience depression at some point in their lifetime.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are the core symptoms of depression?

A
  1. Low mood (may be diurnal)
  2. Anhedonia (inability to derive pleasure)
  3. Anergia (↓ energy)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

True or false: a person must be experiencing symptoms for at least three months for a diagnosis of depression to be made,

A

False.

For a diagnosis of depression to be made, a patient must experience symptoms every day for two weeks.

AND the symptoms can’t be secondary to the affects of drug/alcohol use, organic disease, or bereavement.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

In addition to the core symptoms, what other symptoms are characteristic of depression?

A

Poor concentration

Worthlessness/guilt

Suicidal thoughts

Poor sleep

Reduced libido

Change in appetite

Psychomotor retardation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

How is severity assessed in depression?

A

Mild: 2 core + 2 other

Moderate: 2 core + 3 other

Severe: 3 core + 4 other

Although it is based on symptom count, suicidal intentions or the presence of psychosis indicate a severe depression.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

True or false: Patients with untreated bipolar affective disorder will go on to have an average of at least 10 depression/mania episodes in their lifetime.

A

True

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is the cure for bipolar affective disorder?

A

There isn’t one!

The aim of treatment is to reduce number and severity of relapses.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

True or false: There is no link between genetics and bipolar affective disorder.

A

False

Genes are a major aetiological factor.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

The prevalence of bipolar is roughly __?__%

A

1%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

True or false, bipolar affects as many men as it does women.

A

True.

The M:F ratio is similar.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

When a patient is experiencing a manic episode, what symptoms might they commonly display?

A

Elevated mood

Increased energy

↓ concentration

↓ need for sleep

Grandiosity

Reckless, disinhibited behaviour (overspending, promiscuity)

Increased libido

Racing thoughts, pressured speech

Irritability, aggression

Psychomotor agitation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

How is a diagnosis of mania made?

A

Distinct period lasting at least 1 week of abnormally elevated mood + at least three other symptoms. Impacting negatively on occupational and social functioning.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Your patient is displaying elevated mood, irritability and boorish behaviour. They are not displaying signs of psychosis and their symptoms do not seem to majorly interfere with work or social functioning.

What term describes this patient’s mood?

A

Hypomania

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

How is a diagnosis of bipolar affective disorder made?

A

At 2 least episodes of disturbed mood, one of which is manic or hypomanic.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What are the three broad classifications of antidepressants, based on their action?

A

1) Monoamine reuptake inhibitors - block reuptake of synaptic neurotransmitters, increasing their availability.

2) Receptor antagonists
- ?

3) Monoamine Oxidase inhibitors
- Inhibit the enzyme that degrades synaptic neurotransmitters, increasing their availability.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What are the most commonly used antidepressants?

A

SSRI’s

  • safer in overdose
Citalopram
Escitalopram
Fluoxetine
Sertraline
Paroxetine
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What are the common side effects of SSRI’s?

A

Agitation

Nausea/loss of appetite

GI problems: indigestion, diarrhoea, constipation

Loss of libido, erectile dysfunction

Dizziness/dry mouth/blurred vision/sweating/headaches

21
Q

Why are monoamine oxidase inhibitors rarely used?

A

Poorer tolerability, interactions and dietary restrictions.

Dangerous interactions with amphetamines and certain anaesthetic agents.

As well as monoamine neurotransmitters, Monoamine Oxidase also breaks down tyramine in the gut. Accumulation can lead to fatal hypertensive crisis, therefore sources must be avoided (cheese, red wine, bovril and many more).

22
Q

True or false: Initially when starting antidepressants, there may be an increased risk of suicide.

A

True.

Motivation improves quicker than mood, giving a period of increased risk if a patient has suicidal ideas.

SSRI’s may be implicated more than others, but they have less risk of OD.

23
Q

How might antidepressants cause serotonin syndrome?

A

Increase available serotonin, especially if take with other drugs that increase serotonin levels (e.g. other antidepressants, MaOI’s, St John’s Wort, ecstasy).

24
Q

What are the symptoms of serotonin syndrome?

A

Restlessness, fever, tremor, myoclonus, confusion, seizures, arrhythmias

25
Q

How do you manage serotonin syndrome?

A

Stop the drug(s)

Supportive therapy and monitoring

26
Q

True or false: Antidepressants cause hypernatraemia

A

False

Hyponatraemia is a problem sometimes seen with patients taking antidepressants.

Esp. older thin females in summer with poor renal function. Therefore, monitor at-risk group

SSRI’s are worst culprits

27
Q

How long should an antidepressant be trialled for?

A

At least 4-6 weeks, if tolerated.

It can take this long to see the benefits.

28
Q

When should an antidepressant be stopped?

A

6 to 9 months AFTER RECOVERY.

Stopping earlier can cause a relapse that is more severe than the initial episode.

If relapse is seen, consider taking treatment for at least two years.

And never stop suddenly!

29
Q

What other drugs can be used to augment the effects of antidepressants?

A

Mood stabiliser - lithium

Antipsychotic

30
Q

What are the indications for treatment with lithium?

A

Mania: treatment and prophylaxis

Bipolar affective disorder

Recurrent depression

Aggressive or self-mutilating behaviour

31
Q

True or false: Lithium is absorbed rapidly

A

True

32
Q

True or false: Lithium is excreted by the liver

A

False.

Lithium is excreted via the kidneys, therefore baseline renal function must be checked prior to commencing

33
Q

True or false: Patients on lithium require monitoring.

A

True

Lithium has a narrow therapeutic window and must be monitored:

Weekly after initiation/dose change

Once stable, every three months (for one year)

Every 6 months after first year

34
Q

True or false: When monitoring lithium levels, sample should be taken 6 hours after the last dose

A

False

Sample should be taken 12 hours after last dose.

35
Q

What are the guidelines for lithium use in pregnancy

A

Avoid if possible, particularly in the first trimester (risk of teratogenicity, including cardiac abnormalities).

If lithium is used during pregnancy, the physiological changes may affect excretion and therefore dose requirements increase during the second and third trimesters (but on delivery return abruptly to normal).

36
Q

What is the recommended serum lithium concentration?

A

05-1.0 mmol/L

37
Q

Side effects of lithium?

A

Early:
Dry mouth, metallic taste, nausea, fine tremor, fatigue, polyuria, polydipsia

Late:
Diabetes insipidus, hypothyroidism, arrhythmias, ataxia, dysarthria, weight gain

38
Q

What drugs should be avoided when taking lithium as they may lead to lithium toxicity?

A

The drugs that decrease Li excretion:

  • ACEi’s. NSAIDs, diuretics (esp. thiazide)
39
Q

What are the symptoms of lithium toxicity?

A

Early:
Blurred vision, anorexia, nausea, vomiting, diarrhoea, coarse tremor, ataxia, dysarthria

Late:
Confusion, renal failure, delirium, fits, coma, death

40
Q

What management is required for lithium toxicity?

A

Medical emergency

STOP lithium
Fluids
Dialysis/diuresis
Treat the cause

41
Q

What are the more common causes of lithium toxicity?

A

Drugs (ACEi, NSAID, diuretics)

Renal failure

UTI

Dehydration

42
Q

When does NICE recommend using ECT?

A

“Severe life threatening or treatment-resistant depression, catatonia or severe mania”

43
Q

How much ECT is usually required?

A

Twice-weekly for approximately 12 sessions in total

44
Q

True or false: Light sedation is given prior to ECT

A

False

ECT is carried out under general anaesthetic + muscle relaxant

45
Q

What are the common side effects of ECT?

A

Headache, nausea, muscle pan, amnesia

46
Q

What treatment is recommended for mild to moderate depression?

A

Low intensity psychological interventions, not medication.

Sleep hygiene
Regular exercise
Self-help CBT or group CBT

47
Q

What treatment is recommended for moderate to severe depression?

A

Antidepressant medication and high intensity psychological intervention. 16-20 session over 3-4 months.

CBT
IPT
Behavioural activation

48
Q

What are the stepped tiers for mental health referrals to secondary care?

A

Tier 1: GP

Tier 2: Primary care mental health worker

Tier 3: Community mental health team

Tier 4: Home treatment or in-patient

49
Q

When should patients be referred for emergency secondary mental health care?

A

Significant risk of harm to self or others

Psychotic symptoms

Severe agitation

Y4 Psychiatry (9 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions