Affective Disorders Flashcards
What are the main types of affective disorder?
Depression
Mania
Women are __?__ as likely as men to develop depression.
twice
F:M 2:1
What is the prevalence of depression?
5%
remember, prevalence is the proportion of the population with a disease at any given time
What is the lifetime rate of depression?
20%
That is, 20% of people will experience depression at some point in their lifetime.
What are the core symptoms of depression?
- Low mood (may be diurnal)
- Anhedonia (inability to derive pleasure)
- Anergia (↓ energy)
True or false: a person must be experiencing symptoms for at least three months for a diagnosis of depression to be made,
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.
In addition to the core symptoms, what other symptoms are characteristic of depression?
Poor concentration
Worthlessness/guilt
Suicidal thoughts
Poor sleep
Reduced libido
Change in appetite
Psychomotor retardation
How is severity assessed in depression?
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.
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.
True
What is the cure for bipolar affective disorder?
There isn’t one!
The aim of treatment is to reduce number and severity of relapses.
True or false: There is no link between genetics and bipolar affective disorder.
False
Genes are a major aetiological factor.
The prevalence of bipolar is roughly __?__%
1%
True or false, bipolar affects as many men as it does women.
True.
The M:F ratio is similar.
When a patient is experiencing a manic episode, what symptoms might they commonly display?
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 is a diagnosis of mania made?
Distinct period lasting at least 1 week of abnormally elevated mood + at least three other symptoms. Impacting negatively on occupational and social functioning.
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?
Hypomania
How is a diagnosis of bipolar affective disorder made?
At 2 least episodes of disturbed mood, one of which is manic or hypomanic.
What are the three broad classifications of antidepressants, based on their action?
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.
What are the most commonly used antidepressants?
SSRI’s
- safer in overdose
Citalopram Escitalopram Fluoxetine Sertraline Paroxetine
What are the common side effects of SSRI’s?
Agitation
Nausea/loss of appetite
GI problems: indigestion, diarrhoea, constipation
Loss of libido, erectile dysfunction
Dizziness/dry mouth/blurred vision/sweating/headaches
Why are monoamine oxidase inhibitors rarely used?
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).
True or false: Initially when starting antidepressants, there may be an increased risk of suicide.
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.
How might antidepressants cause serotonin syndrome?
Increase available serotonin, especially if take with other drugs that increase serotonin levels (e.g. other antidepressants, MaOI’s, St John’s Wort, ecstasy).
What are the symptoms of serotonin syndrome?
Restlessness, fever, tremor, myoclonus, confusion, seizures, arrhythmias
