Affective Disorders Flashcards
9 types of depression?
Depressive disorder Bipolar affect disorder Dysthymia disorder Cyclothymia disorder Recurrent depressive disorder atypical depression Adjustment disorder Mixed anxiety and depression Post natal depression
3 cardinal features of depressive disorder?
Loss of energy
Anhedonia
Low mood
Additional features of depressive disorders?
Loss of concentration Inability to sleep Loss of appetite Thoughts of guilt and self blame Thoughts of hopelessness Suicidal or life worth not living Reduced self esteem
4 somatic symptoms of depression?
Weight loss
Early morning wakening
Anhedonia
Loss of libido
Different in classification between mild, moderate and severe depression?
Mild = 2 core, 2 additional Moderate = 2 core, 3/4 additional Severe = psychosis, 3 core, 4 additional
What psychotic symptoms may a severely depressed person present with?
Hallucinations - derogatory
Delusions - mood congruent
Cotards Syndrome - think they dont exist or rotting inside
Investigations performed on someone with depressive disorder?
FBC, U&E, LFTS, B12, folate, bone profile, TFTs
history, MSE, drug and alcohol history
ECG, Brain CT/MRI
Psychological intervention for mild depression?
CBT for 9-12 weeks
group physical intervention for 10-12 weeks
Biopsychosocial intervention for mid/moderate depression?
Either bio or psycho
Bio - SSRI for 9 months for remission, 2 years for relapse
Psycho - high intensity CBT, behavioural activation
Biopsychosocial intervention for moderate-severe depression?
Bio and psycho
Bio - SSRI, antipsychotic, ECT
Psycho - high intensity intervention, psychodynamic psychotherapy
Treatment options for refractory depression?
Change SSRI to different type or class Add lithium Add T3 Add antipsychotic 2nd gen Combine mirtazapine and a SSRI/SNRI ECT
5 examples of SSRI?
Paroxetine Sertraline Escitalopram Fluoxetine Citalopram
Side effects of SSRIs?
Weight loss Agitation Poor sleep Loss of libido Nausea and vomiting Bleeding
2 examples of SNRIs?
Duloxetine
Venlafaxine
What 2 things can venlafaxine increase?
QTc and BP
3 examples of TCAs?
Amitriptyline
Clomipramine
Iofepramine
Side effects of TCAs, why?
dry mouth Constipation Sedation Blurred vision Heart block - arrythmias Due to being potent SNRI, anticholinergic and antagonist at a1 adrenergic receptor
3 modes of action of TCAs?
SNRI
Anticholinergic
alpha 1 adrenergic receptor antagonist
2 examples of MAOI?
Phenelzine
Moclobemide
Mode of action of MAOI?
Inhibit monoamine oxidase to reduce amine neurotransmitter breakdown
Potential side effects of MAOIs?
Rise in BP with certain tyramine foods (mature cheese, pickle, broad beans, oxo, marmite) Postural hypotension Sedation Headache serotonin syndrome
Mirtazapine is what drug class? SE?
NaSSA Weight gain Low WBC Sedation Dizziness
Describe features of serotonin syndrome?
Headache Agitation Hallucinations Shivering Sweating Nausea and vomiting Hyperthermia Myoclonus Hyperreflexia Tremor
Drug that treats serotonin syndrome?
Cyproheptadine
4 symptoms of discontinuation syndrome?
Flu like symptoms
GI upset
vivid dreams
Electric shocks
3 main indications for ECT? other ways?
Suicidal high risk
Depressive stupor
Life threatening because of refusal of food or fluids
Treatment resistant depression
psychotic depression
Psychomotor retardation
Mean time suffering depressive episode?
4-6 months
Describe recurrent depressive disorder?
recurrent depression, no mania
mean 6 months episodes
Atypical depression?
Low mood but responds to happy events hyperinsomnia weight gain Interpersonal rejection sensitivity occupational and social impairment Responds with older MAOI
Describe dysthymia?
Chronic depression
Antidepressants and psychological intervention
Difficult to treat
Not quite depression
Cyclothymia?
Cycling between mild elation and mild depression
Not quite BPAD
Mood stabilisers
Mixed anxiety and depressive disorder?
Together both anxiety and depression are symptoms but when uniquely analysed, neither of them meet criteria
How long does hypomania have to be present for to be diagnosed?
4 consecutive days?
Symptoms of hypomania?
Increased sex drive
Mild spending sprees or reckless behaviour
Increased energy
Decreased need for sleep
Increased talkativeness (pressure of speech)
Define hypomania
Elevated or irritable mood out of character for the individual and sustained for 4 consecutive days with interference to activities of daily living
Define mania?
Elevated, irritable or expansive behaviour that is out of character for the individual lasting for at least 7 days and with severe interference to activities of daily living
Symptoms of mania?
Increased sex drive and inappropriate behaviour Increased talkativeness (pressure of speech) Flight of ideas - distractible Grandiosity Decreased need for sleep Distractibility Appetite increased Increased energy Reduced concentration Reckless behaviour and spending
What can antidepressants do in BPD?
precipitate manic episode
Long term treatment of BPD with what 3 drugs?
Lithium, antipsychotics, valproate
3 indications for long term medication of BPD?
It they are suffering frequent episodes with severe functional impairment
If they have a manic episode with severe consequences
2 or more acute episodes
6 differential diagnosis of BPD?
Schizophrenia Schizoaffective disorder Anxiety Cyclothymia Organic disorder in the frontal lobe Anorexia nervosa
3 subcategories of BPD and their severity?
BPD 2
BPD 1
rapid cycling BPD
Drug classes used to treat a manic episode?
Anti-psychotics
Mood stabilisers
Benzodiazepines
ECT
Antipsychotics used to treat BPD?
Haloperidol
Chlorpromazine
Aripiprazole
Olanzapine
Risperidone
Quetiapine
SE of antipsychotics?
Increase prolactin Metabolic syndrome Hypotension Sedation Anticholinergic effects
Monitoring requirements of antipsychotics? Baseline and follow up?
Weight/ glucose/ HbA1c/ BMI/ waist circumference FBP/ lipids/ cholesterol TFT/ LFT/ U&E ECG and BP History or FH of HD Smoking Baseline check then check at 12-16 weeks Repeat yearly
What monitoring is required for Lithium and how often?
Height and weight
LFT
U&E and TFT (6 monthly)
ECG
How often do serum levels of Lithium need to be taken?
Weekly till stabilised at 0.6-0.8 mmol/l
then every 3 months
Side effects of lithium?
GI fine tremor Renal impairment Hyperparathyroidism Hypercalcaemia Hypothyroidism Oedema Weight gain Polydipsia/polyuria
What drugs interact with Lithium?
NSAIDs Antipsychotics ACE inhibitors Diuretics CCBs - neurotoxicity Pregnancy - ebsteins anomaly
What do toxic levels of lithium present with?
Ataxia Nystagmus Tremor Dysarthria Renal impairment Seizures
3 examples of AEDs and side effects associated?
Lamotrigine, Carbomazepine, Sodium Valproate
Teratogenic GI upset Weight gain Thrombocytopenia Hair loss Tremor Ataxia Aggression Vasculitis Hepatic dysfunction Confusion Stupor Pancytopenia Leucopenia Pancreatitis
Mean age of onset of BPAD?
19
CALMER pneumonic for BPAD?
CBT Antipsychotics Lorazepam Mood stabilizers ECT Risk assessment
2 drugs used in rapid tranquilisation?
Lorazepam
Haloperidol
how does mood stabilizer choice change depending on if the person is experiencing a manic depressive or manic episode?
Mania = lithium Depressive = Lamotrigine
Combination of what 2 drugs is used for rapid cycling?
Lithium and sodium valproate
