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Psychiatry > Affective Disorders > Flashcards

Affective Disorders Flashcards

1
Q

9 types of depression?

A 
Depressive disorder
Bipolar affect disorder
Dysthymia disorder
Cyclothymia disorder
Recurrent depressive disorder
atypical depression
Adjustment disorder
Mixed anxiety and depression
Post natal depression
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2
Q

3 cardinal features of depressive disorder?

A

Loss of energy
Anhedonia
Low mood

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3
Q

Additional features of depressive disorders?

A 
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
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4
Q

4 somatic symptoms of depression?

A

Weight loss
Early morning wakening
Anhedonia
Loss of libido

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5
Q

Different in classification between mild, moderate and severe depression?

A 
Mild = 2 core, 2 additional
Moderate = 2 core, 3/4 additional
Severe = psychosis, 3 core, 4 additional
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6
Q

What psychotic symptoms may a severely depressed person present with?

A

Hallucinations - derogatory
Delusions - mood congruent
Cotards Syndrome - think they dont exist or rotting inside

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7
Q

Investigations performed on someone with depressive disorder?

A

FBC, U&E, LFTS, B12, folate, bone profile, TFTs
history, MSE, drug and alcohol history
ECG, Brain CT/MRI

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8
Q

Psychological intervention for mild depression?

A

CBT for 9-12 weeks

group physical intervention for 10-12 weeks

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9
Q

Biopsychosocial intervention for mid/moderate depression?

A

Either bio or psycho
Bio - SSRI for 9 months for remission, 2 years for relapse
Psycho - high intensity CBT, behavioural activation

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10
Q

Biopsychosocial intervention for moderate-severe depression?

A

Bio and psycho
Bio - SSRI, antipsychotic, ECT
Psycho - high intensity intervention, psychodynamic psychotherapy

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11
Q

Treatment options for refractory depression?

A 
Change SSRI to different type or class
Add lithium
Add T3
Add antipsychotic 2nd gen
Combine mirtazapine and a SSRI/SNRI
ECT
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12
Q

5 examples of SSRI?

A 
Paroxetine
Sertraline
Escitalopram
Fluoxetine
Citalopram
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13
Q

Side effects of SSRIs?

A 
Weight loss
Agitation
Poor sleep
Loss of libido
Nausea and vomiting
Bleeding
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14
Q

2 examples of SNRIs?

A

Duloxetine

Venlafaxine

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15
Q

What 2 things can venlafaxine increase?

A

QTc and BP

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16
Q

3 examples of TCAs?

A

Amitriptyline
Clomipramine
Iofepramine

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17
Q

Side effects of TCAs, why?

A 
dry mouth
Constipation
Sedation
Blurred vision
Heart block - arrythmias
Due to being potent SNRI, anticholinergic and antagonist at a1 adrenergic receptor
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18
Q

3 modes of action of TCAs?

A

SNRI
Anticholinergic
alpha 1 adrenergic receptor antagonist

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19
Q

2 examples of MAOI?

A

Phenelzine

Moclobemide

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20
Q

Mode of action of MAOI?

A

Inhibit monoamine oxidase to reduce amine neurotransmitter breakdown

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21
Q

Potential side effects of MAOIs?

A 
Rise in BP with certain tyramine foods (mature cheese, pickle, broad beans, oxo, marmite)
Postural hypotension
Sedation
Headache
serotonin syndrome
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22
Q

Mirtazapine is what drug class? SE?

A 
NaSSA 
Weight gain
Low WBC
Sedation
Dizziness
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23
Q

Describe features of serotonin syndrome?

A 
Headache
Agitation 
Hallucinations
Shivering 
Sweating
Nausea and vomiting
Hyperthermia
Myoclonus
Hyperreflexia
Tremor
24
Q

Drug that treats serotonin syndrome?

A

Cyproheptadine

25
Q

4 symptoms of discontinuation syndrome?

A

Flu like symptoms
GI upset
vivid dreams
Electric shocks

26
Q

3 main indications for ECT? other ways?

A

Suicidal high risk
Depressive stupor
Life threatening because of refusal of food or fluids

Treatment resistant depression
psychotic depression
Psychomotor retardation

27
Q

Mean time suffering depressive episode?

A

4-6 months

28
Q

Describe recurrent depressive disorder?

A

recurrent depression, no mania

mean 6 months episodes

29
Q

Atypical depression?

A 
Low mood but responds to happy events
hyperinsomnia
weight gain
Interpersonal rejection sensitivity
occupational and social impairment
Responds with older MAOI
30
Q

Describe dysthymia?

A

Chronic depression
Antidepressants and psychological intervention
Difficult to treat
Not quite depression

31
Q

Cyclothymia?

A

Cycling between mild elation and mild depression
Not quite BPAD
Mood stabilisers

32
Q

Mixed anxiety and depressive disorder?

A

Together both anxiety and depression are symptoms but when uniquely analysed, neither of them meet criteria

33
Q

How long does hypomania have to be present for to be diagnosed?

A

4 consecutive days?

34
Q

Symptoms of hypomania?

A

Increased sex drive
Mild spending sprees or reckless behaviour
Increased energy
Decreased need for sleep
Increased talkativeness (pressure of speech)

35
Q

Define hypomania

A

Elevated or irritable mood out of character for the individual and sustained for 4 consecutive days with interference to activities of daily living

36
Q

Define mania?

A

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

37
Q

Symptoms of mania?

A 
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
38
Q

What can antidepressants do in BPD?

A

precipitate manic episode

39
Q

Long term treatment of BPD with what 3 drugs?

A

Lithium, antipsychotics, valproate

40
Q

3 indications for long term medication of BPD?

A

It they are suffering frequent episodes with severe functional impairment
If they have a manic episode with severe consequences
2 or more acute episodes

41
Q

6 differential diagnosis of BPD?

A 
Schizophrenia
Schizoaffective disorder
Anxiety 
Cyclothymia
Organic disorder in the frontal lobe
Anorexia nervosa
42
Q

3 subcategories of BPD and their severity?

A

BPD 2
BPD 1
rapid cycling BPD

43
Q

Drug classes used to treat a manic episode?

A

Anti-psychotics
Mood stabilisers
Benzodiazepines
ECT

44
Q

Antipsychotics used to treat BPD?

A

Haloperidol
Chlorpromazine

Aripiprazole
Olanzapine
Risperidone
Quetiapine

45
Q

SE of antipsychotics?

A 
Increase prolactin
Metabolic syndrome
Hypotension
Sedation
Anticholinergic effects
46
Q

Monitoring requirements of antipsychotics? Baseline and follow up?

A 
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
47
Q

What monitoring is required for Lithium and how often?

A

Height and weight
LFT
U&E and TFT (6 monthly)
ECG

48
Q

How often do serum levels of Lithium need to be taken?

A

Weekly till stabilised at 0.6-0.8 mmol/l

then every 3 months

49
Q

Side effects of lithium?

A 
GI
fine tremor
Renal impairment 
Hyperparathyroidism 
Hypercalcaemia
Hypothyroidism 
Oedema
Weight gain
Polydipsia/polyuria
50
Q

What drugs interact with Lithium?

A 
NSAIDs
Antipsychotics
ACE inhibitors
Diuretics
CCBs - neurotoxicity
Pregnancy - ebsteins anomaly
51
Q

What do toxic levels of lithium present with?

A 
Ataxia
Nystagmus
Tremor
Dysarthria
Renal impairment
Seizures
52
Q

3 examples of AEDs and side effects associated?

A

Lamotrigine, Carbomazepine, Sodium Valproate

Teratogenic 
GI upset
Weight gain
Thrombocytopenia
Hair loss
Tremor
Ataxia
Aggression
Vasculitis 
Hepatic dysfunction
Confusion
Stupor
Pancytopenia
Leucopenia
Pancreatitis
53
Q

Mean age of onset of BPAD?

A

19

54
Q

CALMER pneumonic for BPAD?

A 
CBT
Antipsychotics
Lorazepam
Mood stabilizers
ECT
Risk assessment
55
Q

2 drugs used in rapid tranquilisation?

A

Lorazepam

Haloperidol

56
Q

how does mood stabilizer choice change depending on if the person is experiencing a manic depressive or manic episode?

A 
Mania = lithium
Depressive = Lamotrigine
57
Q

Combination of what 2 drugs is used for rapid cycling?

A

Lithium and sodium valproate

Psychiatry (17 decks)

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