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Affective Mood Disorders Flashcards

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1
Q

1 year prevalence of depression

A

5.3%

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2
Q

Lifetime prevalence of depression

A

13%

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3
Q

Mean age of onset of depression

A

30

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4
Q

What % of primary care patients have symptoms of depression

A

30%

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5
Q

core sx of depression

A

low mood
anhedonia
anergia

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6
Q

list 3 categories of further depression Sx

A

biological
negative cognitions
psychotic

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7
Q

list biological sx of depression

A

poor:
sleep
appetite
concentration
libido

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8
Q

list negative cognitions sx of depression

A

hopelessness
helplessness
worthlessness
guilt

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9
Q

list psychotic sx of depression

A

mood congruent delusions eg nilihistic
hallucinations
catatonia

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10
Q

how long do symptoms have to be present for depression to be diagnosed

A

more than 2 weeks

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11
Q

what is a nihilist

A

either believe their body doesn’t exist anymore or that their body is dead/dying

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12
Q

define mild depression

A

2 core + 2 other

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13
Q

define moderate depression

A

2 core + 3 others

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14
Q

define severe depression

A

3 core + 4 others

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15
Q

define immediate severe depression

A

3 core + 4 others + psychotic symptoms (delusions+/-hallucinations)

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16
Q

atypical depression sx

A

increased appetitie, increased sleep, fatigue, leaden paralysis

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17
Q

dysthymia sx

A

chronic low grade depression symptoms for 2+ years

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18
Q

SAD sx

A

low mood related to the seasons

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19
Q

tx of SAD

A

responds to light therapy

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20
Q

How are the other types of depression treated first line

A

SSRIs

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21
Q

what is the monoamine theory of depression

A

NA and serotonin are produced in locus coeruleus and raphe nucleus
NA and serotin descending tracts are involved in connections to stomachs / joints - can explain physical Sx
these are thought to be involved in mediating mood

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22
Q

risk factors for depression

A

female 2:1
previous Hx of depression
significant physical illness - chronic / neuro esp
concurrent mental health issues - personality
Afro-Caribean, Asian, refugees/asylum seeker
poor social support system
unemployed
early maternal loss
>3 children
lack of confiding relationships

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23
Q

DDx of depression

A

Medicatioms
substance misuse
psychiatric illness - bipolar, anxiety
neuro illness - dementia, PD, stroke
endocrine - hypoglycaemia, Addisons, Cushings
anaemia, menopause

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24
Q

What medications cause depression

A

steroids
anti HTN - esp beta blockers
Histamine blockers
sedatives
sex hormones - oestrogen,

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25
Q

Ix for depression

A

Bloods: U&Es, LFTs, TFTs, CA, FBC
HIV, syphillis, tox screen
MRI head

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26
Q

how can you screen for depression in hospital

A

PHQ-9 (patient health questionnaire)

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27
Q

symptoms of mania

A

increased talkativeness/pressure speech
flight of ideas
increased self esteem / grandiosity
decreased need for sleep
distractibility
impulsive, reckless behaviour
increased sexual drive, sociability or goal directed activity

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28
Q

define bipolar affective disorder

A

at least 2 episodes of mood disturbance
- one of these is hypomanic/manic

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29
Q

2 types of bipolar

A

type 1 = mania +/- depression
type 2 = hypomania +/- depression

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30
Q

why is misdiagnosis of bipolar as depression be worrying

A

SSRIs is main stay of Tx of depression, but it can precipitate a manic episode in bipolar patients

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31
Q

define a manic episode

A

mood must be predominantly elevated, expansive or irritable, plus increased activity
>7 days (unless severe enough for hospital admission)
at least 3 of the key symptoms

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32
Q

define hypomania

A

> 4 days
decreased degree of functional impairment compared to mania
all symptoms, just to a lesser extent

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33
Q

epidemiology of bipolar

A

1.5% point prevalance
15-18x higher suicide rate

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34
Q

mean age of onset

A

18-21

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35
Q

causes of secondary mania

A

organic brain damage
hyperthyroidism

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36
Q

Mx of BPAD

A

biological - medication
psychological - stress relief

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37
Q

risk factors for BPAD

A

greater incidence in the upper social classes compared to to other psychiatric illnesses - better adapted to their regular life
no difference in ethnicities or sexes
7x incidence in first degree relatives

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38
Q

what % of patients with depression as first Sx actually have bipolar

A

10% patients who present with depression go on to have mania within 10 years

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39
Q

what is the main psychological tx in NHS

A

CBT

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40
Q

what is CBT used for

A

lots of psychiatric disorders

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41
Q

list classifications of psychological therapy

A

individual
couples therapy
family therapy
group therapy

counselling
behavioural
cognitive
psychodynamic
other - CAT, IPT, MBT, DBT

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42
Q

who is DBT useful for

A

BPD patients

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43
Q

what is behavioural therapy

A

arose in 1950s based on the idea that maladaptive behaviour is learned, therefore adaptive behaviour can also be learned

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44
Q

what is operant conditioning

A

behaviour modified by consequence (rewards)

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45
Q

what is classical conditioning

A

behaviour modified by antecedent (stimulus/response)

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46
Q

what is reciprocal inhibition conditioning

A

counter conditioning
change a bad response to a stimulus to a good response to the same stimulus

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47
Q

what is systematic desensitisation

A

using hierarchy to overcome fears by replacing anxiety feelings with relaxation
start with imagining the feared stimulus then relaxing after each exposure, increasing the intensity of stimulus each time

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48
Q

what is systematic desensitisation used for

A

simple phobias and OCD

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49
Q

what can get in the way of habituation of anxiety

A

safety behaviours - escape/avoidance/resassurance

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50
Q

key features of exposure therapy

A

hirearchies
gradual exposure
habituation
extinction
watching out for safety behaviours

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51
Q

what is systematic desensitisation not useful for

A

anxiety and depression

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52
Q

who is aaron beck

A

founding father of CBT

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53
Q

what is the negative cognitive triad

A

negative view of yourself, the world and the future

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54
Q

why are TCAs not used for depression as much as they had been in the past

A

dangerous in overdose

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55
Q

what is the difference between CBT and behavioral therapy

A

CBT includes thoughts to link the event to behavioural emotion

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56
Q

what is the ABC of CBT

A

a = activating event
b = beliefs
c = consequences
a –> b –> c
different thoughts give rise to different emotions

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57
Q

why do people have different Bs and Cs of ABC of CBT

A

previous experiences
your general mood that day

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58
Q

what is formulation

A

rationale for patient’s problems
- origin
- current status
- maintenance

59
Q

how is formulation carried out in CBT

A

in COLLABORATION with patient

60
Q

types of formulation

A

longitudinal
hot cross buns

61
Q

describe longitudinal formulation

A

early experience –> core beliefs –> rules and assumptions –> critical incident –> create negative thoughts to emotions to sensations to mood

62
Q

What is in a CBT session

A

agenda
progress and homework from last week
specific
homework for next week

63
Q

list types of cognitive distortion

A

all or nothing thinking
over generalising
mental filter
disqualifying the positive
jumping to conclusions - eg mind reading
magnification (catastrophising) and minimising

64
Q

how can we challenge the thought distortion

A

tools/techniques - thought record
guided discovery - socratic questioning

65
Q

what is the use of thought record

A

analyse what the evidence for a thought is, what alternative thoughts are, what is the effect on me of the thought

66
Q

list elements of CBT

A

developing a therapeutic relationship
empathic and collaborative
socratic questioning
time-limited
agenda setting / goals
formulation
homework
relapse prevention

67
Q

when should CBT be used in depression

A

first line !!

68
Q

when should CBT be used in anxiety

A

ALL anxiety disorders - social anxiety, PTSD, OCD

69
Q

what is third wave CBT

A

3rd generation of CBT
target the process of thoughts rather than their content
mindfulness based

70
Q

how can CBT be used in physical illness

A

adherence to Tx
illness behaviour that can maintain illness
concurrent psychiatric illness

71
Q

what is ECT

A

passage of small electric current through the brain with a view to inducing a generalise fit which is therapeutic

72
Q

which part of ECT is therapeutic

A

the seizure activity in brain - maybe the actual passing of current through brain too

73
Q

indications for ECT

A

severe depressive illness only if life threatening situation: poor food intake, suicidal, Tx resistant
uncontrolled mania
catatonic

74
Q

can you refuse ECT?

A

informal patient with capacity - can refuse
lack capacity - MHA to give up to 2 Tx

75
Q

what is the modified ECT procedure

A

use anaesthetic and muscle relaxant
NBM 8 hours prior to reduce aspiration
medical monitoring prior, during and after

76
Q

side effects of ECT

A

common (80%): confusion, muscle pain, headache, nausea
cognition effect: retrograde/anterograde memory loss, resolves after 6 months
rare to have long term complications
anaesthetic risks

77
Q

What is bilateral ECT?

A

2 electrodes are placed over 2 hemispheres
+ effective at threshold, more efficacious, quicker

78
Q

What % of people respond to ECT

A

80%

79
Q

How long does the ECT seizure last

A

15 - 25 seconds

80
Q

contraindications of ECT

A

Technically NO absolute contraindications as its a life saving procedure
heart disease / stroke
pace maker
raised ICP
anaesthetics contraindications
risk of cerebral bleeding - HTN/stroke
pregnant

81
Q

what is TMS

A

intermediate step between treatment resistance and ECT

82
Q

step 1 of depression tx

A

watch and wait

83
Q

step 2 of depression tx

A

CBT +/- SSRIs

84
Q

factors necessitating admission

A

self neglect
risk of suicide / self harm
risk to others
poor social support
psychotic Sx
lack of insight
Tx resistance

85
Q

how do SSRIs work

A

block serotonin pump

86
Q

when are SSRIs indicated

A

1st line drug Tx for depression

87
Q

side effects of SSRIs

A

headache
GI disturbance
sleep disturbance / vivid dreams
sexual dysfunction
rare increased risk of suicide

88
Q

complications of SSRIs

A

hyponatraemia
GI bleeding

89
Q

examples of SSRIs

A

citalopram
sertraline
fluoxetine

90
Q

how long should pt take sertraline for

A

6-12 months once well
2 years for those greater risk of relapse

91
Q

when do you review someone on sertraline

A

after 2 weeks then regularly after

92
Q

what drug is preferred in children for depression

A

fluoxetine

93
Q

what are TCAs

A

serotonin and NA re-uptake inhibitors

94
Q

side effects of TCAs

A

dry mouth, blurred visions, constipation, urinary retention
cardiotoxic - QT prolongation, ST elevation, AV block
anti-histaminergic - sedation, postural hypotension, weight gain

95
Q

examples of TCAs

A

amytriptilyin
nortripyline
clomipramine
lofepramine

96
Q

discontinuation Sx of TCAs

A

flu like Sx, headaches, dizziness, trouble sleeping, anxiety

97
Q

what is the key problem with TCAs

A

lethal in overdose

98
Q

what are MAOIs

A

increase availability of serotonin and NA in synapse

99
Q

contrast older and newer MAOIs

A

newer are reversible, others are irreversible

100
Q

what is the key interaction in MAOIs & what should they avoid

A

Tyramine reaction - cheese / dairy / smoked meats / red wine / soy sauce / high caffeine / chocolate

101
Q

what drug is mirtazipine

A

NaSSA - blocks presynaptic alpha 2 adrenergic Rs

102
Q

side effects of NaSSA

A

drowsiness, increased appetite, weight gain

103
Q

what drug is venlafaxine / duloxetine

A

SNRI - serotonin and NA reuptake inhibitor

104
Q

side effects of SNRI

A

same as SSRIs

105
Q

risks of SNRI

A

HTN

106
Q

what are NRIs

A

NA reuptake inhibitor

107
Q

example of NRIs

A

reboxetine

108
Q

SARI example

A

trazodone

109
Q

side effects of trazodone

A

sedation, arrhytmia, hypotension, priapism

110
Q

risks of agomelatine

A

sedation and sleep disorder

111
Q

vortioxetine benefits

A

improves cognition so better in older people

112
Q

options for refractory depression

A
  1. check adherence / side effects / optimal dose
  2. switch drug to one of same class
  3. change class of drug
  4. combinations ? augmentation with Lithium/antipsychotic ? ECT?
113
Q

serotonin syndrome

A

altered mental state - agitation, confusion, coma
neuromuscular changes - hypotonia, tremor, clonus
autonomic dysfunction - high HR, temp, RR

114
Q

what is serotonin syndrome

A

excessive serotonin in synapses of brain

115
Q

incidence of serotonin syndrome

A

<1%

116
Q

risk factors for serotonin syndrome

A

increased antidepressant use
combinations of antidepressants
overdose of antidepressants
lithium use
ECT
opiates, anti emetics, illicit drugs

117
Q

complications of serotonin syndrome

A

DIC
rhabdomyolysis
renal failure
metabolic acidosis
seizures

118
Q

Mx of serotonin syndrome

A

admit
stop offending medication

119
Q

list 3 classes of mood stabilisers

A

lithium
anti epileptics
atypical antipsychotics

120
Q

what is the gold standard mood stabiliser

A

lithium

121
Q

benefits of lithium

A

good anti suicidal effects

122
Q

uses of lithium

A

BPAD
schizoaffective disorder
depression (recurrent / Tx resistant)

123
Q

complications of lithium use

A

teratogen
arrhytmia
CKD
hypothyroidism

124
Q

common adverse effects of lithium

A

fine tremor
mild GI upset
metallic taste in mouth
sedation

125
Q

LI toxicity adverse effects

A
126
Q

Li consultation

A

Purple book - register pt on purple book
PRE LI
baseline bloods - FBC, U&Es, Ca, TFTs,
ECG
DURING LI
monitor monthly
stay hydrated
3 monthly repeat bloods
go to A&E with febrile illness
avoid NSAIDs / diuretics
do not suddenly stop taking it

127
Q

give a type of anti psychotic

A

olanzipine - zyprexa (brand name)

128
Q

use of olanzapine

A

acute mania and prophylaxis

129
Q

beneift of olanzapine

A

rapid effect

130
Q

how does olanzapine work

A

blocks dopamine Rs
has effect on other neurotransmitter too

131
Q

side effects of olanzapine

A

dizziness
restlessness
difficulty walking
constipation
difficulty going to / staying asleep

132
Q

example of anti convulsants

A

sodium valproate (epilim)
carbamezapine
lamotragene

133
Q

use of sodium valproate

A

acute mania and prophylaxis
IM option - for poor compliance pts

134
Q

side effects of sodium valproate

A

PCOS
teratogenic

135
Q

MOA for sodium valproate

A

increased cytochrome P450 to increase enzyme synthesis

136
Q

use of sodium valproate

A

used for prophylaxis

137
Q

what Ix do you monitor for sodium vaproate

A

FBC - leucopenia / thrombocytopenia

138
Q

lamotrogine use

A

prophylaxis for Bipolar

139
Q

side effects of lamotrogine

A

NV, rash, aggression
Steven Johnson - blistering of mucous membranes, painful, coryzal prodrome

140
Q

drugs causes of steven johnson syndrome

A

phenytoin
lamotragine
carbamazepine

141
Q

acute mania Mx

A

if 1st episode: antipsychotics +/- Li if ineffective alone
stop antidepressant if they are on one, or add antipsychotic

if already on mood stabilisers: optimise the dose and add antipsychotic

often add benzodiazepine on top

142
Q

long term Mx of mania

A

Lithium
+/- valproate / olanzepine

143
Q

Mx of bipolar depression

A

dont use SSRI alone - augment it with antipsychotic or mood stabiliser
olanzapine + fluoxetine / lamotragine

Y5 Psych (10 decks)

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