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Psychiatry > Affective / Mood disorders > Flashcards

Affective / Mood disorders Flashcards

1
Q

what classification system is used for depression and anxiety?

A

International classification of disease - 10

Diagnostic and statistical manual for mental disorders DSM-5 used for research

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2
Q

how do you assess if depression or elevated mood is normal or abnormal?

A

pervasiveness symptoms
persistence symptoms
degree of impairment
specific symptoms and signs

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3
Q

what are the psychological symptoms of depression?

A

change in mood:

  • depression
  • anxiety
  • puerplexity
  • anhedonia

change in thought content:

  • guilt
  • hopelessness
  • neurotic symptoms i.e. hypochondriasis, agoraphobia
  • ideas of reference
  • delusions and hallucinations
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4
Q

what are the social symptoms of depression ?

A 
loss of interests
irritability 
apathy 
withdrawal 
indecisive
loss of confidence, concentration, registration and memory
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5
Q

what are the physical symptoms of depression?

A

change in bodily function

  • sleep
  • appetite
  • enegy
  • libido
  • constipation
  • pain

change in psychomotor function

  • stupor
  • agitation
  • retardation
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6
Q

what are the treatment options for depression?

A

pharmacological antidepressants;

  • selective serotonin rey-take inhibitors
  • tricyclic antidepressants
  • monoamine inhibitors

non-pharmacological;

  • CBT
  • behavioural activation
  • interpersonal psychotherapy
  • family therapy
  • electro convulsant therapy
  • deep brain stimulation
  • vagus nerve stimulation
  • psychosurgery
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7
Q

what is the diagnostic criteria for depression?

A

lasts for 2 weeks
no hypomanic or manic episodes in lifetime
not attributable to psychoactive substance of other organic mental disorder
if psychotic symptoms or stupor then severe depression (need to exclude schizophrenia / schizophrenic disorder)

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8
Q

what is somatic syndrome?

A

a cluster of symptoms that occur with depression

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9
Q

what are the symptoms of somatic syndrome?

A

weight loss (5% of body weight)
wakening up 2 hours before they usually do
marked loss of interests or pleasure
lack of emotional reaction to events or activities that normally produce emotional response
worse in the morning
marked loss of libido
evidence of agitation or psychomotor retardation

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10
Q

give differential diagnoses of depression.

A 
normal reaction to life event 
seasonal affective disorder 
bipolar disorder
dysthymia 
cyclothymia 
AIDS/HIV
hyperparathyroidism 
hypothyroidism 
addisons 
tumour, stroke, dementia
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11
Q

what are the measurement tools for affective disorders?

A

SCID
SCAN
young mania rating scale (YMRS) for mania

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12
Q

what is the typical time course of a depressive episode?

A

4 - 6 months

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13
Q

what percentage of people have recurrent depressive episodes?

A

80%

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14
Q

what are the features of mania?

A 
grandiose ideas
lack of inhibition 
loss of judgement 
over spending 
increased libido 
reckless behaviour 
racing thoughts
flight of ideas 
pressure of speech 
similarities to the effects of stimulants i.e. amphetamines and cocaine 
pathological elevated mood
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15
Q

what are differential diagnoses of mania?

A 
schizophrenic disorder
schizophrenia
cyclothymia 
hyperthyroidism 
ADHD
drugs and alcohol 
tumour, stroke, cushings, epilepsy, neurosyphyllis, SLE
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16
Q

what are the treatment options for mania?

A

antipsychotics;

  • olazapine
  • quetiapine
  • risperidone

mood stabilisers;

  • lamotrigine
  • sodium valproate
  • carbamazepine

lithium
ECT

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17
Q

what is bipolar?

A

repeat episodes (> 2) of depression and mania/hypomania

18
Q

if a patient presents with recurrent episodes of mania but no depression, what is the possible diagnoses?

A

bipolar disorder

hypomania disorder

19
Q

what is the mean age of onset of bipolar?

A

21 years

20
Q

in what sex is bipolar most common in?

A

M = F

21
Q

in what sex is depression most common in?

A

F > M

22
Q

what is the average duration of a manic episode?

A

1-3 months

23
Q

what percentage of patients have recurrent manic episodes?

A

90%

24
Q

what is the first line treatment for a patient with cyclical bipolar ?

A

sodium valproate

25
Q

what is the first line treatment for someone who has ongoing depression and has one episode of mania?

A

lithium

26
Q

a patient is on a SSRI maximum dose for depression but he still doesn’t feel an effect. what 2nd line treatment will you give?

A

switch from SSRI to SNRI

27
Q

what are the different stages of treating depression?

A

1st line: antidepressant e.g. SSRI setralline, fluoxetine
2nd line: switch to another antidepressant
3rd line: adjunct with mirtazepine
4th line: adjunct with lithium
5th line: adjunct with antipsychotic e.g. olazapine, quetiapine, rispiradone
6th line: ECT

28
Q

what are protective factors for depression?

A

no family history
employment status
good coping skills
good social / support network

29
Q

what drugs can cause depressive symptoms?

A

steroids

beta blockers

30
Q

what personality traits increases someones risk of depression?

A

avoidant
dependant
anxious

31
Q

what is the first line treatment for a patient who has catatonia?

A

lorazepam

or ECT if life threatening

32
Q

what defines rapid cycling bipolar?

A

4 or more episodes within 12 months

33
Q

what are the core symptoms of depression?

A

Mood is low
Interest is low
Energy is low

(MIE)

34
Q

what are the ICD-10 criteria for mild, moderate and severe depression?

A

Mild;
- 2 core + 2 cognitive symptoms

Moderate;
- 2 core + at least 3/4 cognitive symptoms

Severe;
- 3 core + at least 5 cognitive symptoms

35
Q

what are the cognitive symptoms of depression which are part of the diagnostic criteria?

A 
weight loss/gain 
insomnia/hypersomnia
decreased concentration 
decreased energy/fatugue
recurrent thoughts of death by suicide
unreasonable feelings of guilt or self blame
agitation or retardation
36
Q

what classes of drugs are used to treat mania?

A

mood stabalizers i.e. carbamazepine

anti-psychotics i.e. olanzapine

37
Q

what is BDI screening?

A

becks depression inventory

screening tool to assess the severity of depression

38
Q

what is MADRAS screening?

A

montgomery-asperg depression rating scale

39
Q

what are the consequences of untreated depression?

A

usually resolves in 6-12 months but even if it does resolve without treatment they are often left with some symptoms such as insomnia

suicide 
psychosis 
social problems;
- problems with work/unemployment 
- family problems 
- social isolation
40
Q

what psychotic features can be found in mania?

A

flight of ideas
hallucinations - 2nd person auditory
delusions - grandiose ‘I am king of the world’

41
Q

what is the diagnostic criteria for bipolar?

A

at least 2 episodes of mania
OR
at least 1 episode of mania + 1 episode of depression

Psychiatry (13 decks)

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