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Block 33 Mental Health > CT 2 - Depression And Mood Disorders > Flashcards

CT 2 - Depression And Mood Disorders Flashcards

1
Q

What are the main symptoms of depression

A

Persistent low mood (for at least 2 weeks)

Anhedonia (lack of interest or pleasure)

Anergia (lack of energy and fatigue to do anything)

Others include:

Sleep disruption
Lowered self esteem
Lack of appetite
Feelings of guilt
Poor concentration
Suicidal ideation and self harm

Maybe an episode or if recurrent then coined as unipolar depressive disorder

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2
Q

What are the risk factors for suicide

A

FHX of mental health problems

Previous suicide attempt

Severity of depression

Anxiety and feelings of hopelessness

Personality disorders

Alcohol abuse

Being male

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3
Q

What are the risks factors for developing depression

A

Heritability

W>M

ACEs

Personality (neuroticism)

Lack of social support + lonely

Physical illness

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4
Q

Give examples of SSRIs

A

Sertraline (first line for adults)
Citalopram
Fluoxetine (first line for children and teens)
Paroxetine

Take 2-4 weeks to work.
* be careful as increase suicidal ideation especially in younger people.

Increase risk of bleeding and can cause hyponatremia

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5
Q

Which SSRI has a longer Half life and greater drug interactions

A

Fluoxetine

Citalopram increases QT interval

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6
Q

What are the side effects of SSRIs

A

D +V

Agitation and restlessness

Increase risk of GI bleeding

Drowsiness

Sexual dysfunction eg impotence

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7
Q

What is serotonin syndrome

A

Symptoms caused by excessive serotonin:

Hypertension
Hyperthermia
Tachycardia
Hyperreflexia
Increased tone

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8
Q

Which combinations of drugs can result in serotonin syndrome

A

Triptans (migraine med) + SSRI

St John’s wort + SSRI

Tramadol + SSRI

MAOI’s + SSRI

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9
Q

Examples of TCA’s

A

Amitriptyline
Clomipramine
Amoxapine

TCA overload causes prolonged QT

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10
Q

Side effects of TCAs

A

Blurred vision
Dry mouth
Constipation
Rash

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11
Q

Examples of monoamine NT’s

A

Serotonin
Dopamine
NA
Adrenaline

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12
Q

How do MAOI’s work and what are they used for

A

They block an enzyme (monoamine oxidase) which breaks down the monoamines. Results in increased levels in synapse.

Used for panic disorders and social phobia

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13
Q

How do MAOI’s work and what are they used for

A

They block an enzyme (monoamine oxidase) which breaks down the monoamines. Results in increased levels in synapse.

Used for panic disorders and social phobia

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14
Q

Examples of MAOI’s

A

Rasagiline
Selegiline
Hydrazine
Phenelzine

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15
Q

What other drug can be used for major depression that is not included in the normal classes of anti-depressants

A

Mirtazapine (A2 receptor antagonist)

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16
Q

Examples of SNRIs

A

Venlafaxine
Duloxetine

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17
Q

Uses for SNRIs

A

Major depressive disorder
Anxiety disorder
OCD
ADHD
Neuropathic pain +fibromyalgia

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18
Q

What are the side effects associated with SNRIs

A

Same as SSRIs

Increased risk of hypertension but milder sexual dysfunction

19
Q

Examples of mood stabilisers

A

1) anti-convulsants like Sodium valproate, lamotrigine, carbamazepine (SE include teratogenic, weight changes and lamotrigine can cause a rash (Steven’s Johnson syndrome)

2) Lithium (gold standard. Can cause kidney failure, nephrogenic diabetes insipidus and hypothyroidism)

3) anti-psychotics can also be used as mood stabilisers

20
Q

What are the side effects of MAOI;s

A

Cheese reaction: fatal hypertensive crisis = tyramine found in common foods like can interact with drug to cause excess release of NA leading to severe vasoconstriction leading to high blood pressure

21
Q

Which drug is reserved for treatment resistant schizophrenia

A

Clozapine

22
Q

Which anti-psychotics are prolactin sparing or may even lower prolactin levels

A

Clozapine

Aripiprazole

23
Q

What are symptoms of hyperprolactinemia

A

Irregular periods

Weight gain***

Infertility

Loss of libido

Galactorrhoea

Gynaecomastia

Can be treated with adding aripiprazole or a dopamine agonist such as bromocriptine or cabergoline

24
Q

as a result of typical anti-psychotics Low levels of dopamine in which pathway leads to extrapyramidal symptoms

A

Nigrostriatal pathway

25
Q

What must you be careful about with the use of anti-psychotics int he elderly population

A

All APs increase risks of strokes and VTE in elderly patients

26
Q

What is neuroepileptic malignant syndrome

A

Presents similarly to serotonin syndrome but occurs over a few days rather than acutely. It is also caused by very low levels of dopamine as opposed to high levels of serotonin in SS.

Is caused by anti-psychotics.

Hypertension, fever, tachycardia, sweating, lead pipe rigidity of limbs

27
Q

Indications for ECT (electroconvulsive therapy)

A

Severe refractory depression (has not responded to meds)

Catatonia

Mania

Works by electrodes administering mild electric impulses to brain under anaesthesia which can trigger release of NTs

50% relapse within 12 months

28
Q

Variations in mood can be normal but when are they considered pathological

A
  • long duration of symptoms
  • causes distress to oneself or others
  • despondent (low in spirit in depression or driven in mania)
  • dysfunction is present (social impairment and ADLs are affected)
29
Q

What are the symtoms of mania without psychotic symptoms

A

Elevation of mood. Carefree and very happy. Uncontrollable excitement
Increased energy and over activity
Rapid rate of delivery of speech
Decreased need for sleep
Loss of normal social inhibitions resulting in reckless or impulsive behaviour
Self esteem is inflated with grandiose ideas

30
Q

What are the symptoms of mania with psychotic symptoms

A

All the symptoms of mania + now delusions are present (usually grandiose), hallucinations.
Excessive motor activity
Flight of ideas very extreme that communicating with patient is impossible

31
Q

What is hypomania

A

Persistent mild elevation of mood, increased energy and activity,increased socialability, talkativeness, increased sexual energy and decreased need for sleep . ‘

However these symptoms are not severe enough to cause disruption of work or impact ADLs

Must be present for at least 4 days and there shouldn’t be much fluctuation throughout the day.

There are no hallucinations or delusions

32
Q

What is bipolar affective disorder

A

Two or more episodes in which there is disruption to the patients mood or energy levels. Can have manic episodes and depressive episodes on other occasions

33
Q

What is type I bipolar disorder

A

Manic and depressive episodes

34
Q

What is type II bipolar disorder

A

Hypomanic and depressive episodes

35
Q

What is cyclothymia

A

Persistent instability of mood with periods of depression and mild elevation of mood but are not severe or prolonged enough to warrant diagnosis of bipolar affective disorder

36
Q

What is dysthymia

A

Chronic depression of mood lasting several years which is not severe enough to justify diagnosis of mild,moderate or severe recurrent depressive disorder

37
Q

What is recurrent depressive disorder

A

Repeated episodes of depression without any history of episodes with mood elevation. *note following a depressive episode and commencement of anti-depressants mild elevation of mood may be observed

  • for this diagnosis to be applicable must NOT have any history of mania!!!!!
38
Q

How must a diagnosis of depression be classified

A

By mild, mod or severe

Presence or absence of psychotic symptoms

39
Q

What is problem solving therapy

A

Helps patient identify triggers and deal with negative emotions, encouraging them to come up with strategies to help themselves and not be avoidant

Is used for major depressive disorder, GAD, suicidal ideation, personality disorders

40
Q

How are mild to moderate depressive symptoms treated

A

Advice on sleep hygiene, active monitoring, self guided CBT, group physical therapy

41
Q

What is interpersonal psychotherapy IPT

A

Therapist works with patient to identify problems within relationships that are impacting mental health.

Eg

Grief
Conflicts with partners, family members, friends etc
Personal difficulties like social isolation
Helping with life changes etc

42
Q

How is mania treated

A

Stop anti-depressants

Start on anti-psychotics and ECT in severe cases

Psychoeducation (identifying triggers and making action plans)

43
Q

Treatment of bipolar affective disorder

A

Gold standard is lithium and is used to prevent recurrence

Anti-convulsants such as lamotrigine as mood stabilisers

For mania or hypomanic episode in bipolar affective disorder can use anti-psychotics

Block 33 Mental Health (12 decks)

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