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Psychiatry > Depression and bipolar affective disorder > Flashcards

Depression and bipolar affective disorder Flashcards

1
Q

core syx of depresssion 3

A

depressed mood for most of day, every day
-may be diurnal mood variation( worse in mornigs * improves as day proceeds)

anhedonia
-loos of interest or pleasure in daily life

fatigue- lack of energy goes beyond poor sleep and pervades life

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2
Q

typical syx of depression outwith core syx 7

A

poor appetite w marked weight loss

disrupted sleep

psychomotor retardation

decreased libido

reduced ability to concentrate

feelings of worthlessness

recurrent thoughts of death

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3
Q

how long do sy x have to be present for and what is needed for a diagnosis of depression

A

syx presnet for every or nerarly every day for over 2 weeks

represent a change from normal personality

must have at least 2 of 3 core syx
-plus 2 or more typical syx

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4
Q

biological risk factors for depression 3

A

FHx

twin studies

also monoamine theory of depression
-decreased monoamines may cause depression

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5
Q

psychological risk factors for depression 3

A

personality traits
-mood lability, automonic hyperarousal

low self esteem

childhood experiences

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6
Q

social risk facotrs for depression 2

A

disruption due to life events

stress associtwed w poor social environment

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7
Q

differentials for depression 4

A

psychaitric disorders- bipolar, schizo, anorexia, anxiety

substance misue

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8
Q

criteria for severity of depression (mild,moderate, severity)

A

mild -2 typical syx
-2 core syx

moderate- 2 typical syx
-3+ core syx

severe- 3 typical syx
-4+ core syx

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9
Q

what are the stages of the bereavment process 5

A

denial

anger

bargaining

depression

acceptance

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10
Q

management of mild depresssion

A

suggest low intensity psycoloigcal interventions
-focus on sleep hygiene
-anxeity management
-problem solving techniques

examples:
-self help guided resources
-computerised CBT

only if syx persist beyond 8 weeks or previous history of depression then antidepressnat can be considered

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11
Q

management of moderate depression

A

combo of antidepressant and high intensity psychological intervention

for a first episode of depression
-generic SSRI is recommeneded

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12
Q

what does severe depression include 3

A

includes psychoitc depression, high risk of suicide and atypical depression

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13
Q

management of severe depression

A

need a rapid sepcalist mental health assessment with consideration of inpatient admission or ECT

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14
Q

mechanism of ECT

A

interrupts hyperconneceivity between various areas of the brain that maintain depression

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15
Q

indications for ECT 3

A

prolonged or severe manic episode

severe depression

catatonia

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16
Q

side effects of ECT

A

memeory loss- short term retrograde amnesia (usually resolves completely

confusion

headaches

clumsiness

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17
Q

follow up for depresion

A

reviewed regularly, frequently at first then less often

18
Q

use of st john worts for depression

A

non prescribed herbal remedy or dpession

has superiority to placebo and equivalent antidepressants with fewer side effects

-use not encourage as upregulates livers CP450 so affects metabolism of drugs

19
Q

which antidepressants for depression

A

often trial and error

combinded use of CBT and anti-depressant for mild to moderate depression

discuss side-effects
-warn patient of initial worseing symptoms in first weeks to preserve before therapeutic effects are seen

then assess formally after 4 weeks

SSRIs are recommended first line

20
Q

first line medicl management of depression

A

generic SSRI
-low starting dose titrated up
-adise full effects may take up to 6 weeks
-continue for at least 6 months after recovery

21
Q

examples of SSRIs 3

A

fluoextine- only antidepressnat licensed for <18s

citalopram

sertraline

22
Q

side effects and monitoring in SSRI use

A

monitor FBC- for anaemia due to GI bleeding and avoid concurrent NSAIDs

U&Es for hyponatraemia

citaloprma- dose dependent prolongation of QTc intervals

23
Q

second line depression management

A

an alternative SSRI from first line

24
Q

third line for depression managent

A

no particular order

mirtazapine- can cause drowsiness at low doses
-may be helpful to aid sleep

venlafaxine
-can be helpful for anxious patients
-require baseline BP and ECG. monitoring for any cardiovascular side effects

25
Q

fourth line for depression

A

tricyclics - nortriptyline

MAOIs- moclobemide

SARI-trazodone

26
Q

signs of mania regarding cognititon 5

A

cognition
-grandiosity
-distractibiltiy/poor concentration
-flight of idea/racing thoughts
-confusion
-lack. of insight

27
Q

signs of mania regarding mood 3

A

irritability

euphoria

lability

28
Q

signs of mania regarding behaviours 5

A

rapid speech

hyperactivity

sleep

hypersexuality

extravagance

29
Q

psychotic syx of mania 2

A

delusison

hallucinations

30
Q

define hypomania

A

state with characterisitic syx of mania except for:

psychotic syx,
-impairemnt of daily functioning
-need for inpatient treatment

31
Q

define bipolar affective disorder

A

depression alternates with mania

32
Q

medical causes of mania 3

A

steroids

illiect substances
-amphetamines-
-cocaine

antidepressants

33
Q

physical causes of mania

A

infection

stroke

neoplasm

epilepsy

MS

metabolic distrubnaces

34
Q

what to ask when assessing a manic person

A

infections

drug use

personal or FHx of psych disorders

35
Q

invesitgations for a manic person 3

A

CT of the head

EEG

screen for drugs/toxins

36
Q

management of acute mania

A

for moderate/severe with psychotic syx, cycling speed, suicide risk:
-any 2nd gen antipsychotic
or
-semisodium valproate

may need mental health act

37
Q

prophylaxis for patients with bipolar affective disorder

A

mood stabiliser for longerterm control

give lithium carbonate
-if compliance good, U&Es, ECG and T4 normal

38
Q

psychosocial interveniton for bipolar affective disorder 3

A

psychoeducation

CBT

support groups

39
Q

pregnancy and bipolar affective disorder

A

lithium is teratogenic
but stopping mediaction in pregnancy can carry risks of manic relapse

EBSTEINS ANOMALY

if they continue lithium
-regulary perinatal reviews and close contact

if they stop
-immeditate lithium postpartum with breastfeeding advice

40
Q

medications if lithium does not work for bipolar affective diosrder

A

antivonvulsnats-sodium valporate- 2nd line

antipsychotics-olanzapine

combination treatments
-lithium plus carbamazepine

antidepressants with lithium

Psychiatry (21 decks)

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