Depression and bipolar affective disorder Flashcards
core syx of depresssion 3
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
typical syx of depression outwith core syx 7
poor appetite w marked weight loss
disrupted sleep
psychomotor retardation
decreased libido
reduced ability to concentrate
feelings of worthlessness
recurrent thoughts of death
how long do sy x have to be present for and what is needed for a diagnosis of depression
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
biological risk factors for depression 3
FHx
twin studies
also monoamine theory of depression
-decreased monoamines may cause depression
psychological risk factors for depression 3
personality traits
-mood lability, automonic hyperarousal
low self esteem
childhood experiences
social risk facotrs for depression 2
disruption due to life events
stress associtwed w poor social environment
differentials for depression 4
psychaitric disorders- bipolar, schizo, anorexia, anxiety
substance misue
criteria for severity of depression (mild,moderate, severity)
mild -2 typical syx
-2 core syx
moderate- 2 typical syx
-3+ core syx
severe- 3 typical syx
-4+ core syx
what are the stages of the bereavment process 5
denial
anger
bargaining
depression
acceptance
management of mild depresssion
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
management of moderate depression
combo of antidepressant and high intensity psychological intervention
for a first episode of depression
-generic SSRI is recommeneded
what does severe depression include 3
includes psychoitc depression, high risk of suicide and atypical depression
management of severe depression
need a rapid sepcalist mental health assessment with consideration of inpatient admission or ECT
mechanism of ECT
interrupts hyperconneceivity between various areas of the brain that maintain depression
indications for ECT 3
prolonged or severe manic episode
severe depression
catatonia
side effects of ECT
memeory loss- short term retrograde amnesia (usually resolves completely
confusion
headaches
clumsiness
follow up for depresion
reviewed regularly, frequently at first then less often
use of st john worts for depression
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
which antidepressants for depression
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
first line medicl management of depression
generic SSRI
-low starting dose titrated up
-adise full effects may take up to 6 weeks
-continue for at least 6 months after recovery
examples of SSRIs 3
fluoextine- only antidepressnat licensed for <18s
citalopram
sertraline
side effects and monitoring in SSRI use
monitor FBC- for anaemia due to GI bleeding and avoid concurrent NSAIDs
U&Es for hyponatraemia
citaloprma- dose dependent prolongation of QTc intervals
second line depression management
an alternative SSRI from first line
third line for depression managent
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
fourth line for depression
tricyclics - nortriptyline
MAOIs- moclobemide
SARI-trazodone
signs of mania regarding cognititon 5
cognition
-grandiosity
-distractibiltiy/poor concentration
-flight of idea/racing thoughts
-confusion
-lack. of insight
signs of mania regarding mood 3
irritability
euphoria
lability
signs of mania regarding behaviours 5
rapid speech
hyperactivity
sleep
hypersexuality
extravagance
psychotic syx of mania 2
delusison
hallucinations
define hypomania
state with characterisitic syx of mania except for:
psychotic syx,
-impairemnt of daily functioning
-need for inpatient treatment
define bipolar affective disorder
depression alternates with mania
medical causes of mania 3
steroids
illiect substances
-amphetamines-
-cocaine
antidepressants
physical causes of mania
infection
stroke
neoplasm
epilepsy
MS
metabolic distrubnaces
what to ask when assessing a manic person
infections
drug use
personal or FHx of psych disorders
invesitgations for a manic person 3
CT of the head
EEG
screen for drugs/toxins
management of acute mania
for moderate/severe with psychotic syx, cycling speed, suicide risk:
-any 2nd gen antipsychotic
or
-semisodium valproate
may need mental health act
prophylaxis for patients with bipolar affective disorder
mood stabiliser for longerterm control
give lithium carbonate
-if compliance good, U&Es, ECG and T4 normal
psychosocial interveniton for bipolar affective disorder 3
psychoeducation
CBT
support groups
pregnancy and bipolar affective disorder
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
medications if lithium does not work for bipolar affective diosrder
antivonvulsnats-sodium valporate- 2nd line
antipsychotics-olanzapine
combination treatments
-lithium plus carbamazepine
antidepressants with lithium
