depression and mania in mood disorders

Question 1

cord symptoms of depression

Answer 1

• Feeling persistently sad ( low mood)
• Loss of pleasure in previously enjoyable activities (anhedonia )
• Loss of energy (anergia)

Additional symptoms
Loss of appetite, sleep disturbance (wake 2 hours earlier )
Recurring negative thoughts – guilt/worthless/hopelessness
Suicidal thoughts, plans and behaviours
Poor concentration, reduced libido, psychomotor retardation or agitation

Question 2

differentials for depression

Answer 2

• Normal sadness – can be improved
• Adjustment disorder – depressive symptoms under the threshold for a depressive episode
• Personality disorder – pervasive and enduring non-episodic low mood and negative thoughts, arising from neglectful or abusive upbringing, often accompanied with trauma. Antidepressant are often ineffective in the variant of personality disorder know as borderline
• Dementia – progressive cognitive and functional decline. Low mood very common in dementia but does not respond to antidepressants.

Question 3

treatment depression

Answer 3

Mild depressive episode – guided self-help and lifestyle adjustments. GP +- primary care level psychological therapy ( eg talk works Devon)
Moderate – CBT +/- antidepressant (sertraline 50mg od) primary care based
Severe – more intensive med strategy. Often needs secondary care eg community mental health team CMHT. May be too unwell to make use of this therapy

Severe depressive episodes with psychosis – antidepressants and antipsychotics eg olanzapine 10mg od , and possibly ECT ( electro compulsive therapy) especially if life threatening and poor oral intake. Need secondary care

Recurrent depression – antiD , lifestyle adjustments and self-help. Psychological therapies are longer form to help prevent relapse ( between episodes best to start)

Question 4

Diagnosis of BPAD

Answer 4

Have one episode of elevated mood( mania or hypo) and one other episodes of affective disorder ( depression, mania, hypo, or mixed)
Some people have predictable cycles
Manic episode very often followed by depressive episode

Question 5

treatment fro BPAD

Answer 5

Hypomania – may get better on won, maybe sleeping tablets often need anti-manic treatment. All antipsychotics are also anti-manic – olanzapine 20mg od – mamged in primary care