depression & bipolar Flashcards
what is depression
a mood/affective disorder characterised by low mood and loss of interest/enjoyment in activities
what hormones are involved with depression and what are their key roles
in depression there is an imbalance between serotonin, norepinephrine and dopamine
regulate sleep, appetite, mood, reward motivated behaviour
what are the requirements for a depressive episode
lasting at least 2 weeks
symptoms impair daily function
symptoms are not attributable to anything else
what are the three core symptoms of depression
low mood
adhedonia
anergia
what two screening questions could you ask if you suspected depression
During the last month, have you often been botheredby feeling down, depressed or hopeless?
During the last month, have you been botheredby having little interest or pleasure in doing things?
what is the DSM IV/V criteria
a list of symptoms used to grade depression
symptoms must have been present everyday for at least two weeks
what are the 9 symptoms (2 criteria) on the DSM IV/V list and what is the minimum amount needed for depression to be diagnosed
depressed mood
loss of interest/pleasure (anhedonia)
weight/appetite change insomnia/hypersomnia fatigue psychomotor changes problems concentrating feelings of worthlessness/guilt suicidal ideation/self harm
at least 5 of the 9 symptoms with at least one symptom from the first two
what is the score for mild depression
5+ symptoms (at least one from first criteria)
mild functional impairment
what is the score for moderate depression
2 core + 3/4 cognitive
what is the score for severe depression
at least 5 symptoms with marked functional impairment
or any depression involving psychosis
what is psychosis
inability to distinguish between symptoms of hallucination, delusion and disordered thinking from reality
what is a hallucination
a sensation that has the full force/clarity of a true perception that happens in the external space
no external stimuli
not willed/controlled
hallucinations of the 5 special senses
what are delusions
unshakable belief that is out of keeping with the persons social/cultural background
what are types of delusions
grandiose
paranoia
hypochondrial
self-referential
what is step one of treating depression
assessment support psycho-education lifestyle advice - diet, exercise, sleep hygiene review in 2 weeks
what is step 2 in treating depression
low intensity interventions - group CBT and physical activity
active monitoring
sleep hygiene advice
when would you consider using anti-depressants at step 2
if patient has a PMH of moderate/severe depression
if they have subthreshold (<5) symptoms for <2yrs and havent responded to other intervention
if they have subthreshold symptoms lasting 2+ years
what is step 3
add an antidepressant (SSRI 1st)
higher intensity intervention - individual CBT etc
consider fitness to work/drive
follow up (2 weeks)
what is the first line antidepressant
an SSRI - sertraline or fluoxetine
what if the patient doesn’t respond to step 3
increase the dose of the antidepressant or swap to a different SSRI
can swap to a TCA or MAOI
can combine the anti-depressant with lithium or an anti-psychotic or another anti-depressant
increase level of support
why do you need to wean patients off SSRIs
stopping an SSRI suddenly causes withdrawal syndrome
reduce dose gradually
what is step four in managing depression
this is for severe/complex depression that is not responding to treatment
risk of self-neglect and/or suicide
refer to psychiatry
what do you need to establish in a suicide risk assessment
thought of suicide/self harm previous attempts protective factors risk factors intent/ideas change their will current stressors access to lethal methods/weapons social support alcohol/drug misuse
what are risk factors for suicide
previous attempts/self harm other mental health problems physical illness low socioeconomic status relationship breakdown
what is bipolar disorder
repeated episodes of depression and mania/hypomania
how long does the manic episode need to last in bipolar disorder
1-3 months
when does bipolar disorder present
early - age 15-19
strong family history
how do you treat mild bipolar disorder
CBT exercise meditation psychological intervention stop anti-depressants if patients become hypomanic
first line medication for bipolar disorder
fluoxetine with olanzapine
OR
antipsychotic on it’s own - quetiapine or olanzapine
consider stopping any SSRI the patient is on if patient is in mania
second line medication for bipolar disorder
lamotrigine or valproate (anti-convulsants)
or lithium
who cannot use valproate
women of childbearing age (unless they have effective contraception and sign an agreement)
what is mania
pathological inappropriately elevated mood
associated with grandiose ideas, disinhibition, loss of judgement
what is hypomania
a lesser degree of mania
doesn’t disrupt work or cause social rejection
NO PSYCHOSIS
what are features of mania
PSYCHOSIS elevated mood grandiosity increased energy overactivity decreased need for sleep alteration of senses extravagant spending irritability pressure of speech increased sexual activity
