depression & bipolar

Question 1

what is depression

Answer 1

a mood/affective disorder characterised by low mood and loss of interest/enjoyment in activities

Question 2

what hormones are involved with depression and what are their key roles

Answer 2

in depression there is an imbalance between serotonin, norepinephrine and dopamine
regulate sleep, appetite, mood, reward motivated behaviour

Question 3

what are the requirements for a depressive episode

Answer 3

lasting at least 2 weeks
symptoms impair daily function
symptoms are not attributable to anything else

Question 4

what are the three core symptoms of depression

Answer 4

low mood
adhedonia
anergia

Question 5

what two screening questions could you ask if you suspected depression

Answer 5

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?

Question 6

what is the DSM IV/V criteria

Answer 6

a list of symptoms used to grade depression

symptoms must have been present everyday for at least two weeks

Question 7

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

Answer 7

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

Question 8

what is the score for mild depression

Answer 8

5+ symptoms (at least one from first criteria)

mild functional impairment

Question 9

what is the score for moderate depression

Answer 9

2 core + 3/4 cognitive

Question 10

what is the score for severe depression

Answer 10

at least 5 symptoms with marked functional impairment

or any depression involving psychosis

Question 11

what is psychosis

Answer 11

inability to distinguish between symptoms of hallucination, delusion and disordered thinking from reality

Question 12

what is a hallucination

Answer 12

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

Question 13

what are delusions

Answer 13

unshakable belief that is out of keeping with the persons social/cultural background

Question 14

what are types of delusions

Answer 14

grandiose
paranoia
hypochondrial
self-referential

Question 15

what is step one of treating depression

Answer 15

assessment 
support 
psycho-education
lifestyle advice - diet, exercise, sleep hygiene 
review in 2 weeks

Question 16

what is step 2 in treating depression

Answer 16

low intensity interventions - group CBT and physical activity
active monitoring
sleep hygiene advice

Question 17

when would you consider using anti-depressants at step 2

Answer 17

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

Question 18

what is step 3

Answer 18

add an antidepressant (SSRI 1st)
higher intensity intervention - individual CBT etc
consider fitness to work/drive
follow up (2 weeks)

Question 19

what is the first line antidepressant

Answer 19

an SSRI - sertraline or fluoxetine

Question 20

what if the patient doesn’t respond to step 3

Answer 20

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

Question 21

why do you need to wean patients off SSRIs

Answer 21

stopping an SSRI suddenly causes withdrawal syndrome

reduce dose gradually

Question 22

what is step four in managing depression

Answer 22

this is for severe/complex depression that is not responding to treatment
risk of self-neglect and/or suicide
refer to psychiatry

Question 23

what do you need to establish in a suicide risk assessment

Answer 23

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

Question 24

what are risk factors for suicide

Answer 24

previous attempts/self harm 
other mental health problems
physical illness
low socioeconomic status 
relationship breakdown

Question 25

what is bipolar disorder

Answer 25

repeated episodes of depression and mania/hypomania

Question 26

how long does the manic episode need to last in bipolar disorder

Answer 26

1-3 months

Question 27

when does bipolar disorder present

Answer 27

early - age 15-19

strong family history

Question 28

how do you treat mild bipolar disorder

Answer 28

CBT 
exercise 
meditation 
psychological intervention
stop anti-depressants if patients become hypomanic

Question 29

first line medication for bipolar disorder

Answer 29

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

Question 30

second line medication for bipolar disorder

Answer 30

lamotrigine or valproate (anti-convulsants)

or lithium

Question 31

who cannot use valproate

Answer 31

women of childbearing age (unless they have effective contraception and sign an agreement)

Question 32

what is mania

Answer 32

pathological inappropriately elevated mood

associated with grandiose ideas, disinhibition, loss of judgement

Question 33

what is hypomania

Answer 33

a lesser degree of mania
doesn’t disrupt work or cause social rejection
NO PSYCHOSIS

Question 34

what are features of mania

Answer 34

PSYCHOSIS
elevated mood 
grandiosity 
increased energy 
overactivity 
decreased need for sleep
alteration of senses 
extravagant spending 
irritability 
pressure of speech 
increased sexual activity