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Year 4 Psychiatry > Depressive Disorders > Flashcards

Depressive Disorders Flashcards

1
Q

aetiology: depressive disorder

A
  • 1 in 5 lifetime prevalence
  • 4.5% in UK
  • peak in elderly
  • F:M 2:1
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2
Q

core symptoms: depression

A
  • lowered moof
  • anhedonia
  • reduced energy levels
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3
Q

somatic symtpoms: depression

A
  • anhedonia
  • early morning wakening
  • diurnal mood variation
  • psychomotor retardation/agitation
  • marked loss of libido
  • appetite and weight loss
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4
Q

accessory symptoms: depression

A
  • reduced concentration and attention
  • reduced self-esteem and confidence
  • ideas of guilt and inworthiness
  • bleak and pessimistic views of futures
  • ideas or acts of self-harm/suicide
  • distrubed sleep
  • diminished appetite and weight loss
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5
Q

def: mild depression

A
  • 2 core symptoms
  • 2 accessory symptoms
  • with somatic symtpoms if 4+ present
  • not present to intense degree
  • minimum 2 weeks
  • patient distressed, some impact on work and social activites but not ceasing to function
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6
Q

def: moderate depression

A
  • 2 core symtpoms
  • 3-4 accessory symtpoms
  • several ssymptoms to marked degree
  • minimum 2 weeks
  • severe difficulty continuing with work/social/domestic activities
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7
Q

def: severe depression

A
  • all 3 core symtpoms
  • 4+ accessory symtpoms
  • severe accesoty symtpoms
  • minimum 2 weeks
  • unlikely to be able to continue with work/social/domestic activities
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8
Q

def: severe depression with psychotic features

A
  • severe depression with hallucinations/delusions/stupor
  • delusions usually mood congruent (sin, poverty, self blame, guilt etc)
  • hallunctinations usually derogatory voices/unpleasant smells
  • severe motor retardation
  • Cotard’s syndrome - delusional belief that he/she deos not exist/is dead/rotting inside
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9
Q

def: Cotard’s syndrome

A

delusional belief they do not exist/are dead/rotting inside

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10
Q

def: recurrent depressive disorder

A
  • recurrent episodes depression with no mania
  • remission between episodes
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11
Q

def: atypical depression

A
  • low mood but responds to positive events
  • increased appetite and weight gain
  • yperinsomnia
  • heavy sensation in limbs (Leaden paralysis)
  • interpersonal rejection sensitivity - tendency for deep and anxiety and humiliation at slightest rebuff
  • significant occupations and social impairment
  • responds better to MAOI
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12
Q

ix: depression

A
  • full hx and MSE inc drug/alcohol
  • physical examination
  • blood tests - FBC, U+E, LFT, TFT, bone profile, B12 and folate
  • ECG
  • CT brain/MRI if indicated
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13
Q

what electrolyte disturbance and organ dysfunction can cause depressive symptoms?

A

hypocalcaemia
thyroid

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14
Q

rx: mild depression

A

psychological: CBT
social: adress precipitating facots (debt/ work/housing etc

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15
Q

rx: mild-moderate depression

A

SSRI
high intensity CBT

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16
Q

rx: moderate-severe depression

A

SSRI
antipsychotic if also psychotic fx
psychological: CBT high intensity

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17
Q

rx: depressive stupor/catatonia

A

ECT and lorazepam as well as CBT and SSRI

18
Q

rx: refractory depression

A
  • change SSRI to alternative SSRI
  • add lithium if that fails
  • add antipsychotic
  • combine mirtazepine with SSRI?SNRI
  • ECT
19
Q

SSRI: names

A

sertraline
fluoxetine
paroxetine
citalopram
escitalopram

20
Q

SNRI: names

A

venlafaxine
duloxetine

21
Q

interations: SSRI

A

dangerous with St John’s Wort
increases levels of antipsychotics and benzos
citalopram/escitalopram - QT prolongation

22
Q

SE: SSRI

A

GI - nausea, vomiting, dyspepsia
headache
agitation/anxiety
sexual dysfunction
hypotnatramia
increased risk bleeding
+/- insomnia
no weight gain
citalopram/escitalopram - QT prolognation

23
Q

SE: SNRI

A
  • GI - N+V, dyspepsia
  • headache
  • anxiety/agitation
  • hyponatramia
  • sexual dysfunction
  • sweating
  • +/- insomnia
  • elevation of BP at higher doses
  • venlafaxine - QTc prolongation
24
Q

TCA: names

A

amitriptyline
clomipramine
lofepraina

25
Q

SE: TCA

A

potent SNRI and anticholinergic and antihistimines
general - N+V, headache
histamine - sedation and hangover
alpha 1 - postural hypotension, tachycardia and arrhythmia
anticholinergic - dry mouth, blurred vision, consiptation, urinary retention

26
Q

MAOI: names

A

phenelzine
moclobemide

27
Q

SE: MAOI

A
  • dangerous rise in BP when given with tyramine (cheese, pickle etc)
  • postural hypotension
  • sedation
  • headache
  • serotonin syndrome
  • weight gain
  • heatpotoxicity
  • leucopenia
  • hypertensive crisis
  • anticholinergic effects
28
Q

NaSSA: name

A

mirtazepine

29
Q

SE: NaSSA

A
  • sedation
  • weight gain and increased appetite
  • low WBC
  • dizziness
30
Q

vortioxetine: pros and cons

A

pro-cognitive
less sexual dysfunction
SE: N+V, headache, dry mouth, abnormal dreams

31
Q

def: serotonin syndrome

A

excess serotonin
cognitive: headache, agitation, hallycinations
autonmic: shivering, sweating, hyperthermia, N+V
somatic effects: myoclonus, hyperreflexia, tremor

32
Q

rx: serotonin syndrome

A

remove causitive aget
may need cyproheptadine antagonist

33
Q

def: discontinuation syndrome

A

Flu like symptoms
* vivid dreams
* electric shock sensations
* GI upset
* taper drugs, PRN diazepam.
* most likely with paroxetine/venlafaxine

34
Q

indications: ECT

A
  • life-threatening situation becuase of refusal of food and fluids
  • high risk suicide
  • depressive stupor
  • marked psychomotor retardation
  • psychotic depression
  • treatment resistent depression
35
Q

neurochemical amine hypothesis depression (monoamine hypothesis)

A

deperession cauased by functional deficiency of monamines (serotonin and noradrenaline)

36
Q

RFs: depression

A

family hx
childhood experiences
adverse life events
anxious/impulsive/obessional peronality
alcohol
physical illness
old age
women 2:1

37
Q

def: dysthymia

A
  • chronic depression/longstanding lowered mood
  • does not meet criteria for depression
  • difficult to treat, combination of antidepressants and psychological interventions
38
Q

def: cyclothymia

A
  • persistent instability of mood
  • fluctuating between mild elevation and mild lowering of mood
  • does not meet criteria for BPAD or recurrent depression
  • mood stabilisers rx
39
Q

def: adjustment disorder

A
  • subjective emotional distress in period of adaptation to significant life event/change
  • does not meet criteria for depression
  • not over 6 months usually
  • not treated with antidepressants
  • increased risk suicide
40
Q

def: post-natal depression

A

baby blues - 3-5 days after birth and spontaneously resolves with reassurance
PND - treat as depression

Year 4 Psychiatry (13 decks)

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