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elearning on affective disorders Flashcards

1
Q

burden of disease with depression?

A

2nd highest in world by 2020

highest in 15-34 yrs

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2
Q

lifetime prevalence depression?

A

20%

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3
Q

gender depression

A

2:1 females until >55

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4
Q

age of onset depression

A

late 20s

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5
Q

one distinctly female symptom of depression?

A

amenorrhoea

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6
Q

organic causes of low mood

A
  1. endocrine: adrenal, thyroid, hypoPituitarism
  2. infections - mono, syph, AIDS, encephalitis
  3. neuro - stroke, parkinsons, MS, tumour
  4. carcinoma - paraneoplastic syndrome
  5. meds: statins, interferon, isoretinoin
  6. .nutritional deficiencies
    MI, cerebral ischaemia
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7
Q

importance of substance abuse?

A

must abstain from substance for 2 wks before can diagnose

cannot MSE in acute intoxication

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8
Q

ddx for mild depression?

A

normal

reactive eg bereavement/job loss

anxiety

BPAD

personality disorder

dysthymia

OCD

eating disorder

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9
Q

ddx when severe depression w/o psychotic sx

A
  1. prodromal psychotic illness
  2. dementia - normal sleep, no diurnal variation, gradual onset, focal neuro signs eg apraxia, agnosia, dysphasia
  3. severe/chronic OCD

if psychosis also think schizophrenia

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10
Q

what’s disulfiram?

A

used in aversive tx of alcohol abuse

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11
Q

combination therapy of antidepressants?

A

no not usually except maybe SSRI+ mirtazapine in refractory

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12
Q

response rate to antidepressants?

A

short term response rate 60%

eventual response unlikely if nothing at 4 wks

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13
Q

if not responding to meds in depression?

A
  1. try another class
  2. discuss compliance
  3. review comorbid substance use
  4. augment - lithium, combination tx
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14
Q

relapse rates antidepressant

A

continued tx for 6 months = 20-25% rate relapse, 50% on placebo

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15
Q

if symptoms reduce can reduce dose of antidepressant?

A

no, relapse rate will increase

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16
Q

what is ecstasy

A

extreme state of subjective transcendence of the outside world

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17
Q

what is elation

A

abnormal mood state without an infectious quality

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18
Q

what is euphoria

A

normal mood state with an infectious quality

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19
Q

biological symptom BPAD has in common with mania?

A

early morning waking often 1st sign

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20
Q

psychotic symptoms of BPAD

A

mood congruent - magical powers, deification, hallucinations

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21
Q

BPAD completed suicide risk

A

15-20%

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22
Q

what are the types of mood stabilisers?

A
  1. Lithium
  2. Anticonvulsants eg lamotrigine, valproate, carbamazepine
  3. antipsychotics - some have a mood stabilising effect eg olanzapine, quetiapine, risperidone
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23
Q

what medical condition can blunt the response to antidepressants and mood stabilisers?

A

hypothyroidism

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24
Q

can you use antidepressants in BPAD?

A
  1. yes in depressive episodes

2. low dose, watch for manic switch

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25
Q

what is a spotter?

A

friend, family member or partner of patient who is given psychoeducation to recognise early warning signs of mood disturbance

26
Q

CBT in BPAD

A

limited evidence of its effect

27
Q

additional indications for the use of antidepressants

A

anxiety disorders - agoraphobia, GAD, social phobia

OCD

28
Q

adequate therapeutic trial?

29
Q

steps when drug not working

A
  1. ensure diagnosis correct
  2. check compliance and tolerability
  3. consider increasing dose
30
Q

risk factors for hyponatraemia when on antidepressants?

A
  1. previous hyponatraemia
  2. old age
  3. diuretics
  4. DM
  5. HTN
  6. renal failure
  7. COPD
31
Q

when do side effects of SSRIs appear and disappear?

A
  1. early, before therapeutic effect

2. dissipate after 1st week slightly

32
Q

sexual side effects of antidepressants?

A
  1. reduced libido
  2. delayed orgasm
  3. ED
33
Q

List 6 SSRIs

A 
fluox
parox
fluvoxamine
sertaline
citalopram
escitalopram
34
Q

list 4 TCAs

A

amitriptaline
clomipramine
lofepramine
dothiepin

35
Q

list 2 SNRIs

A

venlafaxine

duloxetine

36
Q

list 3 MAOIS

A

phenelzine
tranylcypromine
moclobamide

37
Q

are antidepressants addictive?

38
Q

elderly people and antidepressant dosing once symptoms improve

A

leave on them for longer as would for recurrent episodes, 2yrs

39
Q

stopping an antidepressant?

A

gradually

inform of discontinuation symptoms

40
Q

which MAOI doesn’t require dietary restrictions?

A

reversible inhibitors of MAO-A eg moclobamide UNLESS high dose

41
Q

steps in prescribing antidepressants

A
  1. thoroughly assess
  2. confirm diagnosis
  3. discuss drug, s/e, discontinuation with patient
  4. consider severity of illness, past response to tx, potential lethality in OD
42
Q

increase dose or switch class?

A 
increase dose if tolerable
switch class if not
43
Q

first step in mania presentation?

A

stop antidepressant

44
Q

treatment of mania/hypomania?

A

drugs: lithium/ antipsychotics/ sodium valproate

short acting benzos

45
Q

before prescribing lithium tell patients:

A
  1. side effects and toicity
  2. salt free diet is contraindicated
  3. maintain adequate hydration
  4. don’t double up on doses
  5. contraception
46
Q

indications for lithium

A
  1. prophylaxis against manic and depressive relapse in BPAD
  2. tx acute mania and hypomania
  3. tx resistant unipolar depression
47
Q

tests to do before starting lithium?

A

renal
cardiac
thyroid
calcium - risk hyperparathyroidism

48
Q

what is the plasma level of lithium aimed for?

49
Q

tremor and lithium?

A

normal s/e - not toxic

see with mild thirst and polyuria

50
Q

what skin conditions can be exacerbated by lithium

A

acne

psoriasis

51
Q

what is the long term complication of lithium?

A

nephrotoxicity
reduced GFR in 20% - usually benign - small number can develop interstitial nephritis

also, nephrogenic DI - cause of the thirst and polyuria

52
Q

endocrine complication of lithium?

A

hypothyroidism - doesn’t mean should stop tx, just replace thyroxine

can also cause hyperthyroidism - less common

53
Q

lithium and NSAIDs

A

can increase serum lithium levels by up to 40%

lithium toxicity

DO NOT CO-PRESCRIBE
AND INFORM PATIENTS

54
Q

signs of lithium toxicity

A
  1. coarse tremor
  2. ataxia
  3. slurred speech
  4. drowsiness
  5. disorientation
  6. seizures
55
Q

lithium side effects at therapeutic plasma level

A 
GI - NVD
fine tremor
dry mouth
polyuria/dipsia
vertigo
weight gain
hypo/er thyroidism
worsened acne/psoriasis
56
Q

lithium 1.2-2mmol side effects

A
  1. coarse tremor
  2. ataxia
  3. dysarthria
  4. nystagmus
  5. renal impairment
  6. anorexia
  7. muscle weakness
57
Q

lithium >2 mmol/L side effects

A
  1. hyperreflexia and hyperextension of limbs
  2. convulsions
  3. syncope
  4. oliguria
  5. CVS failure
  6. seizure
  7. coma
  8. death
58
Q

intermittent use of lithium in BPAD?

A

can worsen the course
high incidence of manic relapse after discontinuing

Don’t start lithium unless intend to continue long term

can reduce risk of relapse by gradually reducing amt

59
Q

suicide and lithium?

A

long term lithium tx reduces the risk of suicide to that of general population

60
Q

carbamazepine + pregnancy

A

nope

spina bifida

Psych (23 decks)

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