Mood Flashcards
Core symptoms of low mood
At least 2 weeks of daily:
- low mood
- loss of interest or pleasure (anhedonia)
- fatigability (anergia)
Symptoms to ask (deppression)
Bio
- Sleep (early morning waking (2 hrs),insomnia or waking regularly)
- Depression worse in morning
- Marked decrease in appetite or weight loss (5% in a month)
- psychomotor retardation
- Agitation
- Loss of libido or sex drive
Cognitive
- reduced concentration and memory (destracted/indecisive, ‘can you follow your favourate TV programme’)
- Poor self esteem (efficacy or self worth)
- Guilt (innapropriate)
- Hopelessness (pessimistic)
- self harm/ suicide (ideation or planning?, ‘its common for people to feel . . .’)
Psychotic
- severe cases (delusions, hallucinations or depressed stupor)
- congruent or incongruent
- persecutory 2nd person or smell of rotting flesh
- psychomotor retardation and mutism
Low mood DDX
Episode of depression
-See ICD-10
recurrent depressive disorder
-80% have another after first . . . need 2 episodes
Dysthymia
- chronically > 2 years
- often from childhood
- seldom severe enough to meet criteria
Bipolar Affective disorder
- unipolar without manic
- Cyclothymia - below criteria
Schizoaffective disorder
-sepressed or manic with simultaneous schizophrenic symptoms
Anxiety Disorder
- associated . . . treat depression first
Adjustment Disorder
- meet criteria but obviously related to life event
Personality/neurodevelopment
-no baseline and significal psychosocial functioning affected
Dementia/delirum
-low mood apathy and hypsomia can be delirium and dementia can have cognitive decline
Secondary to general medica and psychoactive substances
-see other card
Depressive episode ICD-10
sx present for at least 2/52 with at least 2 of the following: -depressed mood -loess of interest or enjoyment -reduced energy or increased fatigability and some of; -disturbed sleep -diminished appetite -psychomotor retardation or agitation -reduced concentration or attention -decrease self esteem or confidence -ideas of guilt -hopelessness -ideas of self harm and suicide
depression severity
mild = some difficulty in continuing with normal activities
moderate = considerable difficulty but still fuction ins some domains
severe = unable to continue normal activities
severe with delusions
Ax questions
core
- have you been cheerful or quite low in mood or spirits lately?
- do you find that you no longer enjoy the things like you used to?
- do you find yourself being tired or wawrn out?
bio
- is your mood worse in the mornings or the evenings?
- has anyuomne mentioned you seem slow/restless?
- sometimes people find they have poor sex drive . . . does this happen to you?
Cognitive
- how do you see things turning out in the future?
- do you ever feel life is not worth living?
- are you able to concentration on your favourite TV programme?
Psychotic Sx
- do you hear people say bad things about you when they are not there?
- do you ever smell something that you find hard to explain?
- Do you feel your body is healthy?
ax general
-history (remember collateral)
-examination (neurological/endocrine)
Investigations - (bloods?)
Bloods for low mood?
FBC (anaemia, infection and increased MCV(alcohol))
U&E - hyponatraemia and renal function
LFTs -Alcohol intake
TFTs - hypo/erthyroidism
Calcium (hypercalcaemia
if indicated
- crp and esr
- vit b12/folate
- urine drug screen
- ecg
- CT head?
Mood epidemiology
recurrent depressive disorder
- lifetime risk = 10-25% (f) and 5-12% (M)
- onset = late 20s
- F:M 2:1
Bipolar
- risk - 1%
- onset 20 years
- 1:1
cyclothymia
- risk =0.5-1
- onset adolescence
- 1:1
dysthymia
- 3-6%
- onset adolescence/early adulthood
- 2-3:1
Mood aetiology
Genetics
- 40-50% heritability
early life experiences -parental separation -childhood adversary (negect, abuse etc) -postnatal depresseion -affect child personality -personality disorders eg Borderlin or OCD
Acute stress
- loss
- humiliation
- bereavement
- reklationship breakdown
- redundency
chronic stress
- child support
- unemployment
- raising child alone
- relationship ending
- chronic pain/illness
neurobiology
- structural shrinking or infarcts in old
- hyperactivity of the hypothalamic pituitary adrenal axis
- deficiency in monoamines (NA, serotonin and dopamine)
depression Setting
- Primary usually
- day hospital to get up?
intensive home support or inpatient if:
- highly distressing hallucinations/delusions
- high suicide/sellf harm risk
- extreme self neglect
Detentiona may be necessary
depression Tx general
Bio
- pharmacology
- lifestyle
- sleep hyegine
Psycho
- CBT
- IPT
- Family intervention
- psychodynamic therapy
- marital interventions
- mindfulness based cbt
Social
- social care?
- carer support?
- group sessions?
deppreseion lifestyle
- avoid alchol/substances
- healthy diet
- exercise
- sleep hyegine
depression pharmacologiucal tx
Use: first line mod/severe and 2nd line for mild
1st line - SSRI
considerations
- previous medications work?
- overdose risk (greater with TCAs and venlafaxine)
- Venlafaxine and TCA work better though (hospital use?)
comorbidity and intercations
- SSRIs with hyponataemia and NSAIDs, warfarin and heparin
- increased bleeding risk on SSRIs
- TCAs in MIs and arythmia
ADDs not working
- confirm concordance
-at least 4 weeks - reassess diagnosis, substances and stresses
-Psychotherapy
-increase dose
-change SSRI or trial 2
-try venaalfaxine or mirtaxapine
aygment with mirtaxipine, lithium or antipsychotic
-consider ect
