mood (affective) disorders Flashcards
most important question to ask in depression history
any prior manic, hypomania or mixed episodes that would indicate presence of bipolar disorder
mild vs moderate vs severe depression
domain = family, social, educational, occupationa etc
mild - difficultly continuing to function in 1 or more
mod - difficultly multiple domains
severe - most domains
ICD-11 classification of a depressive episode
a period of depressed mood or diminished interest in activities occurring most of the day, nearly every day lasting at least 2 weeks accompanied by other symptoms such as
o Difficulty concentrating
o Feelings of worthlessness or excessive or inappropriate guilt
o Hopelessness
o Recurrent thoughts of death or suicide
o Changes in appetite or sleep
o Psychomotor agitation or retardation
o Reduced energy or fatigue
cotard’s syndrome
More common in elderly
Often nihilistic (life in meaningless) delusions – I cant eat because my bowels have turned to dust
(type of psychotic depression)
depression severity scales
Hamiltons rating scale for depression (HRSD)
Montgomery-Asperg Depression rating scale (MADRS)
Beck depression inventory (BDI)
management of mild depression
Antidepressants not recommended initially
Watchful waiting, assess again in 2 weeks
Consider offering one or more low-intensity psychosocial interventions – CBT
management of moderate-severe depression
Offer antidepressant combined with high intensity psychological treatment - CBT or interpersonal therapy (IPT)
First line = SSRI – escitalopram, sertraline, mirtazapine
* No benefit felt by 6 weeks – change drug
2nd line = switch SSRI
3rd line = different class of antidepressant
* Venlafaxine (SNRI)
* Tricyclic antidepressant - cardiotoxic
* MAOI - phenelzine, moclobemide
Urgent psychiatric referral if suicidal ideas or plans (someone else at risk), psychotic, severely agitated or self-neglecting
o ECT (electroconvulsive therapy) is reserved for most severe cases - generalised seizure is induced
when a child responds to depression medication, how long should it be continued for?
6 months post remission
- response can take several weeks
if no response -> intensive psychological therapy
admnit if high risk of self harm, sicide, self-neglect, or safegaurding issue
management of mild depression in children
Watchful waiting for 2 weeks
Group IPT/CBT, non-directive supportive therapy for 2-3months
management of moderate to severe depression in children
Individual psychological therapy - CBT, IPT, family therapy, non-directive supportive – 4-6sessions
1st line = fluoxetine, 10mg to max of 20mg
2nd line = sertraline or citalopram
pathophysio of self harm
self-harm promotes release of endorphins
Brings temporary distress reduction – through negative reinforcement, these behaviours are repeated
biggest risk factor for suicide
most are attempts to maintain control in very stressful situations
Self harm scoring system
SAD PERSON
sex, age, depression, previous attempt, ethnol abuse, rational thinking loss, social supports lacking, organised plan, no spouse, sickness
guidelines for action with self harm scale
SAD PERSONS
0-2 send home with follow up
3-4 close follow up, consider hospitalisation
5-6 strongly consider hospitalisation
7-10 hospitalise or commit
what question is important to ask post self-harm?
feelings of hopelessness
no release of discomfort after self injury
intent to escape pain
“one way out”
define mania
severe functional impairment or psychotic symptoms for 7 days or more
- psychotic symptoms - delusions, auditory hallucinations
- euphoria, irritability
- pressure speech, increased self-esteem
- decreased need for sleep
