Mood & affective disorders Flashcards
Define mania and hypomania?
Mania: abnormally elevated mood and affect to such an extent where the person does not function normally and is out of touch with reality
Hypomania: same as mania, but to a lesser extent, the person can still function and is still in touch with reality
Features of elevated mood?
Disinhibition: sexually, socially, financially
Euphoria Grandiosity Irritability Pressured speech Not needing sleep Creativity
3 types of disinhibition seen in elevated mood, define them.
Sexual disinhibition: inappropriate comments, behaviour
Social disinhibition: overfamiliarity
Financial disinhibition: spending lots of money on unnecessary things
Causes of mania?
Bipolar disorder
Drug or alcohol intoxication
Some drugs: steroids
What is bipolar affective disorder?
There are 3 types, describe.
A severe mental disorder causing repeated episodes of depression and mania
Type I: equal numbers of depressive and manic episodes
Type II: primarily depressive episodes with occasional hypomania
Cyclothymia: mild form of bipolar
Who is affected by bipolar affective disorder?
Males and females equally
In females prevalence peaks 15-19
In males 20-24
A patient with bipolar disorder presents at A+E with severe mania and psychotic delusions, how do you treat them?
Treat with an atypical anti-psychotic OR valproate semisodium
Consider admission if there is significant risk
A patient has just been treated successfully for a manic episode, what treatment do they need for more long-term control?
Lithium carbonate
Also consider pyscho-education, CBT, support groups
Risk factors for depression?
Chronic disease Chronic pain Family history Neurotic personality traits Difficult childhood experiences Low self-esteem Significant life event: divorce, job loss Poor socio-economic background
You think a patient has depression, what are some other differential diagnoses?
Bipolar disorder
Anxiety
Psychotic disorder
Substance misuse
Dementia (often confused with depression in the elderly)
Neurological illness
Physical illness (such as hypothyroidism)
What are some organic causes of depression?
Parkinson’s, Huntington’s, MS
Endocrine: hyperthyroid, Cushing’s, Addison’s, hyperparathyroid
SLE
Infection
Malnutrition
How is depression classified?
Should have these symptoms most of the time for 2 weeks.
Mild: 2 core + 2 other
Moderate: 2 core + 3 other
Severe: 3 core + 4 other
Severe with psychosis
What are the core symptoms of depression?
- Low mood
- Low energy
- Anhedonia (loss of interest in things)
What are the ‘other’ symptoms of depression? Categorise them into 2 groups.
Cognitive:
- suicidal ideation
- poor concentration
- low self-esteem
- guilt, worthlessness
- psychomotor retardation (slowness, sluggishness)
Biological / somatic
- poor sleep, early morning waking
- lack of appetite
- decreased libido
What are the 5 components of suicide you should ask about?
- Ideation
- Intent
- Plan
- Access to lethal means
- History of suicide attempts
Name a patient rating scale to assess someone with depression? One for post-natal depression?
Patient health questionnaire 9 (PHQ9)
Edinburgh post-natal depression scale
Presentation of severe depression with psychosis?
Will present with the symptoms of severe depression (3 core + 4 other)
Also with delusions, hallucinations, paranoia which are congruent to their low mood (negative, self-critical, nihilistic)
What is cyclothymia and dysthymia?
Cyclothymia: mild mood disorder, mood swings often between mild depression and hypomania
Dysthymia: persistent mild depression
What are the ‘baby blues’? When does it occur and for how long? Symptoms?
When a new mother feels tearful, anxious and irritable
3-5 days after delivery
Lasts up to 2 weeks
Transient and self-limiting. Seen in 75% of new mothers
How do you treat baby blues?
Reassurance from midwife that it is a common problem and will probably go away.
Monitor closely and if doesn’t resolve in 2 weeks seek psychiatric review
Who is at more risk of post-natal depression?
Mothers with previous history of it
Mothers with history of depression or bipolar disorder
Unplanned pregnancy Lack of support Relationship problems Sleep deprivation Social circumstances
How long does post-natal depression take to resolve usually? Is it ok to simply wait it out?
6 months. No, because:
- PND in a mother impairs the cognitive and social skills of the infant
- disruption of mother-baby bond
- suicide in a new mother is a really awful situation
Management of post-natal depression?
Have a low threshold for referring.
Counselling, CBT, input from health visitor
Drugs: SSRIs and tricyclics
In severe cases consider sectioning and ECT
Which drugs are good (and which aren’t) to treat post-natal depression? Why.
SSRIs and tricylcics are good to use as they are minimally excreted in breast milk.
Fluoxetine shows higher levels in breast milk so don’t use.
When does post-partum psychosis usually start?
2 weeks after birth
Presentation of post-partum psychosis?
Psychotic episode which is either depressive or manic
There will be congruent psychotic features
Rapidly fluctuating
Mood lability
Insomnia
Disorientation
Risk factors for post-partum psychosis?
Previous mental illness
Single parenthood
Previous PND or PPP
Reduced support
Name the types of antidepressants, and list a few of each category.
SSRI (selective serotonin inhibitor)
- citalopram
- fluoxetine
- sertraline
- paroxetine
SNRI (serotonin and noradrenaline reuptake inhibitors)
- duloxetine
- venlafaxine
Tricyclic:
- amitriptyline
- imipramine
Monamine oxidase inhibitors (MAOI)
- isocarboxazid
Risk factors for self harm?
Previous self harm Female Diagnosed psychiatric disorder Financial issues Bullying Stress at work
