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Psychiatry > Mood & affective disorders > Flashcards

Mood & affective disorders Flashcards

1
Q

Define mania and hypomania?

A

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

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2
Q

Features of elevated mood?

A

Disinhibition: sexually, socially, financially

Euphoria
Grandiosity
Irritability
Pressured speech
Not needing sleep
Creativity
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3
Q

3 types of disinhibition seen in elevated mood, define them.

A

Sexual disinhibition: inappropriate comments, behaviour

Social disinhibition: overfamiliarity

Financial disinhibition: spending lots of money on unnecessary things

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4
Q

Causes of mania?

A

Bipolar disorder
Drug or alcohol intoxication
Some drugs: steroids

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5
Q

What is bipolar affective disorder?

There are 3 types, describe.

A

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

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6
Q

Who is affected by bipolar affective disorder?

A

Males and females equally

In females prevalence peaks 15-19
In males 20-24

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7
Q

A patient with bipolar disorder presents at A+E with severe mania and psychotic delusions, how do you treat them?

A

Treat with an atypical anti-psychotic OR valproate semisodium

Consider admission if there is significant risk

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8
Q

A patient has just been treated successfully for a manic episode, what treatment do they need for more long-term control?

A

Lithium carbonate

Also consider pyscho-education, CBT, support groups

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9
Q

Risk factors for depression?

A 
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
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10
Q

You think a patient has depression, what are some other differential diagnoses?

A

Bipolar disorder
Anxiety
Psychotic disorder
Substance misuse
Dementia (often confused with depression in the elderly)
Neurological illness
Physical illness (such as hypothyroidism)

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11
Q

What are some organic causes of depression?

A

Parkinson’s, Huntington’s, MS

Endocrine: hyperthyroid, Cushing’s, Addison’s, hyperparathyroid

SLE

Infection
Malnutrition

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12
Q

How is depression classified?

A

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

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13
Q

What are the core symptoms of depression?

A
  1. Low mood
  2. Low energy
  3. Anhedonia (loss of interest in things)
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14
Q

What are the ‘other’ symptoms of depression? Categorise them into 2 groups.

A

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
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15
Q

What are the 5 components of suicide you should ask about?

A
  1. Ideation
  2. Intent
  3. Plan
  4. Access to lethal means
  5. History of suicide attempts
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16
Q

Name a patient rating scale to assess someone with depression? One for post-natal depression?

A

Patient health questionnaire 9 (PHQ9)

Edinburgh post-natal depression scale

17
Q

Presentation of severe depression with psychosis?

A

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)

18
Q

What is cyclothymia and dysthymia?

A

Cyclothymia: mild mood disorder, mood swings often between mild depression and hypomania

Dysthymia: persistent mild depression

19
Q

What are the ‘baby blues’? When does it occur and for how long? Symptoms?

A

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

20
Q

How do you treat baby blues?

A

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

21
Q

Who is at more risk of post-natal depression?

A

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
22
Q

How long does post-natal depression take to resolve usually? Is it ok to simply wait it out?

A

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
23
Q

Management of post-natal depression?

A

Have a low threshold for referring.

Counselling, CBT, input from health visitor

Drugs: SSRIs and tricyclics

In severe cases consider sectioning and ECT

24
Q

Which drugs are good (and which aren’t) to treat post-natal depression? Why.

A

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.

25
Q

When does post-partum psychosis usually start?

A

2 weeks after birth

26
Q

Presentation of post-partum psychosis?

A

Psychotic episode which is either depressive or manic

There will be congruent psychotic features

Rapidly fluctuating
Mood lability
Insomnia
Disorientation

27
Q

Risk factors for post-partum psychosis?

A

Previous mental illness
Single parenthood
Previous PND or PPP
Reduced support

28
Q

Name the types of antidepressants, and list a few of each category.

A

SSRI (selective serotonin inhibitor)

  • citalopram
  • fluoxetine
  • sertraline
  • paroxetine

SNRI (serotonin and noradrenaline reuptake inhibitors)

  • duloxetine
  • venlafaxine

Tricyclic:

  • amitriptyline
  • imipramine

Monamine oxidase inhibitors (MAOI)
- isocarboxazid

29
Q

Risk factors for self harm?

A 
Previous self harm
Female
Diagnosed psychiatric disorder
Financial issues
Bullying
Stress at work

Psychiatry (17 decks)

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