Mood and Affective Disorders Flashcards
What are the risk factors for depression?
Bio: - Low monoamines - Being female - Chronic health problem Psycho - Personality type - Poor coping strategies - Mental health co-morbidities Social: - Poor support network - Stressful events
What is beck’s triad for depression?
Negative views about the world
Negative views about oneself
Negative views about the future
What are the core symptoms of depression?
Low mood
Lack of energy
Anhedonia - no pleasure in normally pleasurable activities
What are the other symptoms of depression?
Cognitive: - Suicidal ideation - Guilt/worthlessness - Lack of concentration Biological: - Diurnal mood variation - Loss of appetite - Early morning wakening - Loss of libido - Psychomotor retardation Psychotic - 2nd person auditory hallucinations - Persecutory, nihilistic, guilt, hypochondriacal delusions
How long must symptoms be present for before considering a diagnosis of depression?
> 2 weeks
What are the DSM-IV (NICE guidelines) stages of depression?
Subthreshold: <5 symptoms
Mild: 5 symptoms with minimal functional impairment
Moderate: Somewhere between mild and severe
Severe: Most symptoms with significant impairment
What differentials would you consider for depression?
Functional - bipolar, schizophrenia, seasonal affective disorder
Organic - drug use, dementia, hypothyroidism
How is subthreshold and mild depression managed?
Watchful waiting with monitoring and sleep hygiene advice
Low intensity therapy: Self help, computerised CBT, group physical activity class
Group based CBT
Antidepressants if:
- > 2 years
- Past episode of severe
- Physical health complications
- Failure of other interventions
How is moderate-severe depression managed?
Suicide risk assessment
SSRI
High intensity therapy: CBT, IPT, behavioural activation
When is ECT used in depression?
Life threatening
Psychotic
Severe psychomotor retardation
Failure of other therapies
What is dysthymia?
Depressive state for >2 years which doesn’t meet depression criteria
What is cyclothymia?
Mood fluctuations for >2 years where elation and depression do not meet criteria
What is atypical depression?
Mild-moderate depression with reversal of biological symptoms: e.g. overeating, hypersomnia
What is masked depression?
Mood isn’t the prominent feature however sleep disorders and diurnal mood variation are present?
What is seasonal affective disorder? How is it managed?
Depressive episodes occurring in the winter months
Treated same as mild depression but don’t give sleeping tablets as makes it worse
What is bipolar affective disorder?
Chronic episodic mood disorder characterised by at least 1 episode of mania/hypomania and a further episode of mania or depression
What differentials would you consider for bipolar disorder?
Thyroid problems Space occupying lesion Substance misuse Schizophrenia Personality disorders
What is the difference between bipolar 1 and 2?
1 - mania to depression
2 - hypomania to severe depression
What symptoms are associated with bipolar disorder (mania episodes)?
More energy Increased appetite Grandiose delusions Increased libido Little insight Flight of ideas Little sleep Irritable Easily distracted Disinhibited
What is the difference between hypomania and mania?
Hypomania:
- symptoms >4 days
- milder symptoms
- slightly interfere with life
- partial insight
Mania:
- symptoms >1 week
- Greater extent of symptoms - completely disrupt life
- no insight
- psychotic symptoms (grandiose delusions or auditory hallucinations)
Outline the management strategy for bipolar affective disorder
Antipsychotic (olanzapine/haloperidol) Mood stabiliser (1. lithium 2. valproate) CBT
(Stop anti-depressants during manic episode but if one is needed for depression prescribe fluoxetine)
How is depression screened?
Quick check on mood/anhedonia in hx - if yes then more detailed screen
HAD scale and PHQ-9
What are some side effects to ECT?
Short term - headache, nausea, memory loss, arrhythmia
Long term - some pt. report impaired memory
