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Year 3 Psychiatry Block > Mood Disorder > Flashcards

Mood Disorder Flashcards

1
Q

What is Masked Depression

A

Depressed mood not prominent, but other features of depression are

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2
Q

Define Mood

A

Patient’s sustained emotional state over a period of time

Can be Dysthymic (Low), Euthymic (Normal) or Elevated

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3
Q

Define Affect

A

Transient flow of emotion in response to a particular stimulus

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4
Q

Define Mood Disorder

A

Condition characterised by distorted/excessive/inappropriate moods for a sustained period of time

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5
Q

State the ICD10 class 1-7 for mood disorders

A

1 - Manic Episode (inc Hypomania)
2 - BPAD
3 - Depressive Episode
4 - Recurrent Depressive Episode
5 - Persistent Mood Disorders (Dysthymia, Cyclothymia)
6 - Other Mood Disorders
7 - Unspecified Mood Disorders

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6
Q

State the two classifications of Mood Disorder and give example

A

Unipolar - Depressive Disorders, Dysthymia

Bipolar - Cyclothymia, BPAD

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7
Q

State three causes of Secondary Mood Disorders

A

Physical Disorders (Hypothyroid, Cushing)

Psychiatric Disorders (Schizophrenia, Dementia)

Drug Induced

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8
Q

Define Depressive Disorder

A

Affective mood disorder characterised by persistent low mood, loss of pleasure and lack of energy

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9
Q

Give a Bio, Psycho, and Social PREDISPOSING factor for Depressive Disorder

A

Bio - Female
Psycho - Failure of effective stress control
Social - Lack of support

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10
Q

Other than the three core symptoms, give two cognitive symptoms of Depressive Disorder

A

Lack of conc. and decision making
Excessive guilt

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11
Q

Other than the three core symptoms, give two biological symptoms of Depressive Disorder

A

Diurnal Variation
Loss of Appetite

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12
Q

What is Becks Triad?

A

Negative thoughts about Self, World and Future

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13
Q

State the ICD10 classification of Mild, Moderate and Severe Depressive Disorder respectively

A

Mild - 2 core symptoms and 2 other symptoms
Mod - 2 core symptoms and 3-4 other symptoms
Severe - 3 core symptoms and >4 other symptoms

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14
Q

Name three diagnostic questionnaires for Depressive Disorder

A

PHQ9
HADS

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15
Q

Other than questionnaires, name two other investigations you could do for Depressive Disorder

A

Bloods (fbcs, tfts, glucose)

Head CT/MRI (sol)

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16
Q

What is Seasonal Affective Disorder?

A

Where mood is severely affected by change in seasons

Mood normally lowest in Winter months

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17
Q

What is Masked Depression

A

Depressed mood not prominent, but other features of depression are

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18
Q

What is Atypical Depression?

A

Presenting with the opposite of the typical features - such as Overeating and Hypersomnia

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19
Q

Define Dysthymia and Cyclothymia

A

Dysthymia - Depressive state for two years not meeting threshold

Cyclothymia - Chronic Mood Fluctuation for two years, insufficient to meet threshold

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20
Q

Give four non Pharmacological mainstay treatments of Depression

A

Self Help Programmes
CBT
Physical Activity Programmes
Psychotherapies

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21
Q

When would you use Antidepressants in Mild to Mod Depression?

A

Lasted a long time
History of Mod - Severe
Failure of other interventions

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22
Q

What is the first step in management of a Mod to Severe depressed patient?

A

Suicide risk assessment

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23
Q

When would you refer a Depressed patient to Psychiatry?

A

Suicide Risk High
Severe Depression
Recurrent Depression
Unresponsive to Initial Meds

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24
Q

Describe the pharmacological therapy of Mod to Severe Depression

A

SSRIs first line (continued for 5m after symptom resolution for first episode, reducing dose slowly in last month or 2y if second)

Adjuvants with Lithium or Antipsychotics

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25
Q

Describe the non pharmacological management of Mod to Severe Depression

A

Psychotherapy (CBT, IPT)
Social Support

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26
Q

When could ECT be recommended for a Depressed patient?

A

If acutely life threatening

Depression with Psychotic Symptoms

Severe Psychomotor Retardation

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27
Q

Define Bipolar Affective Disorder

A

Chronic episodic mood disorder characterised by at least one episode of Mania/Hypomania, followed by a further episode of Mania/Depression

(Includes patients who at presentation have only suffered Mania as all will eventually develop depression)

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28
Q

What should you always screen for in a Depressed patient?

A

Mania

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29
Q

What is Hypomania?

A

Mildly elevated/irritable mood for present for at least four days

Interruption of life but not disruption

May have partial insight

30
Q

Define Mania with Psychosis

A

Severely elevated mood with Hallucinations and Delusions

31
Q

Bipolar 1 v 2

A

Bipolar I - Periods of severe mood episodes from Mania to Depression
Bipolar II - Milder form of mood elevation, Hypomania alternating with Depression

32
Q

Neologisms?

A

Creating new words

33
Q

Three components of risk?

A

Others
Self
From others

34
Q

What are the preferred SSRIs to treat depression?

A

Citalopram and fluoxetine

35
Q

When is sertraline preferred over fluoxetine and citalopram?

A

Post MI

36
Q

What is the most common Side effects of SSRIs

A

GI symptoms, increased risk of GI bleeds

37
Q

How often should antidepressants be reviewed

A

2 weeks after start by a doctor 1 week if under 25

38
Q

How long should patients be on antidepressants?

A

6 months after remission, reduced dose over 4 week period before it stops

39
Q

What two types of GABA receptors are they

A

A & B

40
Q

What ion does GABA receptors respond to and what ions influx to cause a reduce in membrane potential

A

GABA and chloride

41
Q

How does benzodiazepines increase the effect of GABA

A

Increases the frequency of chloride channels

42
Q

When are benzos used (5) ?

A

Sedation
Hypnotic
Anxiolytic
Anticonvulsant
Muscle relaxant

43
Q

How long should benzos be prescribed for?

A

2-4 WKS

44
Q

How do barbiturates affect gaba affects?

A

Increased durations of chloride channel opening

45
Q

Frequently bend - during barbecue?

A

Frequency benzos - duration barbiturates

46
Q

What can cause oculogyric crisis

A

Antipsychotics, its a form of acute dystonic reaction

47
Q

Signs of acute dystonic reaction

A

Tongue protrusion, jaw spasm, unable to control gaze, fixed neck

48
Q

Akathisia meaning?

A

Restlessness

49
Q

Tardive dyskinesia meaning?

A

Typically involves the face and involves repetitive involuntary withdrawing movements (lip smacking, tongue protrusion and grimacing)

50
Q

Parkinsonism meaning?

A

General term that mimics Parkinson’s disease (bradykinesia, cogwheel rigidity and shuffling gait)

51
Q

Catatonia meaning?

A

Appear to be in stupor, maintain odd postures and appear awake but unresponsive to external stimuli

52
Q

When can sodium valporate be used in relation to mental health

A

Epilepsy and bipolar

53
Q

When is pregablin used

A

GAD and neuropathic pain

54
Q

First line drug for schizophrenia

A

Olanzapine

55
Q

When may Hypomania be seen

A

Type 2 bipolar affective

56
Q

Epidemiology of bipolar?

A

2% prevalence, develops late teens

57
Q

What are the differences between the bipolar disorders

A

Type 1 - depression and mania
Type 2 - Hypomania and depression

58
Q

First line treatments for bipolar (3)?

A

Psychological interventions, lithium and valproate

59
Q

How to manage bipolar

A

Manage mania/Hypomania - stopping antidepressants, antipsychotic therapy

Depression - talking therapies, fluoxetine

Co-morbidities - 2-3x increased risk of diabetes, CVD

60
Q

What does HAD scale consist of?

A

14 questions (7 for anxiety, 7 for depression)

61
Q

How does HAD work and scoring

A

Each item is scored 0-3 produces a score of 21 for both anxiety and depression.
0-7 = normal, 8-10=borderline, 11+ case

62
Q

PHQ-9 scale explained?

A

9 items scored 0-3, items can include thoughts of self-harm.

0-4 none, 5-9 mild, 10-14 moderate, 15-19 moderately severe, 20-27 severe

63
Q

What criteria does nice use

A

DSM-IV

64
Q

How many symptoms are required to diagnose depression?

A

5/9

65
Q

9 diagnostic tools of depression?

A

1 - depressed mood nearly every day/most of the day
2 - anhedonia
3 - weight loss or weight gain
4 - insomnia/hypersomnia
5 - psychomotor agitation or retardation every day
6 - fatigue or loss of energy
7 - worthlessness or guilt
8 - diminished conc./indecisiveness
9 - recurrent thoughts of death, suicidal ideation

66
Q

Pseudohallucinations are ?

A

Vivid enough to be hallucinations but subjective and unreal they are a symptoms of PTSD

67
Q

Repression vs suppression

A

Suppression = intentional and temporary withholding an idea or feeling from= conscious awareness

Repression = involuntary withholding

68
Q

What type of drug is amitriptyline

A

TCA - tricyclic antidepressant

69
Q

MOA of TCAs

A

Inhibit the uptake of monoamine at the presynaptic membrane
- bind to the ATPase monoamine pump within the presynaptic membrane

70
Q

Splitting is?

A

Believing that people are either all good or all bad

71
Q

Fixation is?

A

Remaining in a more childish level of development

72
Q

Sublimation meaning?

A

Channeling unacceptable thoughts into socially acceptable alternatives

Year 3 Psychiatry Block (2 decks)

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