Mood Disorder Flashcards
What is Masked Depression
Depressed mood not prominent, but other features of depression are
Define Mood
Patient’s sustained emotional state over a period of time
Can be Dysthymic (Low), Euthymic (Normal) or Elevated
Define Affect
Transient flow of emotion in response to a particular stimulus
Define Mood Disorder
Condition characterised by distorted/excessive/inappropriate moods for a sustained period of time
State the ICD10 class 1-7 for mood disorders
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
State the two classifications of Mood Disorder and give example
Unipolar - Depressive Disorders, Dysthymia
Bipolar - Cyclothymia, BPAD
State three causes of Secondary Mood Disorders
Physical Disorders (Hypothyroid, Cushing)
Psychiatric Disorders (Schizophrenia, Dementia)
Drug Induced
Define Depressive Disorder
Affective mood disorder characterised by persistent low mood, loss of pleasure and lack of energy
Give a Bio, Psycho, and Social PREDISPOSING factor for Depressive Disorder
Bio - Female
Psycho - Failure of effective stress control
Social - Lack of support
Other than the three core symptoms, give two cognitive symptoms of Depressive Disorder
Lack of conc. and decision making
Excessive guilt
Other than the three core symptoms, give two biological symptoms of Depressive Disorder
Diurnal Variation
Loss of Appetite
What is Becks Triad?
Negative thoughts about Self, World and Future
State the ICD10 classification of Mild, Moderate and Severe Depressive Disorder respectively
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
Name three diagnostic questionnaires for Depressive Disorder
PHQ9
HADS
Other than questionnaires, name two other investigations you could do for Depressive Disorder
Bloods (fbcs, tfts, glucose)
Head CT/MRI (sol)
What is Seasonal Affective Disorder?
Where mood is severely affected by change in seasons
Mood normally lowest in Winter months
What is Masked Depression
Depressed mood not prominent, but other features of depression are
What is Atypical Depression?
Presenting with the opposite of the typical features - such as Overeating and Hypersomnia
Define Dysthymia and Cyclothymia
Dysthymia - Depressive state for two years not meeting threshold
Cyclothymia - Chronic Mood Fluctuation for two years, insufficient to meet threshold
Give four non Pharmacological mainstay treatments of Depression
Self Help Programmes
CBT
Physical Activity Programmes
Psychotherapies
When would you use Antidepressants in Mild to Mod Depression?
Lasted a long time
History of Mod - Severe
Failure of other interventions
What is the first step in management of a Mod to Severe depressed patient?
Suicide risk assessment
When would you refer a Depressed patient to Psychiatry?
Suicide Risk High
Severe Depression
Recurrent Depression
Unresponsive to Initial Meds
Describe the pharmacological therapy of Mod to Severe Depression
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
Describe the non pharmacological management of Mod to Severe Depression
Psychotherapy (CBT, IPT)
Social Support
When could ECT be recommended for a Depressed patient?
If acutely life threatening
Depression with Psychotic Symptoms
Severe Psychomotor Retardation
Define Bipolar Affective Disorder
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)
What should you always screen for in a Depressed patient?
Mania
What is Hypomania?
Mildly elevated/irritable mood for present for at least four days
Interruption of life but not disruption
May have partial insight
Define Mania with Psychosis
Severely elevated mood with Hallucinations and Delusions
Bipolar 1 v 2
Bipolar I - Periods of severe mood episodes from Mania to Depression
Bipolar II - Milder form of mood elevation, Hypomania alternating with Depression
Neologisms?
Creating new words
Three components of risk?
Others
Self
From others
What are the preferred SSRIs to treat depression?
Citalopram and fluoxetine
When is sertraline preferred over fluoxetine and citalopram?
Post MI
What is the most common Side effects of SSRIs
GI symptoms, increased risk of GI bleeds
How often should antidepressants be reviewed
2 weeks after start by a doctor 1 week if under 25
How long should patients be on antidepressants?
6 months after remission, reduced dose over 4 week period before it stops
What two types of GABA receptors are they
A & B
What ion does GABA receptors respond to and what ions influx to cause a reduce in membrane potential
GABA and chloride
How does benzodiazepines increase the effect of GABA
Increases the frequency of chloride channels
When are benzos used (5) ?
Sedation
Hypnotic
Anxiolytic
Anticonvulsant
Muscle relaxant
How long should benzos be prescribed for?
2-4 WKS
How do barbiturates affect gaba affects?
Increased durations of chloride channel opening
Frequently bend - during barbecue?
Frequency benzos - duration barbiturates
What can cause oculogyric crisis
Antipsychotics, its a form of acute dystonic reaction
Signs of acute dystonic reaction
Tongue protrusion, jaw spasm, unable to control gaze, fixed neck
Akathisia meaning?
Restlessness
Tardive dyskinesia meaning?
Typically involves the face and involves repetitive involuntary withdrawing movements (lip smacking, tongue protrusion and grimacing)
Parkinsonism meaning?
General term that mimics Parkinson’s disease (bradykinesia, cogwheel rigidity and shuffling gait)
Catatonia meaning?
Appear to be in stupor, maintain odd postures and appear awake but unresponsive to external stimuli
When can sodium valporate be used in relation to mental health
Epilepsy and bipolar
When is pregablin used
GAD and neuropathic pain
First line drug for schizophrenia
Olanzapine
When may Hypomania be seen
Type 2 bipolar affective
Epidemiology of bipolar?
2% prevalence, develops late teens
What are the differences between the bipolar disorders
Type 1 - depression and mania
Type 2 - Hypomania and depression
First line treatments for bipolar (3)?
Psychological interventions, lithium and valproate
How to manage bipolar
Manage mania/Hypomania - stopping antidepressants, antipsychotic therapy
Depression - talking therapies, fluoxetine
Co-morbidities - 2-3x increased risk of diabetes, CVD
What does HAD scale consist of?
14 questions (7 for anxiety, 7 for depression)
How does HAD work and scoring
Each item is scored 0-3 produces a score of 21 for both anxiety and depression.
0-7 = normal, 8-10=borderline, 11+ case
PHQ-9 scale explained?
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
What criteria does nice use
DSM-IV
How many symptoms are required to diagnose depression?
5/9
9 diagnostic tools of depression?
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
Pseudohallucinations are ?
Vivid enough to be hallucinations but subjective and unreal they are a symptoms of PTSD
Repression vs suppression
Suppression = intentional and temporary withholding an idea or feeling from= conscious awareness
Repression = involuntary withholding
What type of drug is amitriptyline
TCA - tricyclic antidepressant
MOA of TCAs
Inhibit the uptake of monoamine at the presynaptic membrane
- bind to the ATPase monoamine pump within the presynaptic membrane
Splitting is?
Believing that people are either all good or all bad
Fixation is?
Remaining in a more childish level of development
Sublimation meaning?
Channeling unacceptable thoughts into socially acceptable alternatives
How does bipolar differ to BPD?
BPD is fluctuating moods over hours whereas bipolar the mania can last 7 days+ and hypomania 4 days+
