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MBBS VI - SpC - Psychiatry > Mood disorder (F3) > Flashcards

Mood disorder (F3) Flashcards

1
Q

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Low mood

Ddx mood disorders

A

MDD
BAD
Dysthymia (current episode 2y), Cyclothymia (multiple episodes >2y)
Schizoaffective disorder (2w)

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2
Q

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Low mood

secondary causes

A

Drugs: BB, Methyldopa, BDZ, Steroids…
Psychiatric: Adjustment disorder (<3mo), psychotic disorder, anxiety disorder
Med: Endo, CNS, PAIN

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3
Q

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Depressive episode

DSM5 criteria

A
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4
Q

Depression

Core symptom questions

A
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5
Q

Depression

Questiuons for biological symptoms

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6
Q

Depression

Questions for cognitive and psychotic symptoms

A
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7
Q

Depression

Questions for risk assessment

A
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8
Q

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Depression

Ix

A
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9
Q

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Elation/ Irritability

Ddx mood disorders

A

Hypomania/ Mania/ BAD
Mixed affective episode
Cyclothymia
Agitated depression

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10
Q

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Elation/ irritability

Ddx psychotic disorders

A

Schizophrenia
Schizoaffective disorder
ADHD
Borderline personality disorder
Delirium
Dementia

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11
Q

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Elation/ irritability

Secondary causes

A

Med: CNS, Endo, Metabolic
Drugs: SA stimulants/ hallucinogens, Steroids, antidepressants
After ECT

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12
Q

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Elation/ irritable mood

DSM-5 criteria

A

DIGFAST

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13
Q

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Bipolar I vs II disorder

DSM-5 criteria

A

Bipolar 1 = at least 1 manic episode
Bipolar 2 = major mood disorder + hypomanic episode

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14
Q

Elation/ irritable mood

Questions for core symptoms

A
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15
Q

Elation/ irritable mood

Questions for biological symptoms

A
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16
Q

Elation/ irritable mood

Cognitive symptoms questions

A
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17
Q

Elation/ irritable mood

Psychotic feature questions

A
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18
Q

Elation/ irritable mood

Risk assessment

A
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19
Q

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Suicide and self-harm

Define: deliberate self harm, suicide attempt, committed suicide, parasuicide

A
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20
Q

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Suicide

Categories of suicidal behavior

A
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21
Q

Paracetamol overdose

Mechanism
Management

A
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22
Q

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Suicidal risk assessment framework

A

Past risk factors
Present – intent, mental state
Future – risk and protective factors

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23
Q

Suicide

Demographic risk factors

A
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24
Q

Suicide

Psychiatric risk factors

A
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25
Suicide Medical risk factors and stressors
26
# * Assessment of suicidality
Past present future + protective factors Depressed mood > Negative thoughts > Passive and active death wish > Plans and preparation > Attempt
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Assessment of suicide intent
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Suicide Questions to assess ideation, reasons
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Suicide Questions to assess intent, plan, communication
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Suicide Questions to assess attempt
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Suicide Questions to assess risk of further attempts, risk factors, protective factors
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# * Suicide Amenable risk factors and protective factors
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Suicide risk assessment scoring questions
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# * Major depressive disorder Core features
Depressed mood: pervasive with morning dysphoria Anergia Anhedonia
35
# * Major depressive disorder Biological symptoms/ clinical features of depression with somatic/ melancholic features
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# * Major depressive disorder Cognitive and psychotic symptoms
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Major depressive disorder Atypical depression characteristics
Variable depressed mood Overeating Oversleeping Leaden paralysis Pronounced anxiety
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Minor depressive disorder Clinical features Classification
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Dysthymia Clinical features
Persistent episode for >2y
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Minor anxiety-depressive disorders Clinical features
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Major depressive disorder Etiologies
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Major depression Pathophysiology
More Ventromedial prefrontal cortex activity Less dorsolateral prefrontal cortex activity Less activity between amygdala and anterior cingulate Less hippocampal volume High cortisol, CRH, proinflammatory cytokines Less BDNF
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# * Major depression Management
+ Novel agent for refractory: Esketamine
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Major depression Management flowchart
Start antidepressants > check after 2 weeks > Continue for 6-9 months or switch or increase dose 3rd line choices: Mirtazepine, Agomelatine
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# * Major depression Classes of antidepressants
Second generation SSRI – Fluoxetine, Citaprolam SNRI – Venlafaxine Atypical: Mirtazapine, Buproprion, Agomelatine First generation TCA – Amitriptyline MAOI - Moclobemide
46
# * Antidepressants Safety Specific contraindications Timing of effect onset D-D interactions
Delay effect for 2w S/E: GI disturbance, neuropsychiatric, sexual dysfunction Black box for suicide D/D: MAOI serotonin syndrome, Antipsychotics EPSE, NSAID GIB, P450 enzyme
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# * Antidepressants Discontinuation symptoms
NAIPD No antidepressant induce poor dreams Nausea, ataxia, irritable, paraesthesia , diaphoresis
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# * Major depression Psychological therapy indication, modalities
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# * Major depression Stimulation therapies
ECT TMS TDCS
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Refractory depression Factors Management
Switch class Combination Add: SGA (Only Aripripazole and Quetiapine), Lithium, T3, electroconvulsive therapy New: Esketamine
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Major depression Clinical course Average duration Prognosis
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Major depression Prognostic factors for relapse
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Bipolar disorder Epidemiology
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Bipolar disorder Definition Core features
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Bipolar disorder Biological features
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Bipolar disorder Cognitive and psychotic symptoms
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# * Hypomania vs mania features
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Alternative presentations of bipolar disorder
Bipolar depression Mood disorder with mixed features Rapid cycling bipolar disorder Cyclothymia
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# * Differential diagnosis of mania
Schizophrenia Organic brain damage Substance abuse Recurrent depression Borderline personality disorder ADHD
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Causes of under and overdiagnosis of bipolar disorder
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Bipolar disorder Etiologies
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# * Management of bipolar disorder
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# * Treatment of acute mania or hypomania
- **Hospitalization for all cases** (except mild mania) - Antimanic medications: Antipsychotics, lithium, valproate, optional BZD Considerations: - **Antipsychotic** is 1st line - Start lithium if compliant; rapid cycling, prominent depressive symptoms and psychotic features predict poorer response - Stop/ **avoid antidepressants** - **Valproate**: avoided in child-bearing age women, use haloperidol and other antipsychotics Unresponsive: consider optimize dose, combination Tx, switch between combination, ECT Duration: - Decrease dose with clinical improvement - **Continue for >6mo and >8w after complete remission**
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Treatment of bipolar depression
Quetiapine alone Olanzepine alone Lithium
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Maintenance therapy for bipolar disorder
Drugs: Lithium antipsychotics AED: Valproate, Lamotrigine, Carbamazepine Combination Psychosocial interventions: CBT Interpersonal and social rhythm therapy (IPSRT) Psychoeducation

MBBS VI - SpC - Psychiatry (22 decks)

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