Mood disorder (F3) Flashcards
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Low mood
Ddx mood disorders
MDD
BAD
Dysthymia (current episode 2y), Cyclothymia (multiple episodes >2y)
Schizoaffective disorder (2w)
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Low mood
secondary causes
Drugs: BB, Methyldopa, BDZ, Steroids…
Psychiatric: Adjustment disorder (<3mo), psychotic disorder, anxiety disorder
Med: Endo, CNS, PAIN
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Depressive episode
DSM5 criteria
Depression
Core symptom questions
Depression
Questiuons for biological symptoms
Depression
Questions for cognitive and psychotic symptoms
Depression
Questions for risk assessment
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Depression
Ix
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Elation/ Irritability
Ddx mood disorders
Hypomania/ Mania/ BAD
Mixed affective episode
Cyclothymia
Agitated depression
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Elation/ irritability
Ddx psychotic disorders
Schizophrenia
Schizoaffective disorder
ADHD
Borderline personality disorder
Delirium
Dementia
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Elation/ irritability
Secondary causes
Med: CNS, Endo, Metabolic
Drugs: SA stimulants/ hallucinogens, Steroids, antidepressants
After ECT
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Elation/ irritable mood
DSM-5 criteria
DIGFAST
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Bipolar I vs II disorder
DSM-5 criteria
Bipolar 1 = at least 1 manic episode
Bipolar 2 = major mood disorder + hypomanic episode
Elation/ irritable mood
Questions for core symptoms
Elation/ irritable mood
Questions for biological symptoms
Elation/ irritable mood
Cognitive symptoms questions
Elation/ irritable mood
Psychotic feature questions
Elation/ irritable mood
Risk assessment
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Suicide and self-harm
Define: deliberate self harm, suicide attempt, committed suicide, parasuicide
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Suicide
Categories of suicidal behavior
Paracetamol overdose
Mechanism
Management
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Suicidal risk assessment framework
Past risk factors
Present – intent, mental state
Future – risk and protective factors
Suicide
Demographic risk factors
Suicide
Psychiatric risk factors
Suicide
Medical risk factors and stressors
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Assessment of suicidality
Past present future + protective factors
Depressed mood > Negative thoughts > Passive and active death wish > Plans and preparation > Attempt
Assessment of suicide intent
Suicide
Questions to assess ideation, reasons
Suicide
Questions to assess intent, plan, communication
Suicide
Questions to assess attempt
Suicide
Questions to assess risk of further attempts, risk factors, protective factors
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Suicide
Amenable risk factors and protective factors
Suicide risk assessment scoring questions
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Major depressive disorder
Core features
Depressed mood: pervasive with morning dysphoria
Anergia
Anhedonia
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Major depressive disorder
Biological symptoms/ clinical features of depression with somatic/ melancholic features
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Major depressive disorder
Cognitive and psychotic symptoms
Major depressive disorder
Atypical depression characteristics
Variable depressed mood
Overeating
Oversleeping
Leaden paralysis
Pronounced anxiety
Minor depressive disorder
Clinical features
Classification
Dysthymia
Clinical features
Persistent episode for >2y
Minor anxiety-depressive disorders
Clinical features
Major depressive disorder
Etiologies
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
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
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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
Refractory depression
Factors
Management
Switch class
Combination
Add: SGA (Only Aripripazole and Quetiapine), Lithium, T3, electroconvulsive therapy
New: Esketamine
Major depression
Clinical course
Average duration
Prognosis
Major depression
Prognostic factors for relapse
Bipolar disorder
Epidemiology
Bipolar disorder
Definition
Core features
Bipolar disorder
Biological features
Bipolar disorder
Cognitive and psychotic symptoms
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Hypomania vs mania features
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
Causes of under and overdiagnosis of bipolar disorder
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
Treatment of bipolar depression
Quetiapine alone
Olanzepine alone
Lithium
Maintenance therapy for bipolar disorder
Drugs:
Lithium
antipsychotics
AED: Valproate, Lamotrigine, Carbamazepine
Combination
Psychosocial interventions:
CBT
Interpersonal and social rhythm therapy (IPSRT)
Psychoeducation
