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PSYCH (Psychiatry) > Mood Disorders > Flashcards

Mood Disorders Flashcards

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1
Q

What is a Mood Disorder?

A

A persistent state when sadness or elation is overly intense, accompanied by certain other typical symptoms and impairs the ability to function physically, socially and at work.

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2
Q

How is a Mood Disorder different to normality?

A

The alteration is beyond the fluctuation we all experience (cyclothymia).

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3
Q

Give 4 factors that make someone a suitable candidate for psychotherapy.

A
  1. Less Severe Depression.
  2. ‘Psychological Mindedness’.
  3. Willingness to Engage in Therapy and Homework.
  4. Preference for Psychological treatment.
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4
Q

What is Major Depression?

A

A mood disorder that causes persistent feelings of low mood, low energy and reduced interest; anhedonia in daily life with a dysphoric mood with symptoms everyday for at least 2 weeks.

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5
Q

Give 7 differences between Depression (5) and Dementia (2).

A

Depression has :-

  1. Shorter history.
  2. Quicker onset.
  3. Biological Symptoms.
  4. Worry over Poor Memory.
  5. Reluctance to Take Tests.

Dementia has :-

  1. Fixed MMTS and Global Memory Loss.
  2. Characteristic Recent Memory Loss.
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6
Q

Give 5 differences between Depression and Grief.

A
  1. Suicidal Thoughts :
    Depression = Common (driven by low mood).
    Grief = Transient (driven by wish to be with loved).
  2. Blame for Situation :
    Depression = Self. Grief = Other People/Fate.
  3. Psychomotor Retardation :
    Depression = Yes. Grief = No.
  4. Psychomotor Agitation :
    Depression = If severe, mood congruent.
    Grief = No, but may see/hear the deceased.
  5. Symptom Course :
    Depression = Pervasive. Grief = Fluctuating.
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7
Q

What 2 questions are used to identify Depression?

A

During the last month…

  1. Have you been bothered by feeling down, depressed or hopeless?
  2. Have you often been bothered by having little interest or pleasure in doing things?
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8
Q

How does NICE diagnose and grade Depression?

A

DSM-IV Criteria - Mild results in minor functional impairment; Severe results in symptoms that markedly interfere with functioning with/without psychotic symptoms.

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9
Q

What can Psychotic Depression look like?

A

Worries and perceived misdemeanours become delusional in intensity e.g. Cotard Syndrome (belief that they are dead); auditory hallucinations (persecutory - you are worthless).

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10
Q

What questionnaires can be used to investigate the severity of Depression?

A
  1. HAD (Hospital Anxiety and Depression) Scale - 14 Questions : 7 Anxiety + 7 Depression. Each question is scored 0-3 so you get a total of 21 for anxiety and depression. A score above 11 indicates depression. Questions need to be answered quickly.
  2. PHQ-9 (Patient Health Questionnaire) - 9 Questions, also scored from 0-3. A score of 5+ indicates depression.
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11
Q

How is Mild Depression managed?

A

Watchful waiting and advice about healthy habits e.g. healthy diet, avoiding substances and 2 week follow-up. This tends to be associated with a single negative event.

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12
Q

How is Moderate/Severe Depression managed for kids?

A

CAMHS Referral - full assessment to establish a diagnosis.
1st Line - Psychological Therapy e.g. CBT, NDST, IT, FT.
2nd Line - Fluoxetine (10mg - 20mg).
3rd Line - Sertraline and Citalopram.
*Continue antidepressant for 6 months after remission is achieved.

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13
Q

Give 4 indications for anti-depressants.

A
  1. History of Moderate/Severe Depression.
  2. Initial Presentation of Sub-Threshold Depressive Symptoms present for a Long Period.
  3. Sub-Threshold Depressive Symptoms persist even after other Interventions.
  4. Chronic Health Problem complicated by Depression.
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14
Q

What is the routine when switching between SSRIs in Depression?

A

If Citalopram, Escitalopram, Sertraline, Paroxetine…
A. Withdraw 1st SSRI before starting 2nd SSRI.
If Fluoxetine…
B. Gap of 4-7 Days before starting a low-dose (Fluoxetine has longer half-life).
If switching to a TCA…
C. Cross-Tapering (Slowly reducing SSRI and increasing TCA).

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15
Q

What questionnaire can be used to assess progress of Depression management during follow-up monitoring in secondary care?

A

Mood-and-Feelings Questionnaire (MFQ).

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16
Q

What is Bipolar Affective Disorder?

A

A chronic mental health disorder characterised by periods of mania/hypomania alongside episodes of Depression, with a characteristic complete recovery between episodes.
Hallmark Feature - at least 2 episodes of mood disorder with at least one of them being mania/hypomania.

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17
Q

What is Mania and what is Hypomania?

A

Both = Abnormally elevated mood or irritability.
Mania - Severe functional impairment or psychotic symptoms (delusions of grandeur or auditory hallucinations) for 7+ days.
Hypomania - Decreased/Increased function for 4+ days.

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18
Q

How is the prognosis of Depression linked to Bipolar Affective Disorder?

A

About 10% of people with recurrent depression go on to develop BPAD.

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19
Q

What are the 2 recognised types of Bipolar Affective Disorder?

A 
Type I (commoner) - Mania (2 weeks to 5 months) and Depression (6 months).
Type II - Hypomania and Depression.
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20
Q

What are the characteristic symptoms of Mania? (5)

A
  1. Decreased need for sleep.
  2. Pressured speech.
  3. Increased libido.
  4. Reckless behaviour without regard for consequences.
  5. Grandiosity.
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21
Q

What is Rapid-Cycling BPAD?

A

An individual experiences 4+ episodes per year (commoner in women and poorer prognosis).

22
Q

How is an acute Manic episode (BPAD) treated?

A
  1. Hospitalisation.
  2. Atypical Antipsychotics.
  3. Long-Term Mood-Stabiliser : Lithium (management of choice), Carbamazepine, Valproate.
  4. Benzodiazepine - Sedation.
  5. Stop Anti-depressants (management of choice : Fluoxetine).
23
Q

How is a Depressive episode (BPAD) treated?

A

Anti-depressants may precipitate a manic episode and should not be prescribed without a mood stabiliser - Quetiapine is effective here.

24
Q

What is recommended by NICE if symptoms suggest Hypomania?

A

CMHT (Community Mental Health Team) Routine Referral.

25
Q

What 2 adverse effects are common to all Anti-Depressants?

A
  1. Hyponatraemia.

2. Sexual Dysfunction.

26
Q

Why should Anti-depressants be used with caution in neurological patients?

A

Lowering of seizure threshold in Epilepsy.

27
Q

Give 4 examples of SSRIs.

A

Citalopram, Fluoxetine, Sertraline, Escitalopram.

28
Q

What is the mechanism of action of SSRIs?

A

Preferential inhibition of neuronal re-uptake of Serotonin from synaptic cleft, thereby increasing availability for neurotransmission.

29
Q

Give 3 indications for SSRIs.

A
  1. Depression (1st line if Moderate/Severe or Psychological Treatments fail in Mild).
  2. Panic Disorder.
  3. OCD.
30
Q

Give 2 cautions of SSRIs.

A
  1. Avoid if on MAO Inhibitors (increased synaptic Serotonin levels = Serotonin Syndrome).
  2. Avoid if on other drugs that prolong the QT Interval.
31
Q

What is Serotonin Syndrome?

  • Clinical Features (3).
  • Causes (3).
  • Management (2).
A

Triad : Autonomic Hyperactivity, altered mental state and neuromuscular excitation.
Cause : High Doses, Overdose, Combination with Other Anti-Depressants.
Management : Treatment Withdrawal and Supportive Therapy.

32
Q

What can a sudden withdrawal of Anti-Depressants cause? (4)

A
  1. GI Upset.
  2. Neurological symptoms.
  3. Flu-like Symptoms.
  4. Sleep Disturbances.
33
Q

Give 3 examples of TCAs.

A
  1. Amitriptyline.
  2. Lofepramine.
  3. Clomipramine.
34
Q

What is the mechanism of action of TCAs?

A

Inhibition of neuronal re-uptake of Serotonin and Noradrenaline from the synaptic cleft, thereby increasing their availability for neurotransmission. They block a wide array of receptors e.g. Muscarinic, H1, A1, A2, D2.

35
Q

Give 2 indications for TCAs.

A
  1. Moderate/Severe Depression (2nd line because more side effects and more toxic in overdose).
  2. Neuropathic pain (but not licensed).
36
Q

Give 3 adverse effects of TCAs.

A
  1. Anti-Muscarinic Effects e.g. Dry Mouth, Constipation, Blurred Vision. (Can’t See, Can’t Pee, Can’t Spit, Can’t Sh*t.)
  2. H1/A1 Blockade Effects : Sedation and Hypotension.
  3. Arrhythmias, Convulsions, Hallucinations, Mania, Breast Changes, Sexual Dysfunction.
37
Q

What is the Mechanism of Action of Venlafaxine and Mirtazapine?

A

Increased availability of Monoamines for neurotransmission.

Venlafaxine - SNRI and Weaker Antagonist of Muscarinic and H2 Receptors than TCAs.

38
Q

Give 2 indications for Venlafaxine/Mirtazapine.

A
  1. Major Depression (2nd Line).

2. GAD.

39
Q

How can Antidepressants be taken with ECT?

A

Reducing the dose (not suddenly stopping).

40
Q

What can long-term Lithium use cause?

A

Hyperparathyroidism and resultant Hypercalcaemia (Stones, Bones, Abdominal Pains, Psychic Groans).

41
Q

What is Mirtazapine?

A

A NaSSA (Noradrenergic and Specific Serotonergic Antidepressant) only used in specialist care of GAD. It is an Antagonist of Inhibitory Pre-Synaptic A2 Receptors and Potent Antagonist of H2 Receptors.

42
Q

Give 3 differences between Mania and Hypomania.

A
  1. Length of Symptoms (Mania = 7+; Hypomania = 3/4).
  2. Severity (Impaired Functioning in Mania).
  3. Presence of Psychotic Symptoms in Mania.
43
Q

Give 2 examples of SNRIs.

A
  1. Venlafaxine.

2. Duloxetine.

44
Q

How are SSRIs dangerous in pregnancy?

A
  1. 1st Trimester : Small Increased Risk of Congenital Heart Defects.
  2. 3rd Trimester : Persistent Pulmonary Hypertension for Newborn.
  3. Paroxetine (especially 1st Trimester) : Increased Risk of Congenital Malformations.
45
Q

Give 2 common adverse effects of Mirtazapine.

A
  1. Increased Appetite.

2. Sedation.

46
Q

What is the classic side effect of MAO Inhibitors?

A

Tyramine Cheese Reaction : consumption of foods rich in Tyramine e.g. Cheese can result in a hypertensive crisis.

47
Q

Give six foods rich in Tyramine.

A
  1. Cheese.
  2. Oxo.
  3. Marmite.
  4. Bovril.
  5. Pickled Herring.
  6. Broad Beans.
48
Q

What monitoring is recommended for patients on SNRIs?

A

BP Monitoring = At initiation; each dose of titration of Venlafaxine.

49
Q

What monitoring is recommended for patients on Citalopram or Escitalopram?

A

ECG Monitoring prior to Initiation = QT Prolongation.

50
Q

When should initial reviews after Antidepressant Use be held?

A 
30+ = 2 Weeks.
<30 = 1 Week.
51
Q

Give 3 Core Symptoms of Depression.

A
  1. Low Mood.
  2. Low Energy.
  3. Anhedonia.
52
Q

Give 2 Somatic Symptoms of Depression.

A
  1. Early Waking.

2. Changes in Appetite and Weight.

PSYCH (Psychiatry) (11 decks)

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