Mood Disorders Flashcards
define bipolar affective disorder (BPAD)
a mental disorder characterised by periods of depression and periods of elevated mood (mania)
triggers of manic episodes in BPAD
stressful life events
physical illness
illicit substance misuse
clinical features of depression periods in BPAD
withdrawn behaviour tearful low mood poor sleep anhedonia self-harm thoughts/actions
clinical features of manic episodes in BPAD
elevated mood irritability impulsive and dangerous decisions little regard to consequence reduced sleep need pressured speech flight of ideas
diagnostic criteria for BPAD by DSM
at least one episode of manic or hypomanic state and one major depressive episode
DSM definition of mania
distinct period of abnormal and persistently elevated, expansive or irritable mood lasting >1wk with three key symptoms
key symptoms included in DSM definition of mania
elevated self-esteem reduced sleep need increased speech rate flight of ideas easily distracted increased interest in goals/activities psychomotor agitation increased pursuit of 'dangerous' activities
DSM definition of hypomania
an episode of mania severe enough to cause marked impairment in social or occupational function with NO psychotic features
DSM definition of major depressive episode
sudden or new onset of at least 4 key symptoms for minimum of 2wks
key symptoms included in DSM definition of major depressive episode
changes in appetite, sleep, weight or motor activity
decreased energy
feelings of worthlessness or guilt
trouble thinking, concentrating or making decisions
thoughts of death
suicidal plans or attempts
acute management of mania WITH agitation in BPAD
IM neuroleptic or benzodiazepine
urgent secure unit admission
acute management of mania WITHOUT agitation in BPAD
oral monotherapy with antipsychotic
sedation and lithium added if necessary
acute management of depression in BPAD
mood stabiliser +/- atypical antipsychotic +/- antidepressant
chronic management of BPAD
lithium
second line: valproate
psychological therapy (e.g. CBT or interpersonal)
chronic management of BPAD if treatment resistant
antipsychotic + anticonvulsants
DSM diagnostic criteria of depression
5 out of the 9 key features present nearly every day for >2wks
key features of DSM criteria for depression
depressed mood or irritable for most of the day anhedonia significant weight change (5%) changes in sleep (insomnia) changes in activity fatigue feelings of guilt/worthlessness decreased concentration suicidality
risk factors of depression
female gender PMHH of depression significant physical illness other MH problems social issues
investigations of depression
thorough history
screening questionnaires
blood tests
thyroid function tests
management of depression (Step One)
low intensity psychological intervention
group-based CBT
management of depression (Step Two)
high intensity psychological therapy (e.g. CBT or IPT) or SSRIs
management of depression (Step Three)
antidepressants AND high intensity psychological therapies
treatment course of antidepressants
continued for 6mnths if benefit from medication
when stopping, reduce dose gradually over 4wk period
management of severe depression
SSRIs and psychological therapy
can include lithium
management of life-threatening depression
electroconvulsive therapy (ECT)
side effects of ECT
short: headache muscle aches/pains nausea temporary memory loss confusion
long:
persistent memory loss
key signs of hypothyroidism vs. depression
weight gain hair loss 'puffy' facial appearance long and heavy periods low mood
