Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Mental Health > Mood Disorders > Flashcards

Mood Disorders Flashcards

1
Q

What is mood?

A

Refers to patient’s sustained, experienced emotional state

Subjective - in patient’s own words, or objective as dysthymic (low) euthymic (normal) or elated

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is affect?

A

Transient flow of emotion in response to a particular stimulus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is a mood disorder?

A

Affective disorder

Any condition characterised by distorted, excessive or inappropriate moods or emotions for a sustained period of time

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is the ICD-10 classification of affective disorders?

A

Manic episode - hypomania, mania without psychotic symptoms or with them.
Bipolar affective disorder
Depressive episode
Recurrent depressive disorder
Persistent mood disorders - cyclothymia, dysthymia
Other mood disorders
Unspecified mood disorders

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is the classification of a mood disorder?

A

Primary - does not result from another medical or psychiatric condition. Either unipolar or bipolar

Secondary - results from another condition

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are causes of secondary mood disorders?

A

Physical e.g. anaemia, hypothyroidism, malignancy, MS
Psychiatric - schizophrenia, alcoholism, dementia, personality disorder
Drug-induced - corticosteroids, digoxin, antiepileptic drugs, antidepressants can induce mania

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is depressive disorder?

A

Affective mood disorder
Characterised by a persistent low mood, loss of pleasure and/or lack of energy
Accompanied by emotional, cognitive and biological symptoms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is the monoamine hypothesis?

A

That a deficiency of monoamines; NA, serotonin and dopamine causes depression.
Overactivity of the hypothalamic pituitary adrenal axis has also been linked to depression.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are the risk factors for depression?

A 
Bio:
- Low monoamines
- Being female
- Chronic health problem
Psycho
- Personality type
- Poor coping strategies
- Mental health co-morbidities
Social:
- Poor support network
- Stressful events
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is beck’s triad for depression?

A

Negative views about the world
Negative views about oneself
Negative views about the future

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are the core symptoms of depression?

A

Low mood
Lack of energy
Anhedonia - no pleasure in normally pleasurable activities

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are the other symptoms of depression?

A

Cognitive:

  • Suicidal ideation
  • Guilt/worthlessness
  • Lack of concentration

Biological:

  • Diurnal mood variation
  • Loss of appetite
  • Early morning wakening
  • Loss of libido
  • Psychomotor retardation

Psychotic:

  • 2nd person auditory hallucinations
  • Persecutory, nihilistic, guilt, hypochondriacal delusions
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

How long must symptoms be present for before considering a diagnosis of depression?

A

> 2 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are the DSM-IV (NICE guidelines) stages of depression?

A

Subthreshold: <5 symptoms
Mild: 5 symptoms with minimal functional impairment, 2 core, 2 other
Moderate: Somewhere between mild and severe, 2 core +3-4 other symptoms
Severe: Most symptoms with significant impairment
With psychosis - 3 core +>4 other and psychosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What differentials would you consider for depression?

A

Functional - bipolar, schizophrenia, seasonal affective disorder

Organic - drug use, dementia, hypothyroidism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

How is subthreshold and mild depression managed?

A

Watchful waiting with monitoring and sleep hygiene advice

Low intensity therapy: Self help, computerised CBT, group physical activity class

Group based CBT

Antidepressants if:

  • > 2 years
  • Past episode of severe
  • Physical health complications
  • Failure of other interventions
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

How is moderate-severe depression managed?

A

Suicide risk assessment
Psychiatry referral indicated if suicide risk is high, depression severe, recurrent depression or unresponsive to treatment

SSRI are first line e.g. citalopram
Other anti-depressants include tricyclic, SNRIs or monoamine oxidase inhibitors prescribed only by specialists
Should be continued for 6 months after resolution of first episode or 2 years after second

High intensity therapy: CBT, IPT, behavioural activation

ECT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

When is ECT used in depression?

A

Life threatening
Psychotic
Severe psychomotor retardation
Failure of other therapies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What are predisposing factors for depression?

A

Female gender
Neurochemical inbalance
Physical comorbidities
Past history of depression

Personality type
Poor coping strategies
Other mental health problems
Stressful life events
Lack of social support
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What are the precipitating factors to depression?

A 
Poor compliance with meds
Corticosteroids
Acute stressful life events
Unemployment
Poverty
Divorce
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What are the perpetuating factors to depression?

A

Chronic health problems e.g. diabetes, COPD, CF
Poor insight, negative thoughts - Beck’s triad
Alcohol and substance misuse
Poor social support and social status

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What is the mnemonic for risk factors of depression?

A

FF, AA, PP, SS

Female, family history
Alcohol, adverse events
Psst depression, physical co-morbidities
Social support, SE status

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What are the main symptoms of depression mnemonic?

A

DEAD SWAMP

Depressed mood
Energy loss
Anhedonia
Death thoughts

Sleep disturbance
Worthlessness/guilt
Appetite or weight change
Mentation - conc reduced
Psychomotor retardation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What can be extracted from the history when diagnosing depression?

A

Explore core symptoms - mood, still enjoy doing things, feel more tired or worn out
Explore cognitive symptoms - lack of concentration, negative thoughts, suicidal thoughts
Biological symptoms - mood worse at certain times of day, early morning wakening, low or restless, loss of libido

25
Q

What is seen in a MSE in depression?

A

Appearance - signs of self-neglect, thin, unkempt, tearful
Behaviour - poor eye contact, tearful, slow movements and responses
Speech - slow, reduced volume and tone
Mood - low and depressed
Thought - pessimistic, guilty, worthless, helpless, suicidal or delusional
Perception - second person auditory derogatory hallucinations
Cognition - impaired concentration
Insight - usually good

26
Q

What are the investigations for depression?

A

Diagnostic questionnaires e.g. PHQ-9, HADS, Beck’s triad

Bloods: FBC (anaemia) TFTs, U&Es, LFTs, calcium
Glucose - diabetes can cause anergia
Imaging - CT or MRI if presentation or examination is atypical, or features of intracranial lesion

27
Q

What are differentials for depression?

A

Other mood disorders e.g. bipolar, other depressive disorders
Secondary to physical condition e.g. hypothyroid
Secondary to psychoactive substance abuse
Secondary to other psychiatric disorder e.g. anxiety, adjustment disorder, personality disorder, ED
Normal bereavement

28
Q

What are other depressive disorders?

A

Recurrent depressive disorder - recurrent after first episode

Seasonal affective disorder - depressive episodes annually at same time each year, usually the winter

Masked depression - depressed mood not particularly prominent, other symptoms e.g. sleep disturbance present

Atypical

Dysthymia
Cyclothymia
Baby blues
Postnatal depression

29
Q

What is dysthymia?

A

Depressive state for >2 years which doesn’t meet depression criteria

30
Q

What is cyclothymia?

A

Mood fluctuations for >2 years where elation and depression do not meet criteria

31
Q

What is atypical depression?

A

Mild-moderate depression with reversal of biological symptoms: e.g. overeating, hypersomnia

32
Q

What is bipolar affective disorder?

A

Prev known as manic depression
Chronic episode mood disorder
Characterised by at least one episode of mania or hypomania and further episodes of mania or depression

33
Q

What is the pathophysiology of bipolar affective disorder?

A

Biological - genetic FH, neurochemical - increase in dopamine and serotonin, endocrine - increase in cortisol, aldosterone, thyroid

Environmental - adverse life events, exams, post partum period, loss of loved one

34
Q

What is the epidemiology and risk factors for bipolar?

A

Mean age onset 19 years
Incidence higher in UK in black and minority ethnic groups
Male:female is 1:1

AAA, SSS
Age in early 20s, anxiety disorders, after depression

Strong FH, substance misuse, stressful life events

35
Q

What can the severity of mania in bipolar be divided into?

A

Hypomania
Mania without psychosis
Mania with psychosis

36
Q

What are the symptoms of mania?

A

I DIG FASTER

Irritability

Distractibility, disinhibited - sexual, social, spending
Insight impaired, increased libido
Grandiose delusions

Flight of ideas
Activity/appetite increased
Sleep decreased
Talkative
Elated mood, energy increased
Reduced concentration, recklessness - behaviour and spending
37
Q

What is seen in hypomania?

A

Mildly elevated or irritable mood for >4 days
Symptoms of mania present to lesser extent than true mania
Not severe disruption to life
Partial insight may occur

38
Q

What is seen in mania without psychosis?

A

Symptoms like hypomania but to a greater extent
Symptoms last >1 weeks
Complete disruption to work or social activities
Grandiose and excessive spending could lead to debt
Sexual disinhibition
Reduced sleep may lead to exhaustion

39
Q

What is seen in mania with psychosis?

A

Severely elated mood
Suspicious mood
Addition of psychotic features - grandiose or persecutory delusions, auditory hallucinations
Patient may show signs of aggression

40
Q

What is the classification of bipolar?

A

Bipolar I - periods of severe mood episodes from mania to depression.

Bipolar II - milder form of mood elevation, milder episodes of hypomania alternating with severe depression

Rapid cycling - more than four mood swings in a 12 month period with no intervening asymptomatic periods, poor prognosis.

41
Q

What is the ICD-10 criteria for mania and bipolar affective disorder?

A

Mania requires 3/9 symptoms to be present - grandiosity, decreased sleep, pressure of speech, flight of ideas, distractability, psychomotor agitation, reckless behaviour, loss of social inhibitions, marked sexual energy.

Bipolar - need at least 2 episodes in which mood and activity significantly disturbed, one of which must be mania or hypomania

42
Q

How does the ICD-10 divide the state of bipolar?

A 
Currently hypomanic
Currently manic
Currently depressed
Mixed disorder
In remission
43
Q

What can be screened for in the history?

A

Always screen for mania in a depressed patient

How would you describe mood
Ever felt on top of the world
Too much energy compared to those around you
Able to concentrate on routine activities
Need less sleep, but not tired
Interest in sex changed?
New interests or new exciting ideas lately
Special abilities - grandiose
Afraid someone will harm you - persecutory delusions
Ask about family history

Not pressure of speech or flight of ideas

44
Q

What can be seen on MSE in a bipolar patient? if manic?

A

Appearance - flamboyant or unusual, heavy makeup, personal neglect if severe

Behaviour - overfamiliar, disinhibited, aggressive, distracted, restless

Speech - loud, pressure of speech, uninteruptable

Mood - elated, euphoric and/or irritable

Thought - optimistic, pressured, flight of ideas, tangeability, grandiose or persecutory delusions

Perception - no hallucination, mood-congruent auditory hallucinations may occur

Cognition - often impaired, fully orientated

Insight - generally very poor

45
Q

What are the investigations for bipolar?

A

Self rating scales - mood disorder questionnaire
Bloods - FBC, TFTs, U&Es, LFTs, glucose and calcium
Urine drug test - illicit drugs can cause manic symptoms
CT head to rule out SOL

46
Q

What are the differentials for bipolar?

A

Mood disorders e.g. hypomania, mania, cyclothymia
Psychotic disorders
Secondary to medical conditions
Drug related
Personality disorders e.g. histrionic, emotionally unstable

47
Q

What is a mnemonic for the management of bipolar?

A

CALMER

Consider hospitalisation
Antipsychotics
Lorazepam
Mood stabilisers e.g. lithium
Electroconvulsive therapy
Risk assessment
48
Q

What is the management of bipolar?

A

BIOLOGICAL
mood stabilisers, benzos, antipsychotics, ECT for severe uncontrolled manias

PSYCHOLOGICAL
Psychoeducation, CBT

SOCIAL
social support groups, self-help groups, encourage calming activities

Full risk assessment incl. suicidal ideation and risk to self
Ask about driving
Mental Health Act

49
Q

When should patients with an acute episode in bipolar be followed up?

A

Once a week initially

Then 2-4 weekly for the first few months

50
Q

When may hospitalisation need to be considered in bipolar disorder?

A

Reckless behaviour causing risk to others
Significant psychotic symptoms
Impaired judgement
Psychomotor agitation

51
Q

What is the pharmacological management of an acute manic episode?

A

First line - offer antipsychotic e.g. elanzapine, resperidone or quetiapine. rapid action of onset.

Mood stabilisers e.g. lithium or valproate second line

Benzos to aid sleep and agitation

Rapid tranquilisation with halloperidol or lorazepam

52
Q

What is the pharmacological management of bipolar depressive episode?

A

Atypical antipsychotics e.g. elanzapine combined with fluoxetine, elanzapine alone or quetiapine alone.

Mood stabilisers e.g. lamotrigine

Antidepressants usually avoided as potential to induce mania

53
Q

What is the long term pharmacological management of BPAD?

A

4 weeks after acute episode has resolved, lithium should be offered first line to prevent relapses.

If lithium ineffective, consider valproate. Olanzapine or quetiapine alternative options.

54
Q

What investigations need to be done before treatment with lithium is commenced?

A

U&Es - lithium has renal excretions
TFTs
Pregnancy status
ECG

55
Q

What are the side effects of lithium?

A

Narrow therapeutic window so drug levels need to be closely monitored

Polydipsia, polyuria, fine tremor
weight gain, oedema
Hypothyroidism
Impaired renal function
Memory problems
Teratogenicity in first trimester
56
Q

What are signs of lithium toxicity?

A

1.5-2 mmol/l - N+V, coarse tremor, ataxia, muscle weakness

Severe toxicity - >2mmol: nystagmus, dysarthria, hyperreflexia, oliguria, hypotension, convulsions and coma.

57
Q

How is the administration of lithium strictly regulated?

A

Lithium levels measured 12 hours following first dose, then weekly until therapeutic level of 0.5-1mmol has been stable for 4 weeks
Once stable check every 3 months

Measure U&Es every 6 months, TFTs every 12 months

Combination of lithium and sodium valproate for rapid cycling

58
Q

What is ECT?

A

Where a generalised seizure without muscular convulsions is electrically induced to manage mental disorders.

Typically 70-120 volts applied externally to patients head, 800 milliamperes of DC passed through brain for 100 milliseconds to 6 seconds duration, temple to temple (bilateral) or front to back (unilateral)

often have treatment twice a week, with few days between each session. On average 9-10 treatments.

59
Q

What are the risks of ECT?

A

Short term side effects - headache, aching in muscles and/or jaw, tiredness whilst effects of anaesthetic wear off
Confusion, sickness, nausea

Memory loss, gaps in memory

Some people have reported change in personality, loss of creativity, energy, lack of emotions

Mental Health (15 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions