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MB3 Psychiatry > Mood Disorders > Flashcards

Mood Disorders Flashcards

1
Q

why is there a decrease in depression in older patients

A

under-reporting

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2
Q

what is euthymia

A

normal mood

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3
Q

what is hyperthymia

A

elevated mood

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4
Q

what is cyclothymia

A

varied mood

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5
Q

what is dysthymia

A

persistent low mood

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6
Q

what is anhedonia

A

loss of enjoyment/pleasure

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7
Q

what is anergia

A

loss of energy

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8
Q

whast is stupor

A

absence of relational functions like action and speech

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9
Q

what is psychomotor retardation

A

subjective/objective slowing of thoughts/movement

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10
Q

MSE depression - appearance/behaviour?

A

reduced facial expression
furrowing of brows
reduced eye contact and gesturing
hard to establish rapport

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11
Q

MSE depression - mood?

A

associated with what pt describes

low, down, miserable, unhappy, sad, empty, black, numb

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12
Q

MSE depression - affect?

A

depressed, limited reactivity, emotional paralysis

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13
Q

MSE depression - thought?

A 
usually normal form 
flow may be slowed or absent 
may have delusion in content 
guilt, nihilism, hypochondriasis, poverty 
suicidal 
cotards syndrome
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14
Q

MSE depression - perception?

A

may have increased self referential thinking - people talking aobut them
hallucinations possible - 2nd person and derogatary

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15
Q

MSE depression - cognition?

A

slowed, often poor memory

pseudo-dementia

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16
Q

MSE depression - insight?

A

insight almost always preserved and aware of symptoms

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17
Q

MSE depression - speech?

A

reduced rate, pitch, intonation, volume

limited content

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18
Q

general criteria (not core) for the patient to meet a depression diagnosis

A

no evidence of mania
>2wks
must be clearly abnormal and severely impact function

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19
Q

core features of depression

A

at least 2/3
low mood and present almost every day for at least 2 weeks
low energy
loss of interest or pleasure in activities

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20
Q

additional features of depression

A 
need at least 4 
loss of confidence/self esteem 
feelings of guilt 
wishing to die 
difficulty in concentration 
change in psychomotor activity, either subjective/objective agitation/retardation 
sleep disturbance 
change in appetite
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21
Q

grading of severity of depression

A

moderate - 2 core symptoms and 4 others to give 6

severe - all 3 and 5 others to give 8

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22
Q

features fo psychotic depression

A

paranoid, mood congruent or hypochondriacal

cotards syndrome

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23
Q

what is cotards syndrome

A

nihilistic delusion in which the patient belives they are not alive or do not exist

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24
Q

what is disruptive mood dysregulation disorder

A

alterantive to bipolar disorder in children 6-18 and cannot be better explained by another disorder

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25
criteria for DMDD
``` Severe recurrent temper outbursts inconsistent with developmental level >3x per week persistently angry most of the day and nearly every day present more than >1yr with relief >3m ```
26
what is bipolar I
current or past episode of mania
27
what is bipolar II
current/past hypomanic episode with current/pasdt depressive episode
28
what is bipolar III
hypomanic episode following antidepressants
29
what is bipolar affective disorder
two or more episodes where mood/activity levels are significantly disturbed mania, hypomania or depression
30
distinguishing depression from bipolar
single episode mania/hypomania before depression is highly likely bipolar first episode mania/hypomania on background of recurrent depression means it is bipolar and no longer depression
31
criteria for hypomanic episode
``` present 4 consecutive days >/= 3 of the following increased activity/restless increased talkativeness difficulty concentrating decreased need for sleep increased libido mild spending spree/reckless and irresponsbile behaviour ```
32
criteria for manic episode
``` elevated/irritable mood and definitely abnormal at least 1 week unless needs admitted >/=3 of increased activity/restless talkativeness flight of ideas loss normal social inhibition decreased need for sleep grandiosity/inflated self esteem distractible reckless behaviour marked increase sexual energy ```
33
typical onset bipolar
20s | FHx implies lower sge onset
34
how much of the time are bipolar pts symptomatic
50% | 1/3 manic 2/3 depressed
35
poor outcomes BAD?
``` early onset poor SE status multiple comorbidity FHx rapid mood flux mixed presentation psychosis ```
36
true/false - genetic influence over mood disorders are polygenic
true
37
brain regions implicated in mood disorders?
``` orbitofrontal cortex ventromedial frontal cortex dorsolateral prefrontal cortex hippocampus amygdala anterior cingulate cortex ```
38
cognitive deficits associated with depression?
poor attention slow memory slow reaction time impaired planning
39
functions of the hippocampus
learning, cognition, HPA axis connection to amygdala for emotion and fear connection to prefrontal cortex for memory, cognition and mood
40
what parts of the brain are responsible for approaching and seeking behaviours and what is the principle neurotransmitter?
``` mesolimbic and cortical projections ventral and dorsal striatum amygdala anterior cingulate orbitofrontal cortex dopamine ```
41
what parts of the brain are responsible for defence and survival behaviours and what is the principle neurotransmitter?
``` central nucleus of amygdala hippocampus ventroanterior and medial hypothalamus periaqueductal grey matter 5-HT ```
42
ways of mood monitoring
IDS-30-SR QIDS MADRS mood diary
43
what is MADRS good for?
profound depression with little to no engagement
44
how to chose AD?
go for fewest side effect profiules first if person responds to drug or class stick with it match side effects to symptoms
45
top 4 ADs
escitalopram sertraline mirtazapine venlafaxine
46
what SSRI has a good cardiac safety profile
sertraline
47
what size effects does mirtazapine have and what side effects is it more protective of
promotes sleep and weight gain | less likely to cause nausea and sexual side effects
48
what choices to make if an AD isnt working?
``` check congruence increase dose swap medicine combine - often SSRI/SNRI and mirtazapine augment with Li or antipsychotic ```
49
how long to keep on AD for depression?
6m for first episode | 1-2yrs for 2nd episode
50
management of acute mania/hypomania
``` stop AD max antimanic dose admit if manic antipsychotic - olanzapine, quetiapine, risperdone OR Li, valproate, ECT, carbamazepine may need IM BZD may be indicated fo symptom control ```
51
management of acute bipolar depression
AD ONLY if with antimanic - valproate, Li or antipsychotic SSRI - fluoxetine preferred quetiapine, olanzapine, lurasidone
52
maintenance management of bipolar disorder
Li gold standard can give antipsychotics, lamotrigine (depressive), valproate (manic/hypomanic) psychoeducation
53
discuss monitoring of lithium?
serum Li, U&E, ECG, TFT, Ca, weekly then move to every 3-6m
54
true/false - in a pt woith hypothyroidism secondary to lithium you should discontinue Li
false - start levothyroxine
55
what may happen if an AD is given on its own to a pt with bipolar
it can precipitate a manic episode
56
what may an SSRI cause in the elderly?
hyponatraemia
57
administration of ECT?
2x weekly and usually inpatient general anaesthetic with muscle relaxant dose of electricity titrated to give seizure 15-30s seizure monitored with EEG and can be ceased with BZD
58
what gen anaesthetic is given for ECT and why can that pose an issue
propofol | can raise seizure threshold
59
what is needed to give ECT without consent
2nd independent dr opinion, unless in an emergency
60
physical side effects of ECT?
``` headache temp cognitive issues memory problems muscle ache confusion nausea cerebrovascular anaesthetic cardiovascular prolonged seizure ```
61
examples of psychological therapies
``` CBT behavioural activation CBASP acceptance and commitment therapy psychoeducation ```
62
what is personality and what are the 5 factors of persoanlity
``` relatively predictable patterns of thinking, feeling and behaving, consistent across time space and context openness conscientiousness extraversion agreeableness neuroticism ```
63
what is a disorder of personality
individual and characteristic pattern of experience deviating from culturally expected and accepted range pervasive, inflexible, distress and cannot be explained vt any other mental disorder
64
rating scales for persoanlity disorder
``` ZAN-BPD PAS PDQ-4 MMPI BDQ IPDE ```
65
diagnostic features of paranoid PD
>/= 4 excess sensitivity to setback tendency to bear grudge suspiciousness or misconstrued perception of friendly activity tenacious sense of personal rights recurrent suspicions of partners sexual fidelity persistent self referential attitude preoccupation with unsubstantiated conspiratorial events of world at large
66
diagnostic features of schizoid PD
``` >/= 4 little/no activities give pleasure flat affect or emotional coldness struggle/unable to show warm feelings little interest in sexual experiences with others solitary activities indifferent to praise/critisism excess preoccupation with fantasy/introspection insensitive to prevailing social norms ```
67
diagnostic features of schizotypal PD
``` >/= 5 ideas of reference odd thinking, magical thinking unusual perceptual experiences odd thinking/speech suspicious/paranoid ideation inappropriate/constricted affect odd, eccentric or peculiar behaviour lack of close friends or confidants excess social anxiety, associated with paranoia and not diminishing with familiarity ```
68
diagnostic features of dissocial PD
>/= 3 unconcern for feelings of others irresponsible and disregard for social norms low tolerance to frustration, aggression and violence incapacity to experience guilt, or to profit from adverse experience proneness to blame others
69
diagnostic features of impulsive EUPD
>/= 3 acting unexpectedly without considering consequences quarrelsome and conflicts with others outburst of action/violence difficulty maintaining course that offers no immediate reward unstable mood
70
diagnostic features of borderline EUPD
``` >/= 2 impulsive and >/= further of disturbed, uncertain self image intense and unstable relationships excess effort to avoid abandonment chronic emptiness recurrent threats or acts of self harm ```
71
diagnostic features of histrionic PD
>/= 4 self dramatisation and theatricality suggestible shallow, labile affect seeking activities where subject is feature of attention inappropriately seductive in appearance/behaviour overly concerned with physical attractiveness
72
diagnostic features of anxious PD
>/= 4 pervasive feelings of tension/apprehension belief oneself is inferior to others excess preoccupation about criticism/rejection in social situation unwilling to get involved unless certain of being liked restricted lifestyle avoidance of activities that have significant interpersonal contact due to rejection, disapproval
73
diagnostic features of dependent PD
>/= 4 encouraging/allowing others to make their important life decision subordination of ones own needs to those of other on whom they are dependent unwilling to make reasonable demands on one depends on feeling uncomfortable/helpless when alone preoccupation with fears of being left to take care of themselves limited capacity to make everyday decisions without excessive advice or reassurance
74
diagnostic features of anankastic PD
>/= 4 excess doubt/caution preoccupied with details, rules, list, order perfectionism excess conscientiousness rigid/stubborn excess adherence to social convention undue preoccupation with productivity leading to exclusion of pleasure and relationships unreasonable insistence that others submit to their way of doing things
75
diagnostic features of narcissistic PD
>/= 5 grandiose self importance fantasies of infinite success, control or brilliance belief they are extraordinary or belief they can only be understood by others of same desire for unwarranted admiration sense of entitlement interpersonal oppressive behaviour resentment of others who are resentful of them egotistical behaviour/attitude
76
when may low dose antipsychotic be good for PD? what type?
can help paranoid BPD reduce suspiciousness in schizoid, paranoid or schizotypal haloperidol, quetiapine, olanzapine
77
when may AD be of benefit in PD
dissocial, emotionally unstable, histrionic and narcissistic mood difficulty reduce anxiety in anankastic, avoidant and dependent
78
when may mood stablisers be of use in PD
lamotrigine | mood and impulsivity in EUPD and BPD
79
first and second line therapies for impulse control
first - SSRI | 2nd - olanzapine, valproate, carbamazepine, low dose antipsychotic
80
first, second, third line therapies for affective dysregulation
1st - SSRI/mirtazapine 2nd - alternative SSRI/mirtazapine 3rd - low dose antipsychotic, valproate, carbamazepine, olanzapine
81
therapies for cognitive perceptual symptoms
low dose antipsychotic
82
pharmacological mx of interpersonal difficulties
none, it would be inappropriate
83
management of dissocial PD
group based psychological therapies
84
psychological therapies for EUPD
dialectal behavioural therapy mentilisation based therapy STEPPS
85
when to admit for EUPD
acute increase suicidal risk use carefully as can cause harm crisis plan
86
pharmacological therapies for EUPD
lamotrigine topiramate AD if needed antipsychotics

MB3 Psychiatry (16 decks)

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