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Mood disorders Flashcards

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1
Q

What are mood (affective) disorders

A

Fluctuations in mood severe enough to cause impairment to activities of daily living

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2
Q

What are the 3 characteristic features of depressive disorder

A

Low mood

Loss of pleasure (anhedonia)

Lack of energy

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3
Q

What are the predisposing factors for depressive disorder

A

Biological
- Female, postnatal period, genetics, neurochemical (low serotonin/dopamine), increased HPA activity, physical co-morbidity, PMH

Psychological
- Personality type, failure of effective stress control, poor coping strategies, mental health co-morbidities

Social
- Stressful life event, lack of social support, asylum seekers, refugees

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4
Q

What are the precipitating factors for depressive disorder

A

Biological
- Poor compliance, corticosteroids

Psychological
- Acute stressful life event

Social
- Unemployment, poverty, divorce

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5
Q

What are the perpetuating factors for depressive disorder

A

Biological
- Chronic health conditions

Psychological
- Poor insight, negative thoughts

Social
- Substance misuse, poor social support, lack of social status

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6
Q

What is the epidemiology of depressive disorder

A

1 in 20 adults every year

Most common in men in 40s, women in 30s

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7
Q

What are the risk factors for depressive disorder

A

Female

Family history

Alcohol

Adverse life event

Past history

Physical co-morbidity

Lack of social support

Lack of socioeconomic status

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8
Q

What are the cognitive symptoms of depressive disorder

A

Lack of concentration

Negative thoughts (about self/world/future)

Excessive guilt

Suicidal ideation

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9
Q

What are the biological symptoms of depressive disorder

A

Diurnal variation in mood (worse in morning)

Early morning wakening (2 hours before normal)

Loss of libido

Psychomotor retardation

Weight loss

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10
Q

What are the potential psychotic symptoms of depressive disorder

A

Hallucinations
- Usually 2nd person auditory

Delusions
- Usually hypochondriacal, guilty, nihilistic, persecutory

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11
Q

What is the ICD-10 classification for the severity of depression

A

Mild
- 2 core + 2 other

Moderate
- 2 core + 3-4 other

Severe
- 3 core + >4 other

Severe depression with psychosis

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12
Q

What investigations are needed in depressive disorder

A

Diagnostic questionnaires
- PHQ-9, HADS, Beck’s depression inventory

Bloods
- FBC, TFTs, U&Es, LFTs, calcium, glucose

Imaging
- CT/MRI head

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13
Q

What are the differential diagnoses for depressive disorder

A

Bipolar affective disorder

Seasonal affective disorder

Psychotic disorders

Anxiety disorders

Personality disorders

Eating disorders

Dementia

Hypothyroidism

Substance abuse

Normal bereavement

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14
Q

What is the management for depressive disorder based on the bio-psycho-social model

A

Biological
- Antidepressants, adjuvants (antipsychotics), ECT

Psychological
- Psychotherapy, self-help programmes, physical activity

Social
- Support groups

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15
Q

What is the management for mild-moderate depression

A

Watchful waiting (2 weeks)

Antidepressants (not first line)

Self-help programmes

CBT

Physical activity programmes

Psychotherapy

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16
Q

What is the management of moderate-severe depression

A

Assess suicide risk

Consider implementing mental health act

Antidepressants (SSRIs first line)

Adjuvants (lithium, mood stabilisers)

Psychotherapy

Social support

ECT

17
Q

How long should antidepressants be taken in moderate-severe depression

A

6 months after resolution of 1st episode

2 years after resolution of 2nd episode

Long-term for recurrent episodes

18
Q

What are the indications for ECT

A

Life-threatening depression

Rapid response needed

Psychotic features

Severe psychomotor retardation

Failure of other treatments

19
Q

What is bipolar affective disorder

A

Chronic episodic mood disorder

At least one episode of mania, then an episode of mania/depression

20
Q

What is the pathophysiology of bipolar affective disorder

A

Biological
- Genetics, neurochemical (high dopamine/serotonin), endocrine (high cortisol/aldosterone/thyroid function)

HPA axis dysfunction

21
Q

What are the epidemiological and risk factors for bipolar affective disorder

A

Lifetime risk 1-3%

Mean age on onset: 19

Black/ethnic minority groups

M=F

Substance misuse

22
Q

What are the symptoms of bipolar affective disorder

A

I DIG FASTER

  • Irritability
  • Distracted/disinhibited
  • Impaired insight
  • Grandiose delusions
  • Flight of ideas
  • Appetite increase
  • Sleep decreased
  • Talkative (pressure of speech)
  • Elated mood/energy increase
  • Reduced concentration/recklessness
23
Q

How may the severity of bipolar affective disorder be classified

A

Hypomania

Mania without psychosis

Mania with psychosis

24
Q

What is hypomania

A

Mildly changed mood for >4 days

Mild symptoms of mania

No severe disruption to work/social life

May have partial insight

25
Q

What is mania without psychosis

A

Symptoms for >1 week

Very elated mood

Complete disruption to work and social life

May have grandiose ideas

Sexual disinhibition

Reduced sleep

26
Q

What is mania with psychosis

A

Severely elated mood

Psychotic features

  • Grandiose or persecutory delusions
  • Auditory hallucinations

May be aggressive

27
Q

What are the classifications of bipolar affective disorder

A

Bipolar 1
- Periods of severe episodes of mania and depression

Bipolar 2
- Milder form of mood elation, severe depression

Bipolar 3

  • > 4 mood swings in 12 months
  • Poor prognosis
28
Q

What investigations are needed for bipolar affective disorder

A

Mood disorder questionnaires

Bloods
- FBC, TFTs, U&Es, LFTs, glucose, calcium

Urine drug test

Consider CT head

29
Q

What are the differential diagnoses for bipolar affective disorder

A

Mood disorders

Psychotic disorders

Secondary to medical condition

Drug-related

Personality disorder

30
Q

What is the management of bipolar affective disorder based on the bio-psycho-social model

A

Biological
- Mood stabilisers, benzodiazepines, antipsychotics

Psychological
- Psychoeducation, CBT

Social
- Support groups, self-help groups, encourage calming activities, consider driving

Need full risk assessment

ECT (if all else fails)

31
Q

What is the pharmacological management for an acute manic/mixed episode in bipolar affective disorder

A

First line
- Antipsychotics (olanzapine, risperidone, quetiapine, haloperidol), can add a second

Mood stabilisers
- Lithium, valproate

Benzodiazepines
- Aid sleep, reduce agitation

Rapid tranquilisation
- Haloperidol, lorazepam

32
Q

What is the pharmacological management for a depressive episode in bipolar affective disorder

A

Atypical antipsychotics
- Olanzapine, quetiapine

Mood stabilisers
- Lamotrigine, lithium

Avoid antidepressants
- If used, also give anti-mania medication

33
Q

What is the long term management for bipolar affective disorder

A

Lithium

  • 1st line for preventing relapses
  • Start 4 weeks after episode has resolved

If lithium not working
- Valproate, olanzapine, quetiapine

Psych (11 decks)

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