Mood Disorders

Question 1

What are the different categories of mental illnesses and some examples

Answer 1

Anxiety
>Panic disorder, GAD, OCD and Acrophobia

Affective:
>Major disorder, Bipolar disorder and dysthymia

Psychosis
> Schizophrenia and Schizoaffective

Question 2

What are the two broad categories of affective disorder

Answer 2

1. Only depressive symptoms that has
2. oscillation between depression and manic symptoms

Question 3

What is depression

Answer 3

Sadness
Feeling of worthlessness and guilt (that they might be a bother to others)
Changes in sleep and appetite

Question 4

What is mania

Answer 4

It is abnormal elevated mood
>intense elation irritability
>hyperactivity, talkativeness, distractability

Question 5

How can depression be diagnosed

Answer 5

DSM-5: SIG: E caps
>Must be over 2 weeks
>Must not be due to bereavement but but can lead to depression
> must have 5 of the following symptoms
S Sleep
I Interest
G: Guilt
E Energy
C Concentration
A Appetite
P Psychomotor retardation
S Suicidality

Question 6

What are physical symptoms that can manifest due to depression

Answer 6

sadness: Vague aches and pains
Loss of interest: headaches
Overwhelmed: sleep disturbances
Anxiety: fatigue
Diminished interest: back pain
guilt : change in appetite leading to weight loss or gain

Question 7

What is Bipolar disorder

Answer 7

It is a episodes of depression alternating with mania

Question 8

What are the hypomania

Answer 8

Symptoms of mania but less intense
>Four or more days of elevated mood
>Doesn’t interfere with functioning
>Hypomania alone is not a DSM diagnostic category

Question 9

What are the DSM-5 criteria for mania and hypomanic episodes

Answer 9

> Elevated, explosive or irritable mood + 3 of the following:
- Psychomotor agitation or increase in goal-directed behaviour
-Excessive talking or pressured speech
-Flights of ideas; racing thoughts
-Reduced need for sleep
-Grandiosity or inflated self esteem
-Easily distractible
-Excessive involvement in pleasurable activities with negative consequences
Manic episode:
- last for 1 week or requires hospitalisation
-causes significant distress or functional impairment
Hypomanic episodes
-lasts at least 4 days
-clear changes in functioning

Question 10

List some subtypes of depression and BP

Answer 10

SAD: mostly winter
Postpartum: within 4 weeks of birthing
Melancholic: inability to experience pleasure

Question 11

what is the pathophysiology behind MMD

Answer 11

Genetics: MMD clusters in families
> heritability is 35%

Environment
hormones
Brain chemicals
Brain region
Immune systems

Question 12

What are the main NT involved in the etiology depression

Answer 12

Serotonin and Norepinephrine
> low levels of NA and 5-HT

Question 13

What are the main classes of medicines used to treat depression

Answer 13

1. Tricyclic antidepressants
2. SS/NRIs
   3.Monoamine oxidase inhibitors (MAOIs)

Question 14

What are the stages the treatment regimen for depression

Answer 14

1. Remission
2. Maintenance: prevent relapse
3. Prophylaxis: avert recurrence after remission

Question 15

List some TCAs

Answer 15

Clomipramine
Amitriptyline
Doxepin
Imipramine
Desipramine

Question 16

Which other conditions alongside with depression are TCAs preferred

Answer 16

Pain
Fibromyalgia
migraine
Insomnia

Question 17

Which other conditions alongside with depression are least TCAs preferred

Answer 17

patients with which anticholinergic effects would be harmful- Prostatic hypertrophy
Overweight patients
Suicidal patients
Cardiac patients
patients with dementia

Question 18

What are the adverse effects of TCAs

Answer 18

mACh receptor antagonist: atropine like side-effects

Histamine H1 antagonist: drowsiness and sedation, weight gain

antagonist activity: postural hypertension, syncope in some Pts and sendation

Question 19

Which TCAs should be avoided in the elderly

Answer 19

Those that have excessive sedative properties
> Amitriptyline
>Doxepin

Question 20

What can overdose of TCAs lead to

Answer 20

Confusion, convulsion, tachycardia, hypotension, ventricular arrhythmia (death)

Suicide- one the main reasons it is not the first line

Question 21

How is TCA overdose treated

Answer 21

Remove remaining drug in the stomach
Anticonvulsant agent- diazepam
Antiarrhythmic drugs and cardiac support

Question 22

How long do SSRIs take before they have significant clinical affect

Answer 22

4-6 weeks
Side effects may dissuade patients compliance

Question 23

What advantages do SSRIs have over TCAs and MAOIs

Answer 23

Better tolerated
Less anticholinergic and cardiovascular side effects
Low acute toxicity

Question 24

List some SSRIs

Answer 24

Fluoxetine (Prozac)
Paroxetine (Paxil)
Sertraline (Zoloft)
Fluvoxamine (Luvox)
Citalopram (Celexa)
Escitalopram (Lexapro)

Question 25

what are the uses of SSRIs

Answer 25

Depression
Social phobia
Panic disorder
Obsessive compulsive disorder
Bulimia Nervosa
Post Traumatic Stress Disorder
Pre Menstrual Dysphoric Disorder (Sarafem)

Question 26

In which patients are SSRIs not preferred

Answer 26

Sexual dysfunction
Nocturnal myoclonus- repetitive jerking of lower limbs during sleep
Consistent agitation
Consistent insomnia

Question 27

What are the adverse effects of SSRIs

Answer 27

GI: N/V/D
sexual dysfunction
Some anticholinergic effects
Headaches
Insomnia
Long-term weight gain
fatigue

Question 27

What are the adverse effects of SSRIs

Answer 27

GI: N/V/D
sexual dysfunction
Some anticholinergic effects
Headaches
Insomnia
Long-term weight gain
fatigue
Akathisia and dystonic reaction

Question 28

What is serotonin syndrome

Answer 28

Altered mental state- confusion, agitation
Autonomic dysfunction- diaphoresis, tachycardia, Bp change, fever
Neuromuscular abnormalities