Mood disorders

Question 1

What defines a mood disorder?

Answer 1

distorted, excessive or inappropriate moods or emotions for sustained period of time, causing impairment of daily living
*can be dysthymic, euthymic or elevated

Question 2

What are some primary mood disorders?

Answer 2

unipolar - depression
bipolar

Question 3

What are some causes of secondary mood disorders?

Answer 3

physical: anaemia, MS, hypothyroid
psychiatric: schizo, alcohol, dementia, PD
drug induced: BB, digoxin, steroids

Question 4

What are the core symptoms of depression?

Answer 4

continuous low mood for at least 2 weeks
lack of energy
anhedonia

Question 5

What are some somatic symptoms of depression?

Answer 5

early morning awakening
appetite and weight changes
psychomotor retardation or agitation
loss of libido

Question 6

What are some cognitive (psychological) symptoms of depression?

Answer 6

low self esteem
guilt
hopelessness
hypochondriac thoughts
poor concentration
suicidal thoughts

Question 7

how does ICD-10 diagnose depression?

Answer 7

mild = 2 core+ 2 other
moderate = 2 core and 3-4 others
severe = 3 core+ 4 or more others
severe + psychosis = 3 core + over 4 others + psychosis

Question 8

What are some features of psychotic depression?

Answer 8

hallucinations: auditory second person, olfactory of nihilistic
delusions: hypochondriacal, guilt, nihilistic, persecutory, poverty

Question 9

Differentiate between the baby blues and post-natal depression.

Answer 9

baby blues are a “normal” reaction as hormones adjust back usually 2-3 days after whereas PND is 1-2 months after

Question 10

What are some risk factors for PND?

Answer 10

personal or FHx of depression
older age
single mother
unwanted pregnancy
poor social support
previous PND

Question 11

What are some proposed theories of depression?

Answer 11

monoamine hypothesis - low NA, Sero, Dop
overactive HPA axis
personality type
stressful life events
substance misuse

Question 12

What is hypomania?

Answer 12

mildly elevated mood/ irritable mood, lasting over 4 days with no severe disruption to life, partial insight preserved

Question 13

What are some Sx of hypomania?

Answer 13

increased energy
increased self esteem sociable, talkative
increased sex drive
reduced need for sleep
difficulty focusing

Question 14

What is Mania?

Answer 14

greater extent of hypomania lasting over 1w, complete disruption to life, showing grandiose ideas and sexual disinhibition and low sleep = loss of insight

Question 15

What are some Sx of mania? (ICD-10)

Answer 15

grandiosity
low sleep
pressure of speech
flight of ideas
psychomotor agitation
reckless
low social inhibitions
sexual drive high

Question 16

What counts as bipolar?

Answer 16

I - at least 2 episodes where mood and activity are disturbed1 or more manic episodes or mixed with 1 or more depressive episodes
II - 1 more more depressive episodes with at least 1 hypomanic episode
ICD 10 - at least 2 episodes, 1 hypomanic, manic or mixed

Question 17

What is cyclothymia?

Answer 17

chronic mood fluctuations for 2 years, mild elation or depression without meeting ICD-10 criteria for bipolar

Question 18

What is dysthymia?

Answer 18

chronic low mood not fulfilling depression criteria, at least 2 years

Question 19

What is a mixed affective state?

Answer 19

mixture or a rapid alternation (within few hours) of hypomanic, manic and depressive sx

Question 20

What are some differentials for mood disorders?

Answer 20

normal fluctuations
adjustment disorder
PTSD
dementia
PD
anxiety disorders
organic causes: anaemia etc

Question 21

What are some pharmacological treatments for mood disorders?

Answer 21

• antidepressants: SSRI, SNRI, MAOI
• Mood stabilisers : lithium, vlaproate, lamotrigine
• combinations

*6m after resolution of first episode and 2 years after 2nd continue tx

Question 22

What is the role in ECT in mood disorders?

Answer 22

triggering of epileptic seizures for severe depression (catatonic), prolonged mania, catatonia, high suicide risk, severe psychomotor retardation

Question 23

What are some psychological treatments for mood disorders?

Answer 23

psychoeducation for pt and family
CBT
IPT (interpersonal therapy) for relationship problems
social support - finances, job housing etc
mindfulness
psychodynamic therapy to understand pt dynamics

Question 24

What are some Mx specifics for bipolar?

Answer 24

risk assessment
ask about driving
MHA - reckless behaviour, risk to others, psychosis, impaired judgement, psychomotor agitation
medication: atypical like olanzapine, lamotrigine for mood stable, antidepressants in combo with anti-manic cover

Question 25

How is acute mania managed?

Answer 25

antipsychotic like olanzapine, risperidone, mood stabilisers like lithium, benzo to aid sleep, rapid tranquilliser with haloperidol

risk assessment

MHA

Question 26

What is the follow up like for BPD?

Answer 26

• acute: once a week then 2-4 weekly for first few months
• 4 weeks after acute mania resolved, lithium offered to prevent relapse, if not valproate, olanzapine or quetiapine

Question 27

What do you need to do before starting long term lithium?

Answer 27

U&E
TFT
pregnancy
ECG baseline
closely monitor lithium levels as narrow therapeutic window –> 12h after first dose, then weekly until stable for 4 weeks, then every 3m

Question 28

What are some side effects of lithium?

Answer 28

polydipsia, polyuria
FINE tremor, weight gain
hypothyroidism, renal toxicity, memory problems and teratogenicity in 1st trimester

Question 29

What are some signs of lithium toxicity?

Answer 29

N+V
COARSE tremor
ataxia
severe: nystagmus, dysarthria, hyper-reflexia, convulsions and coma