Mood disorders Flashcards
What defines a mood disorder?
distorted, excessive or inappropriate moods or emotions for sustained period of time, causing impairment of daily living
*can be dysthymic, euthymic or elevated
What are some primary mood disorders?
unipolar - depression
bipolar
What are some causes of secondary mood disorders?
physical: anaemia, MS, hypothyroid
psychiatric: schizo, alcohol, dementia, PD
drug induced: BB, digoxin, steroids
What are the core symptoms of depression?
continuous low mood for at least 2 weeks
lack of energy
anhedonia
What are some somatic symptoms of depression?
early morning awakening
appetite and weight changes
psychomotor retardation or agitation
loss of libido
What are some cognitive (psychological) symptoms of depression?
low self esteem
guilt
hopelessness
hypochondriac thoughts
poor concentration
suicidal thoughts
how does ICD-10 diagnose depression?
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
What are some features of psychotic depression?
hallucinations: auditory second person, olfactory of nihilistic
delusions: hypochondriacal, guilt, nihilistic, persecutory, poverty
Differentiate between the baby blues and post-natal depression.
baby blues are a “normal” reaction as hormones adjust back usually 2-3 days after whereas PND is 1-2 months after
What are some risk factors for PND?
personal or FHx of depression
older age
single mother
unwanted pregnancy
poor social support
previous PND
What are some proposed theories of depression?
monoamine hypothesis - low NA, Sero, Dop
overactive HPA axis
personality type
stressful life events
substance misuse
What is hypomania?
mildly elevated mood/ irritable mood, lasting over 4 days with no severe disruption to life, partial insight preserved
What are some Sx of hypomania?
increased energy
increased self esteem sociable, talkative
increased sex drive
reduced need for sleep
difficulty focusing
What is Mania?
greater extent of hypomania lasting over 1w, complete disruption to life, showing grandiose ideas and sexual disinhibition and low sleep = loss of insight
What are some Sx of mania? (ICD-10)
grandiosity
low sleep
pressure of speech
flight of ideas
psychomotor agitation
reckless
low social inhibitions
sexual drive high
What counts as bipolar?
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
What is cyclothymia?
chronic mood fluctuations for 2 years, mild elation or depression without meeting ICD-10 criteria for bipolar
What is dysthymia?
chronic low mood not fulfilling depression criteria, at least 2 years
What is a mixed affective state?
mixture or a rapid alternation (within few hours) of hypomanic, manic and depressive sx
What are some differentials for mood disorders?
normal fluctuations
adjustment disorder
PTSD
dementia
PD
anxiety disorders
organic causes: anaemia etc
What are some pharmacological treatments for mood disorders?
- antidepressants: SSRI, SNRI, MAOI
- Mood stabilisers : lithium, vlaproate, lamotrigine
- combinations
*6m after resolution of first episode and 2 years after 2nd continue tx
What is the role in ECT in mood disorders?
triggering of epileptic seizures for severe depression (catatonic), prolonged mania, catatonia, high suicide risk, severe psychomotor retardation
What are some psychological treatments for mood disorders?
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
What are some Mx specifics for bipolar?
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
How is acute mania managed?
antipsychotic like olanzapine, risperidone, mood stabilisers like lithium, benzo to aid sleep, rapid tranquilliser with haloperidol
risk assessment
MHA
What is the follow up like for BPD?
- 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
What do you need to do before starting long term lithium?
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
What are some side effects of lithium?
polydipsia, polyuria
FINE tremor, weight gain
hypothyroidism, renal toxicity, memory problems and teratogenicity in 1st trimester
What are some signs of lithium toxicity?
N+V
COARSE tremor
ataxia
severe: nystagmus, dysarthria, hyper-reflexia, convulsions and coma
