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Year 4 - 2. Psychiatry > Mood disorders > Flashcards

Mood disorders Flashcards

1
Q

State the 3 types of mood disorder

A
  1. Depressive disorder
    - Single
    - Recurrent episodes
  2. Bipolar disorder
    - Mania
    - Hypomania
    - Mixed
  3. Persistent mood disorder
    - Cyclothymia (mixed hypomanic and depressive symptoms, does not reach threshold for bipolar)
    - Dysthymia (milder form of depression, not meeting threshold)
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2
Q

State the 3 core symptoms of depression

A
  • Continuous low mood for at least 2 weeks
  • Low energy
  • Anhedonia (lack of interest / enjoyment)
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3
Q

State some somatic symptoms of depression

A
  • Diurnal variation of mood
  • Sleep changes (early morning wake cycle)
  • Appetite change (typically reduced)
  • Weight change (typically loss)
  • Psychomotor retardation
  • Loss of libido
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4
Q

State some cognitive symptoms of depression

A
  • Poor concentration
  • Low self esteem
  • Guilt / hopelessness
  • Hypochondriacal thoughts
  • Suicidal thoughts
  • Negative thoughts
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5
Q

How is severity of depression diagnosed based on symptoms

A

Mild if:
- 2 core symptoms
- 2 ‘other’ symptoms
- Able to function

Moderate:
- 2 core symptoms
- 3-4 other symptoms

Severe:
- 3 core symptoms
- 4+ other symptoms
+/- psychotic symptoms

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6
Q

State 2 additional symptoms that can present in psychotic depression and what type they are

A
  1. Hallucinations
    - Often auditory
  2. Delusions
    - Guilt
    - Nihilistic
    - Persecutory
    - Hypochondriacal
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7
Q

List some risk factors for postnatal depression

A

Mental health related:
- Previous postnatal depression
- Personal history of depression
- Family history of depression

Other:
- Older age
- Single mother
- Unwanted pregnancy
- Poor social support

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8
Q

State the prevalence of moderate-severe depression in the UK and the M:F ratio

A

Approx. 1 in 6 have moderate-severe depression

M:F ratio 1:2 (twice as many females as males)

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9
Q

State the prevalence of bipolar affective disorder in the UK and the M:F ratio

A

Approx. 1 in 50 = 2%
Average onset 19 years
Higher in black / minority ethnic groups

Equal M:F ratio (1:1)

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10
Q

State how hypomania differs from mania

A

Hypomania and mania are both periods of over-active and high energy behaviour

However hypomania is:
- milder in terms of symptoms
- typically lasts for a shorter period
- doesn’t cause severe disruption to their life (but can cause considerable disruption still)
- may have partial insight
- less likely to have delusions

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11
Q

List some symptoms of hypomania

A
  • Mildly elevated mood / irritable mood
  • Increased energy
  • Reduced need for sleep
  • Increased libido
  • Increased self esteem / self importance
  • Inability to focus on single task / distractible
  • Increased sociability / talkativeness / overfamiliarity
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12
Q

List some symptoms of mania

A

ICD 10 requires 3/9 to be present for diagnosis

  • Elevated mood / irritable mood
  • Increased energy
  • Reduced need for sleep
  • Increased libido
  • Increased self esteem / self importance
  • Distractibility
  • Restlessness / psychomotor agitation

Additional for mania:
- Pressure of speech (can’t be interrupted)
- Flight of ideas
- Delusions of grandeur
- Loss of inhibitions
- Reckless behaviour

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13
Q

Explain cyclothymia

A

Milder form of bipolar disease, not meeting threshold
- Mild periods of elation / depression
- Early onset
- Chronic course
- Common in relatives of bipolar disorder

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14
Q

Explain dysthymia

A

Milder form of depression, not meeting threshold
- More mild depression
- Chronicly low mood

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15
Q

Explain mixed affective state

A

Characterised by a mixture of rapid alternation between: hypomanic, manic and depressive symptoms (typically within a few hours)
- Considered a subtype of bipolar disorder

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16
Q

Explain how bipolar disorder is classified

A

Requires at least one mania (or hypomania) episode, with at least one further episode of mania or depression

Bipolar type 1:
- Manic episode with further manic or depressive episodes

Bipolar type 2:
- Multiple hypomanic episodes (not manic)
- Multiple depressive episodes

ICD-10 requires at least 2 episodes, of which 1 must be manic or hypomanic

17
Q

List some biological, psychological and social risk factors for depression

A

Biological:
- Genetic
- Previous depression
- Female gender
- Chronic physical illness

Psychological:
- Personality type
- Poor coping strategies
- View of self and the world

Social:
- Stressful life event
- Adverse childhood experiences
- Poor social support
- Lack of employment
- Poor socioeconomic status
- Housing / poverty

18
Q

List some biological and environmental causes for bipolar disorder

A

Biological:
- Genetic
- Endocrine or neurochemical disturbance e.g. disruption of HPA axis

Environmental:
- Adverse life events
- Stressful events
- Loss of loved one
- Postpartum period
- Substance misuse

19
Q

State general bio-psycho-social management options for depression

A

Biological:
- Antidepressants
- Adjuvants e.g. antipsychotics or mood stabilisers, anti-anxiolytics
- ECT if severe, life-threatening or resistant
- Physical activity

Psychological:
- Psychotherapies e.g. CBT, interpersonal therapy, counselling, psychodynamic therapy

Social:
- Social support groups

20
Q

State how bio-psycho-social management options for depression changes for mild-mod depression and severe depression

A

Biological:
- Generally don’t use SSRIs as first line in mild-mod depression (first line in severe, +/- adjuvants)
- Group physical activity groups in mild-mod
- ECT considered only in severe

Psychological:
- Self-help programmes as first line mild-mod (don’t consider in severe)
- Computerised CBT, with psychotherapies down the line in mild-mod (straight to more personalised psychotherapies)

Social:
- Social support groups same for both
- Consider psychiatry referral / MHA in severe

21
Q

Explain the monoamine hypothesis

A

States that a deficiency of monoamines (NA, serotonin and dopamine) causes depression
- Supported by antidepressants cause an increase in concentration of these neurotransmitters in the synaptic cleft
- This then improve the clinical features of depression

22
Q

State some drugs from the following categories that can be used in the pharmacological management of depression
- Antidepressants (types not names)
- Mood stabilisers (names)

A

Antidepressants:
- SSRIs
- SNRIs
- TCAs
- MAOIs
- Noradrenaline and specific serotonergic antidepressants (NASSAs)

Mood stabilisers:
- Lithium
- Sodium valproate
- Carbamazepine
- Lamotrigine

23
Q

Briefly outline how ECT works (as if explaining to a patient)

A
  • Treatment involves sending an electric current through the brain
  • Causes a brief surge of electrical activity within your brain (seizure)

Aim is to relieve severe symptoms of some mental health problems

24
Q

List some indications for electroconvulsive therapy (ECT) in mood disorders

A
  • Severe treatment-resistant depressive illness
  • Life threatening illness
  • Prolonged / severe manic episodes
  • Catatonia (abnormal movements) / stupor / severe psychomotor retardation
25
Q

List some side effects for electroconvulsive therapy (ECT)

A

Most common (similar to after natural epileptic attack):
- Confusion
- Headache
- Body aches

  • Memory loss (short term and long term)
  • General anaesthetic risks e.g. MI, arrhythmias, malignant hyperthermia, broken teeth etc.
26
Q

Suggested the prognosis of depression

A

80% have further depressive episode
10% severe unremitting depression

27
Q

Suggest some factors that may indicate a poor prognosis for bipolar disorder

A
  • Early onset (young at first episode)
  • Severe symptoms
  • Late treatment intervention
  • Cognitive deficits
28
Q

Explain how you diagnose someone with bipolar / how long should each symptom be present for (mania and hypomania)

A

Exclude organic causes (but depending on presenting symptoms):
- Physical examination including neurological examination / CT head
- Baseline bloods
- HIV
- Toxicology screen

Referral to specialist team:
Bipolar disorder should be considered when there is evidence of:
- Mania (at least 7 days)
- Hypomania (at least 4 days)
- Depression with a history of manic or hypomanic episodes

29
Q

State the normal range of lithium

A

Ideally between 0.6 - 0.8 mmol/L

  • Minimum effective level = 0.4mmol/L
  • Up to 1.0mmol/L may be
    used in treating acute mania
  • Toxic effects reliably occur above 1.5mmol/L
30
Q

State some symptoms and signs of lithium toxicity

A
  • Diarrhoea
  • Vomiting
  • Muscle weakness / lethargy / drowsiness
  • Dizziness
  • Tinnitus / blurred vision
  • Coarse tremor of the extremities and jaw
  • Dysarthria
31
Q

State some routine investigations that can be done for individuals presenting with mood disturbances (depression or mania)

A
  • FBC for anaemia
  • Thyroid function tests for hypothyroidism
  • U&Es for calcium levels
  • Toxicology screen (substance misuse)
  • Sleep studies (sleep apnoea)
    Consider CT/MRI if atypical presentation or unexplained symptoms e.g. headache
32
Q

State bio-psycho-social management options for bipolar affective disorder

A

Biological:
- Mood stabilisers e.g. Lithium (sodium valproate 2nd line)
- Antipsychotics
- Benzodiazepines
- ECT if severe, uncontrolled mania

Psychological:
- Psychoeducation and calming activities
- Cognitive-Behavioral Therapy (CBT) or Interpersonal therapy

Social:
- Social support groups
- Self help groups

33
Q

State the management options for an acute manic episode

A

First-line: antipsychotic e.g. Risperidone, Olanzapine or Quetiapine (Haloperidol is also effective) - have a rapid onset of action compared to mood stabilisers

  • Mood stabilisers can be added as second line e.g. Lithium or Sodium Valproate
  • Benzodiazepines can be added if agitation and poor sleep
  • Rapid tranquilisation may be required with Haloperidol or Lorazepam
    Consider admission to psychiatric unit
34
Q

State the management options for an acute depressive bipolar episode

A
  • Atypical antipsychotics e.g. Olanzapine or Quetiapine
  • Mood stabilisers can be used e.g. Lamotrigine or Lithium

**Avoid antidepressants (risk of causing mania)

35
Q

State tests that need to be done prior to initiating Lithium

A
  • U&Es to check renal function (for Lithium excretion)
  • Thyroid function levels
  • Pregnancy test
  • Baseline ECG
36
Q

State the number of hours after Lithium dose should levels be tested

A

Blood test 12 hours after Lithium has been taken

37
Q

List some complications of depression

A
  • Suicide (4 Xs higher than without depression)
  • Substance misuse & alcohol use problems
  • Persistent of symptoms over 2 years
  • Recurrence of depressive episodes (majority will have future episodes)
  • Reduced quality of life / strained relationships
  • Unemployment / homelessness
  • Antidepressant side effects e.g. sexual dysfunction, risk of self-harm, weight gain, hyponatraemia and agitation
38
Q

List some complications of bipolar disorder

A
  • Suicide
  • Risk of death by general medical conditions e.g. CVS disease
  • Side effects of antipsychotic drugs e.g. metabolic effects, weight gain and extrapyramidal symptoms
  • Negative drift down socioeconomic ladder

Year 4 - 2. Psychiatry (12 decks)

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