Mood disorders Flashcards
what defines depression? -
anhedonia
anergia
persistant low mood
psychotic depression
most severe becomes psychotic
Cotard’s syndrome - nihilistic / rotting dead
depressive stupor
mood congruity of delusions and hallucinations
atypical depression
more sleep
more food
phibic
- treat with MAOI
what can cause depression?
monoamine hypothesis: 5-HT, NA reduced
altered hypothalamic-pituitary-adrenal regulation
Mx of depression
stepped care model
low intensity therapy
medicate and high intensity _ CBT, IPT
medicate and hight intensity
ECT, crisis, combined, inpatient care
medication for depression
SSRI - sertraline
TCA - wary of overdose
discontinuoation - paroxetine
bipolar type 2
hypomania (lasts 4 days)
core fetaures mild /moderate
partial insight
no psychotic features
Bipolar type 1
mania - 7 days
core features
minimal insight
psychotic symptoms
Managing bipolar
treatment of mania
antipsychotics- risperidone, olanzapine
valproate / lithium
sedation: benzodiazepine
managing bipolar - depressive symptoms
quetiapine - atypical antipsychotic
managing bipolar - just general
lithium
long term treatment offered when at least 2 manic episodes
1 manic
1 depressuve
treatment for 2 years
what is maternity blues
tearful irritable labile
days after pregnancy
postnatal depression
assess with edinburgh scale (>13)
what is the therapeutic range for lithium?
monitor?
0.6-1
1 week when starting/ changing dose monitored weekly
blood sample taken 12 hours after taking lithium
Lithium levels, TFTs, U&Es every 6 month
lithium toxicity
> 1.5mmol/L
patient with BPD on treatment presents to A&e
with renal failure
gross tremor,
Ataxic
2 days before she had run a marathon which had caused a sprained ankle for which she has been taken Ibruprofen
what has happened ?
why?
lithium toxicity
malarthon- dehydration can cause salt and electrolyte disturbance
NSAIDs interfere with the excretion meaning more in the system
managing lithium
check level
stop dose
transfer for emdical care- rehydrate/ osmotic diuresis
role of sodium valproate in BPD
anticonvulsant
treat acute mania
plasma levels do not need monitoring
check BMI, FBC, LFTs
carbamazepine
anticonvulsant
induces liver enzymes
close monitoring required
are all mood stabilisers teratogenic?
yes
lithium - ebstein anomaly
valproate - spina bifida (NTD)
acute management of mania
stop all medications
> antidepressants, recreational drugs, steroids, dopamine agonists
depression in BPAD
fluoextine and olanzapine / quetiapine
opiod overdose?
naloxone
antidepressant overdose
activated charcoal decreases intestinal absorption
paracetamol overdose?
n-acetylcysteine
puerperal psychosis
admit to mother and baby unit
antipsychotic
lithium
benzodiazepine may be needed
what is beck’s cognitive triad?
low self esteem
depressive thoughts - world
the future
what are biological depression symptoms?
reduced sleep
appetite
libido
the limbic system controls for what?
how is it altered in depression?
prefrontal cortex - regulates emotion
reward
executive function
cingulate cortex, nucleus accumbens
