Mood disorders

Question 1

what defines depression? -

Answer 1

anhedonia
anergia
persistant low mood

Question 2

psychotic depression

Answer 2

most severe becomes psychotic
Cotard’s syndrome - nihilistic / rotting dead

depressive stupor

mood congruity of delusions and hallucinations

Question 3

atypical depression

Answer 3

more sleep
more food
phibic

• treat with MAOI

Question 4

what can cause depression?

Answer 4

monoamine hypothesis: 5-HT, NA reduced

altered hypothalamic-pituitary-adrenal regulation

Question 5

Mx of depression

Answer 5

stepped care model

low intensity therapy

medicate and high intensity _ CBT, IPT

medicate and hight intensity
ECT, crisis, combined, inpatient care

Question 6

medication for depression

Answer 6

SSRI - sertraline
TCA - wary of overdose
discontinuoation - paroxetine

Question 7

bipolar type 2

Answer 7

hypomania (lasts 4 days)
core fetaures mild /moderate
partial insight
no psychotic features

Question 8

Bipolar type 1

Answer 8

mania - 7 days
core features
minimal insight
psychotic symptoms

Question 9

Managing bipolar

treatment of mania

Answer 9

antipsychotics- risperidone, olanzapine

valproate / lithium

sedation: benzodiazepine

Question 10

managing bipolar - depressive symptoms

Answer 10

quetiapine - atypical antipsychotic

Question 11

managing bipolar - just general

Answer 11

lithium

long term treatment offered when at least 2 manic episodes
1 manic
1 depressuve

treatment for 2 years

Question 12

what is maternity blues

Answer 12

tearful irritable labile
days after pregnancy

Question 13

postnatal depression

Answer 13

assess with edinburgh scale (>13)

Question 14

what is the therapeutic range for lithium?

monitor?

Answer 14

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

Question 15

lithium toxicity

Answer 15

> 1.5mmol/L

Question 16

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?

Answer 16

lithium toxicity

malarthon- dehydration can cause salt and electrolyte disturbance

NSAIDs interfere with the excretion meaning more in the system

Question 17

managing lithium

Answer 17

check level
stop dose

transfer for emdical care- rehydrate/ osmotic diuresis

Question 18

role of sodium valproate in BPD

Answer 18

anticonvulsant
treat acute mania

plasma levels do not need monitoring
check BMI, FBC, LFTs

Question 19

carbamazepine

Answer 19

anticonvulsant
induces liver enzymes
close monitoring required

Question 20

are all mood stabilisers teratogenic?

Answer 20

yes
lithium - ebstein anomaly

valproate - spina bifida (NTD)

Question 21

acute management of mania

Answer 21

stop all medications
> antidepressants, recreational drugs, steroids, dopamine agonists

Question 22

depression in BPAD

Answer 22

fluoextine and olanzapine / quetiapine

Question 23

opiod overdose?

Answer 23

naloxone

Question 24

antidepressant overdose

Answer 24

activated charcoal decreases intestinal absorption

Question 25

paracetamol overdose?

Answer 25

n-acetylcysteine

Question 26

puerperal psychosis

Answer 26

admit to mother and baby unit

antipsychotic
lithium
benzodiazepine may be needed

Question 27

what is beck’s cognitive triad?

Answer 27

low self esteem
depressive thoughts - world
the future

Question 28

what are biological depression symptoms?

Answer 28

reduced sleep
appetite
libido

Question 29

the limbic system controls for what?
how is it altered in depression?

Answer 29

prefrontal cortex - regulates emotion
reward
executive function
cingulate cortex, nucleus accumbens