Mood Disorders Flashcards
Depression, bipolar
Define depression
Characterised by depressive mood (e.g. sad or empty) or loss of pleasure (anhedonia) + other cognitive, behavioural sx that significantly affect individuals ability to function - persisting for at least 2 weeks.
Sx of depression
Describe 9 features + what is depressive stupor?
Presence of 5/9 of following sx nearly every day for atleast two weeks:
1. Depressed mood or irritability
2. Anhedonia (loss of pleasure)
3. Weight change (inc or dec) / appetite change
4. Sleep alterations (insomnia or hypersomnia)
5. Activity changes (i.e. retardation)
6. Fatigue + loss of energy
7. Guilt or feeling of worthlessness
8. Cognitive issues (dec concentration + indecisiveness)
9. Suicidality
Additional feature:
Depressive stupor - profound immobility, mutism and refusal to eat - may require ECT
What are some examples of organic causes for depression that need to be ruled out during investigations?
- Neuro - Parkinson’s, dementia or MS
- Endo - thyroid, hypo/hyperadrenalism
- Chronic cdtns - diabetes or OSA
- Cancers and malignancy
- Medication side effects
What are the questionnaires used to assess depressive symptoms?
HAD - Hospital Anxiety and Depression scale
PHQ-9 - Patient Health Questionnaire
Tx of mild-to-moderate depression?
1st line - low intensity psychological intervention (individual self-help)
2nd line - high intensity CBT
3rd line - consider antidepressants
Tx of moderate-to-severe depression?
1st line - High intensity CBT + SSRI (i.e. sertraline)
2nd line - SNRIs or mirtazapine
Tx of severe depression and poor oral intake/psychosis/stupor
1st line - ECT (electroconvulsive therapy) - sending an electric current through the brain which causes a brief seizure
SE of ECT - headache, muscle aches, nausea, temporary memory loss
Tx of recurrent depression?
Antidepressant + lithium
Describe monitoring process of antidepressant prescription + process of discontinuing antidepressants.
- In pt 18-25 yrs = inc impulsivity + suicide risk after meds start - follow-up after 1 week
- If > 25yrs - follow up after 2-4 weeks
- Discontinue - gradually tapered over 4 weeks
Difference between baby blues and postpartum depression
Baby blues - do not last for more than 2 weeks after giving birth
PPD - can develop upto 1 year following childbirth and presents with persistent depressive symptoms that may interfere with daily fucntioning and parenting.
Describe aetiology of postpartum depression
Hint: Describe biological, psychological and social factors
Biological:
* Hormone fluctuations
* Alterations in melatonin and cortisol rhythms
* Genetic predisposition
Psychological:
* Hx of mood/anxiety disorders
* Previous PPD
* Unrealistic motherhood expectations
Social:
* Lack of social support
* Relationship issues
* Low socioeconomic status
What is the screening tool used for postpartum depression?
Edinburgh Postnatal Depression Scale (EPDS)
What is meant by dysthymic disorder?
A milder, but long-lasting form of depression (2-5 yrs persistent)
Define bipolar and it’s two types?
Episodes of major depression + either:
* Type 1 - one or manic episodes
* Type 2 - recurrent hypomanic episodes
What is the difference between mania and hypomania?
- Mania = severe functional impairment or psychotic sx, persists at least 7 days
- Hypomania = inc/decreased function for at least 4 days, similar sx as mania but less severe + no psychotic episodes
