Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Psych > Mood Disorders > Flashcards

Mood Disorders Flashcards

1
Q

Image showing possible symptoms of major depressive disorder

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the 2 most common mood disorders?

A

The two most common mood disorders are major depressive disorder and bipolar affective disorder (manic depressive illness).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Definition of major depressive disorder

A

Period of low mood lasting over 2 weeks that is characterised by a mixture of core, biological and cognitive symptoms. Core symptoms: low mood, anhedonia and fatigue.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Core symptoms of depression

A

Anhedonia
Anergia
Apathy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Biological symptoms of depression

A

Sleep disturbance; Appetite/weight disturbance; Low libido; Disturbed sleep (particularly early morning waking); Psychomotor agitation or retardation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Cognitive symptoms of depression

A

Impaired memory; Reduced concentration and attention; Guilt and worthlessness; Low self-esteem and confidence; Bleak view of the future; Ideas or acts of self-harm or suicide

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What symptoms may patients develop in severe depression?

A

patients may develop delusions and hallucinations (psychotic depression). These are congruent to their mood e.g. nihilistic delusions.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Investigations for depression

A

Collateral history
Physical examination
Bloods: FBC, TFT, U&E
Rating Scale: PHQ9, HAD, CDI (children)
Risk Assessment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What must you always do in depression?

A

RISK ASSESS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

PACES: What rating scales can be used for depression?

A

PHQ9, HAD, CDI (children)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What subtypes of depression exist?

A

Seasonal – worse in winter
Psychotic – with psychotic features
Atypical – mood reactivity is core feature, hyperphagia, hypersomnia, leaden feeling in limbs, hypersensitivity to rejection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Management of mild to moderate depression

A

Sleep hygiene
Arrange further assessment within 2 weeks
Low-Intensity Psychosocial Intervention (ALWAYS CBT)

NOTE: Do NOT routinely consider MEDICATION unless:
Past history of moderate or severe depression
Symptoms have been present for a long time (> 2 years)
Symptoms persist despite other interventions
NOTE: Do NOT recommend St. John’s wort but warn patients about uncertainty in dosing and drug interactions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Should you consider medication in mild to moderate depression?

A

Do NOT routinely consider MEDICATION unless:
Past history of moderate or severe depression
Symptoms have been present for a long time (> 2 years)
Symptoms persist despite other interventions
NOTE: Do NOT recommend St. John’s wort but warn patients about uncertainty in dosing and drug interactions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What does management of moderate to severe depression involve?

A

Provide a combination of:
Antidepressant medication
High-intensity psychological intervention (CBT or interpersonal therapy (IPT))

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

1st line medication for moderate to severe depression

A

SSRI (e.g. sertraline)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Best antidepressant for young people

A

Fluoxetine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Which drug class pose a risk of bleeding?

A

SSRIs, need to give PPI if they need NSAIDs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What drugs are at high risk of interactions?

A

Fluoxetine, parocetine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What drug is at high risk of discontinuation symptoms?

A

Paroxetine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What drug causes death from overdose?

A

Venlafaxine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What drug class often causes overdoses?

A

TCAs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What drugs are often stopped due to side effecgts?

A

Venlafaxine, duloxetine, TCAs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Which drug needs BP to be monitored?

A

Venlafaxine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Which drugs cause worsening hypertension?

A

venlafaxine, duloxetine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Which drugs cause postural hypertension and arrhythmia?

A

TCA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

How often should medication be monitored in moderate to severe depression?

A

After starting antidepressant medication, review after 2 weeks for side-effects, then every 2-4 weeks thereafter for 3 months
Patients < 30 years or at increased risk of suicide should be followed-up after 1 week
Review response to treatment after 3-4 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

When should caution be exercised when switching antidepressants? Why?

A

From fluoxetine to other antidepressants (fluoxetine = long half-life)

From fluoxetine or paroxetine to a TCA (both drugs inhibit TCA metabolism so a lower starting dose may be needed)

To a new SSRI, SNRI or MAOI (risk of serotonin syndrome)

From non-reversible MAOI: a 2-week washout period is required (other antidepressants should not be prescribed during this period)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Important note when swithcing fluoxetine to other antidepressants

A

Fluoxetine has a long half life

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Important note when switching from fluoxetine or paroxetine to a TCA

A

both drugs inhibit TCA metabolism so need a lower starting dose

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Important note when switching to a new SSRI, SNRI, or MAOI

A

RISK OF SERETONIN SYNDROME

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Important note when switching from non-reversible MAOI

A

a 2-week washout period is required (other antidepressants should not be prescribed during this period)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Management of complex and severe depression

A

Use crisis resolution and home treatment teams to manage crises
Develop a crisis plan that identified potential triggers and strategies to manage triggers (share with the GP and any other people involved in the patient’s care)
Consider inpatient treatment if significant risk of suicide, self-harm or self-neglect
Consider ECT for acute treatment of severe depression and when a rapid response is required

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

PACES: Who should be used to manage crises in complex and severe depression?

A

Crisis resolution and home treatment teams

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

When to consider inpatient treatment in depression?

A

if significant risk of suicide, self-harm or self-neglect

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

When is ECT used in depression?

A

If tretment regractory

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

What can ECT cause?

A

retrograde amnesia

37
Q

Can ECT be used in depression?

A

Yes

38
Q

Management of catatonic depression

A

Consider ECT for acute treatment of severe depression and when a rapid response is required

39
Q

Definition of BPAD

A

A disorder characterised by 2 or more episodes in which the patient’s mood and activity levels are significantly disturbed, this disturbance consisting on some occasions of an elevation of mood and increased energy and activity (hypomania or mania) and on others of a lowering of mood and decreased energy and activity (depression).

40
Q

How many episodes of mood disturbances are needed in order to diagnose BPAD?

A

2 or mroe

41
Q

What are episodes of hypomania or mania without depression classified as?

A

bipolar

42
Q

Types of BPAD

A

Bipolar I Disorder
At least ONE manic episode
Depressive episodes are common but are NOT necessary to make the diagnosis

Bipolar II Disorder
At least ONE hypomanic episode
At least ONE major depressive episode

Cyclothymia
History of hypomanic episodes with periods of depression that do not meet the criteria for major depressive disorder

43
Q

Requirements for diagnosis for type 1 BPAD

A

At least ONE manic episode
Depressive episodes are common but are NOT necessary to make the diagnosis

44
Q

Requirements for diagnosis of type 2 BPAD

A

At least ONE hypomanic episode
At least ONE major depressive episode

45
Q

Requirements for diagnosis of cyclothymia

A

History of hypomanic episodes with periods of depression that do not meet the criteria for major depressive disorder

46
Q

What does BPAD typically manifest as?

A

a cyclical pattern of mania or hypomania and depression

47
Q

Signs of a manic episode

A

THINK: DIG FAST

Distractibility
Irresponsibility
Grandiosity
Flight of ideas
Agitation
Less sleep
Talking too much (pressured speech)

48
Q

How long does a manic episode last?

A

Lasts at least a week

49
Q

Classic features of a manic episode

A

disinhibition and irresponsibility - spends money, goes out naked, increased self-esteem and confidence, gambling life-savings

50
Q

Typical case of a manic episode

A

a patient with a sudden change in mood to an elevated state, no sleeping, doesn’t go to work, altered behaviour

51
Q

Is social functioning distrubed in mania?

A

Yes

52
Q

Is social functioning distrubed in hypomania

A

Little or no impairment in social functioning

53
Q

Difference ebtween manic and hypomanic episodes

A

Mania has delusions of grandeur
Psychotic Symptoms in mania
Impairment of social functioning

54
Q

How long does a hypomanic episode need to last?

A

At least 4 days

55
Q

Investigations for BPAD

A

Collateral history
Physical examination (establish baseline state)
Bloods: FBC, TSH, U&E, LFT, ECG
Urine drug screen
Rating scale: Young Mania Rating Scale
Risk assessment

56
Q

PACES: What rating scale is used in BPAD?

A

Young Mania Rating Scale

57
Q

What is the mainstay of management in BPAD? What are the main drugs?

A

Mood stabilisers

Main drugs:
Lithium
Sodium valproate
Carbamazepine

58
Q

What is the therapeutic range of Lithium? When does it become toxic?

A

Therapeutic range: 0.6-1.0 mmol/L, becomes toxic >1.2 mmol/L

59
Q

How often should Lithium levels be monitored?

A

Lithium levels should be checked 1 week after starting or changing dose and monitored weekly until a steady therapeutic level is achieved
It should be monitored every 3 months from then on

60
Q

What blood test results should be monitored in Lithium use? How often? Why?

A

U&E and TFTs should be monitored every 6 months (can cause renal impairment and hypothyroidism)

61
Q

When does lithium toxicity occur?

A

Level > 1.2 mmol/L

62
Q

How does Lithium toxicity present?

A

GI disturbance; polyuria/ polydipsia; sluggishness; giddiness; ataxia; gross tremor; seizures; renal failure

NOTE: It is life threatening

63
Q

What triggers lithium toxicity?

A

Salt balance changes (e.g. dehydration, D&V)
Drugs interfering with lithium excretion via the kidneys (e.g. diuretics)
Accidental or deliberate overdose

64
Q

How is lithium toxicity managed?

A

Check lithium level
Stop lithium. WARNING: stopping lithium abruptly could precipitate symptoms of mania/depression)
Transfer for medical care (rehydration, osmotic diuresis). If overdose is severe, the patient may need gastric lavage or dialysis.

65
Q

What type of drug is Sodium Valproate? What does it treat in BPAD?

A

Anticonvulsant
Treats acute mania
Prophylaxis in BPAD

NOTE: Plasma levels do not need monitoring. Dose-related toxicity is NOT usually an issue

66
Q

What type of drug is carbamezapine? What issues can it cause in management of BPAD?

A

Anticonvulsant
Can cause toxicity at high doses
Induces liver enzymes (check for drug interactions before prescribing)

67
Q

What must be checked before prescription of carabamazepine? Why?

A

Drug interactions, it induceds liver enzymes

68
Q

Risks of mood stabilisers in pregnancy

A

Mood stabilisers are teratogenic
Risk of harm should be weighed against harm of manic relapse
Lithium - Ebstein’s anomaly
Valproate + carbamazepine - spina bifida

69
Q

PACES: Advice to give women of childbearing age on mood stabilisers

A

Women of childbearing age should be given contraceptive advice and prescribed a folate supplement if using valproate

70
Q

What does Lithium cause in pregnancy?

A

Ebstein’s anomaly

71
Q

What does Valproate and carbamazepine cause in pregnancy?

A

Spina bifida

72
Q

Besides mood stabilisers, what other drugs can be used for management of BPAD?

A

Antipsychotics (e.g. olanzapine)
Usually atypical (e.g. olanzapine, risperidone, quetiapine) because of fewer side-effects

Anticonvulsants
Lamotrigine is 2nd line for prophylaxis in BPAD type II

73
Q

What is the acute treatment of mania or hypomania?

A

Stop medications that may induce symptoms (e.g. antidepressants, drugs of abuse, steroids and dopamine agonists)
Monitor food and fluid intake to prevent dehydration

If treatment free:
Give an antipsychotic OR mood stabiliser (can be given together if not responding)
A short course of benzodiazepines may be added for sedation (sleep deprivation can exacerbate mania)

If already on treatment
Optimise the medication; check compliance; adjust doses
Consider adding another agent (e.g. antipsychotic as well as mood stabiliser)
Short-term benzodiazepines may help

74
Q

After stopping medications that may induce symptoms, what is the acute treatment of mania or hypomania if treatment free?

A

Give an antipsychotic OR mood stabiliser (can be given together if not responding)
A short course of benzodiazepines may be added for sedation (sleep deprivation can exacerbate mania)

75
Q

Why might a short course of benzodiazepines be added in the acute treatment of mania or hypomania?

A

A short course of benzodiazepines may be added for sedation (sleep deprivation can exacerbate mania)

76
Q

After stopping medications that may induce symptoms, what is the acute treatment of mania or hypomania if already on treatment?

A

Optimise the medication; check compliance; adjust doses
Consider adding another agent (e.g. antipsychotic as well as mood stabiliser)
Short-term benzodiazepines may help

77
Q

How to treat depression in BPAD?

A

DIFFICULT because antidepressants can cause a switch to mania
To reduce this risk, antidepressants should only be given with a mood stabiliser or antipsychotic
1st line: fluoxetine + olanzapine/quetiapine
2nd line: lamotrigine

78
Q

Why is it difficult to treat depression in BPAD?

A

antidepressants can cause a switch to mania

79
Q

What must antidepressants be given with in the treatment of depression in BPAD? Why?

A

antidepressants should only be given with a mood stabiliser or antipsychotic
1st line: fluoxetine + olanzapine/quetiapine
2nd line: lamotrigine

Because antidepressants can cause a switch to mania

80
Q

What psychological therapy is used in BPAD?

A

CBT

81
Q

What medication should you consider stopping during an acute manic episode?

A

During an acute manic episode, consider stopping antidepressant (if the patient is on one)

82
Q

What is the antidepressant of choice in the management of depression in BPAD? What must it be given with?

A

fluoxetine is the antidepressant of choice (given with olanzapine or quetiapine)

83
Q

How should primary care refer people with BPAD?

A

Symptoms of hypomania 🡪 routine referral to CMHT
Symptoms of mania or severe depression 🡪 urgent referral to CMHT

84
Q

PACES: Important questions to ask when risk assessing those with depression

A

Have you ever thought about/attempted to end your life?

Have you ever purposefully hurt yourself or want to hurt yourself?

85
Q

PACES: Important things to explore if patient has displayed thoughts or intent of harming themselves

A

Before – trigger, planned/impulsive, intoxication, preventing discovery
During – Method (cutting, OD, burning, hitting oneself), thoughts during act, where were they
After – who called for help, current mood, regret, would they do it again, will they accept treatment

86
Q

Suicide risk factors

A

THINK: SAD PERSONS

S - sex (male)
A - age (young, elderly)
D - depression
P - previous attempt (highest risk factor)
E - ethanol or drug use
R - rational thinking loss (psychosis)
S - sickness (medical illness)
O - organised plan
N - no social support
S - states future intent

87
Q

Protective factors against suicide

A

family support
having children at home
religious belief

88
Q

What are some factors that suggest increased risk of completed suicide?

A

efforts to avoid discovery
planning
leaving a written note
final acts such as sorting out finances (e.g. sorting a will)
violent method

89
Q

Beck’s cognitive triad of depression

A

Psych (11 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions