Mood disorders 2 Flashcards
What are the symptoms of hypomania?
- Mildly elevated/unstable mood
- Increased energy
- Mild overspending, risk-taking
- Increased sociability, overfamiliarity
- Distractibility
- Increased sexual energy
- Decreased need for sleep
What are the symptoms of mania?
- Elevated, expansive, irritable mood
- Increased activity
- Reckless behaviour
- Disinhibition
- Marked distractibility
- Markedly increased sexual energy
- Sleep severely impaired/absent
- Grandiosity
- Flight of ideas
How many days do symptoms last in hypomania?
4+ days of symptoms
How does hypomania effect function?
won’t usually severely disrupt function
many precede more severe mania
How long do symptoms of mania last?
7 days or severe enough for admission
What psychotic symptoms are experienced?
- Usually mood-congruent i.e. delusions of grandiosity or persecution
- Hallucinations may be 2nd person auditory
may be difficult to differentiate mania with psychosis from schizophrenia especially if seen at the height of mania
What are the organic differentials for mania?
Substance misuse i.e. steroids (may be a precipitating factor) Hyperthyroidism – if very severe SOL especially frontal lobe Metabolic disorders Epilepsy
How long does the average mania episode last?
6/12
How likely is relapse?
At least 90% will have a further episode – average = 10 episodes in 25 years
20-30x risk of suicide
Define bipolar
> 2 episodes of disturbance of mood and activity levels, sometimes mania/hypomania and sometimes depression
complete recovery between episodes
Incidence of bipolar
1%
How is acute mania managed? BIO
- Stop any antidepressants
- Offer antipsychotic: haloperidol, olanzapine, risperidone, quetiapine
- Consider lithium or valproate
- Consider benzos
How is acute mania managed? PSYCHO
Psychoeducation
How is acute mania managed? SOCIAL
- Consider MHA or inpatient admission
- Calming, low-stimulus environment
- Advise to maintain relationships with carers
- Advise to avoid making serious decisions
How is bipolar depression? BIO
- Consider mood stabiliser, optimise current doses
- Can use antidepressant (SSRI) with anti-manic agent
- Consider atypical AP i.e. quetiapine, olanzapine
How is bipolar depression? SOCIAL
- Consider inpatient admission
- Support carers
- Work on social inclusion
- Support for education, training, employment etc.
How is relapse prevented? BIO
- Offer lithium (if female and ?child-bearing age consider AP instead)
- Avoid antidepressants, especially “unopposed”
How is relapse prevented? PSYCHO
- Psychoeducation
- CBT
- Family therapy
How is relapse prevented? SOCIAL
- CPN and OPD F/Ups
- Work on social inclusion
- Support for education, employment etc.
- Support for housing and benefits
When are mood stabilisers used?
- Bipolar prophylaxis
- Acute mania or hypomania
- treatment of bipolar depression
- augmentation of antidepressants in treatment-resistant depression
Why is lithium used?
significantly reduces the risk of suicide
What is a potential problem with lithium?
Narrow TW for avoiding toxicity
What are the SEs of lithium?
GI upset fine tremor polyuria/polydipsia weight gain oedema
What are the toxic S&S of lithium?
coarse tremor ataxia dysarthria nystagmus confusion nephrotoxic and thyrotoxic avoid in pregnancy - teratogenic
How are patients monitored when they are on lithium
lithium levels monitored ever 3/12
U&Es, TFTs every 6/12
Name 3 SSRIs
Fluoxetine Paroxetine Citalopram Sertraline Fluvoxamine Escitalopram
What are the common SEs associated with SSRIs
Nausea Anxiety Insomnia, fatigue Akathisia Sexual dysfunction Withdrawal syndrome
NB paroxetine = teratogen
Name 2 SNRIs
Venlafaxine
Duloxetine
What are the common SEs associated with SNRIs
Same as SSRIs
Slightly more sedative
Name 3 TCAs
Amitriptyline Imipramine Clomipramine Dosulepin Lofepramine
What are the SEs of TCAs
Toxic in overdose, avoid if high risk of suicide Constipation Blurred vision Dry mouth Sedation Weight gain Hypotension
Name some MAOIs (rarely used)
Phenelzine
Tranylcypromine
Isocarboxazid
Moclobemide
What are the SEs of MAOIs?
Hypertensive “cheese” reaction
Nausea
Diarrhoea
Headache
Name a NaSSA
Mirtazapine
Why are NaSSAs particularly useful
Very effective for anxiety and augmentation of other meds
What are some SEs of NaSSAs
Weight gain
Sedation
In which people is self harm most common?
M:F = 1:2
Divorced > single > widowed > married
2/3 are <35 years old
What are the most common ways to self harm?
Overdose and cutting are most common
What BIO factors influence self harm?
genetics
substance misuse
younger age
What are the PSYCHO factors that influence self harm?
sexual, physical, emotional abuse bereavement relationship breakdown difficult feelings endings, change
What are the SOCIAL factors that influence self harm?
Friends that self harm Housing or money worries Endings, change School or work pressures Isolation, loneliness
Spiritual factors that can lead to self harm?
Crisis of faith
How should you manage a patient who has self harmed
Assess physical health Mental state Safeguarding concerns Risk of repetition and suicide Social circumstances
–> Comprehensive psychosocial assessment
What are the main risk factors for repeated self harm?
- No. of previous episodes
- PD
- Hx violence
- Alcohol misuse or dependence
- Unmarried
What are the main RFs for suicidal intent?
- Precautions to avoid intervention
- Planning
- Leaving a note, making a will, settling debts
- Violent methods
- Perceived lethality of act
What is the most common way to commit suicide?
45% of suicide is hanging or strangulation
23% overdose
Is suicide more common in M or F?
M:F
3:1
What are the indication for ECT?
Treatment resistant depression
Life threatening, severe depression
Treatment resistant mania
Catatonia
In what pts is ECT contraindicated?
In patients with cochlear implants
What are the relative C/Is for ECT?
- Increased ICP
- Intracranial or aortic aneurysms
- Hx cerebral haemorrhages
- Recent MI
- Uncontrolled arrhythmias
- Acute respiratory infections
- DVT
What is the start dose and max dose of ECT?
Start dose 50mC
Max dose 250mC
How many treatments will patients usually have?
8-12 treatments
