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Mood disorders 2 Flashcards

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1
Q

What are the symptoms of hypomania?

A
  • Mildly elevated/unstable mood
  • Increased energy
  • Mild overspending, risk-taking
  • Increased sociability, overfamiliarity
  • Distractibility
  • Increased sexual energy
  • Decreased need for sleep
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2
Q

What are the symptoms of mania?

A
  • Elevated, expansive, irritable mood
  • Increased activity
  • Reckless behaviour
  • Disinhibition
  • Marked distractibility
  • Markedly increased sexual energy
  • Sleep severely impaired/absent
  • Grandiosity
  • Flight of ideas
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3
Q

How many days do symptoms last in hypomania?

A

4+ days of symptoms

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4
Q

How does hypomania effect function?

A

won’t usually severely disrupt function

many precede more severe mania

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5
Q

How long do symptoms of mania last?

A

7 days or severe enough for admission

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6
Q

What psychotic symptoms are experienced?

A
  • 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

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7
Q

What are the organic differentials for mania?

A 
Substance misuse i.e. steroids (may be a precipitating factor)
Hyperthyroidism – if very severe
SOL especially frontal lobe
Metabolic disorders 
Epilepsy
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8
Q

How long does the average mania episode last?

A

6/12

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9
Q

How likely is relapse?

A

At least 90% will have a further episode – average = 10 episodes in 25 years
20-30x risk of suicide

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10
Q

Define bipolar

A

> 2 episodes of disturbance of mood and activity levels, sometimes mania/hypomania and sometimes depression

complete recovery between episodes

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11
Q

Incidence of bipolar

A

1%

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12
Q

How is acute mania managed? BIO

A
  • Stop any antidepressants
  • Offer antipsychotic: haloperidol, olanzapine, risperidone, quetiapine
  • Consider lithium or valproate
  • Consider benzos
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13
Q

How is acute mania managed? PSYCHO

A

Psychoeducation

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14
Q

How is acute mania managed? SOCIAL

A
  • Consider MHA or inpatient admission
  • Calming, low-stimulus environment
  • Advise to maintain relationships with carers
  • Advise to avoid making serious decisions
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15
Q

How is bipolar depression? BIO

A
  • Consider mood stabiliser, optimise current doses
  • Can use antidepressant (SSRI) with anti-manic agent
  • Consider atypical AP i.e. quetiapine, olanzapine
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16
Q

How is bipolar depression? SOCIAL

A
  • Consider inpatient admission
  • Support carers
  • Work on social inclusion
  • Support for education, training, employment etc.
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17
Q

How is relapse prevented? BIO

A
  • Offer lithium (if female and ?child-bearing age consider AP instead)
  • Avoid antidepressants, especially “unopposed”
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18
Q

How is relapse prevented? PSYCHO

A
  • Psychoeducation
  • CBT
  • Family therapy
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19
Q

How is relapse prevented? SOCIAL

A
  • CPN and OPD F/Ups
  • Work on social inclusion
  • Support for education, employment etc.
  • Support for housing and benefits
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20
Q

When are mood stabilisers used?

A
  • Bipolar prophylaxis
  • Acute mania or hypomania
  • treatment of bipolar depression
  • augmentation of antidepressants in treatment-resistant depression
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21
Q

Why is lithium used?

A

significantly reduces the risk of suicide

22
Q

What is a potential problem with lithium?

A

Narrow TW for avoiding toxicity

23
Q

What are the SEs of lithium?

A 
GI upset 
fine tremor 
polyuria/polydipsia
weight gain 
oedema
24
Q

What are the toxic S&S of lithium?

A 
coarse tremor
ataxia
dysarthria
nystagmus
confusion 
nephrotoxic and thyrotoxic
avoid in pregnancy - teratogenic
25
Q

How are patients monitored when they are on lithium

A

lithium levels monitored ever 3/12

U&Es, TFTs every 6/12

26
Q

Name 3 SSRIs

A 
Fluoxetine
Paroxetine
Citalopram
Sertraline
Fluvoxamine
Escitalopram
27
Q

What are the common SEs associated with SSRIs

A 
Nausea
Anxiety
Insomnia, fatigue
Akathisia
Sexual dysfunction 
Withdrawal syndrome

NB paroxetine = teratogen

28
Q

Name 2 SNRIs

A

Venlafaxine

Duloxetine

29
Q

What are the common SEs associated with SNRIs

A

Same as SSRIs

Slightly more sedative

30
Q

Name 3 TCAs

A 
Amitriptyline
Imipramine
Clomipramine
Dosulepin 
Lofepramine
31
Q

What are the SEs of TCAs

A 
Toxic in overdose, avoid if high risk of suicide
Constipation
Blurred vision
Dry mouth 
Sedation 
Weight gain 
Hypotension
32
Q

Name some MAOIs (rarely used)

A

Phenelzine
Tranylcypromine
Isocarboxazid
Moclobemide

33
Q

What are the SEs of MAOIs?

A

Hypertensive “cheese” reaction
Nausea
Diarrhoea
Headache

34
Q

Name a NaSSA

A

Mirtazapine

35
Q

Why are NaSSAs particularly useful

A

Very effective for anxiety and augmentation of other meds

36
Q

What are some SEs of NaSSAs

A

Weight gain

Sedation

37
Q

In which people is self harm most common?

A

M:F = 1:2
Divorced > single > widowed > married
2/3 are <35 years old

38
Q

What are the most common ways to self harm?

A

Overdose and cutting are most common

39
Q

What BIO factors influence self harm?

A

genetics
substance misuse
younger age

40
Q

What are the PSYCHO factors that influence self harm?

A 
sexual, physical, emotional abuse 
bereavement 
relationship breakdown 
difficult feelings
endings, change
41
Q

What are the SOCIAL factors that influence self harm?

A 
Friends that self harm 
Housing or money worries
Endings, change 
School or work pressures
Isolation, loneliness
42
Q

Spiritual factors that can lead to self harm?

A

Crisis of faith

43
Q

How should you manage a patient who has self harmed

A 
Assess physical health 
Mental state
Safeguarding concerns 
Risk of repetition and suicide
Social circumstances

–> Comprehensive psychosocial assessment

44
Q

What are the main risk factors for repeated self harm?

A
  • No. of previous episodes
  • PD
  • Hx violence
  • Alcohol misuse or dependence
  • Unmarried
45
Q

What are the main RFs for suicidal intent?

A
  • Precautions to avoid intervention
  • Planning
  • Leaving a note, making a will, settling debts
  • Violent methods
  • Perceived lethality of act
46
Q

What is the most common way to commit suicide?

A

45% of suicide is hanging or strangulation

23% overdose

47
Q

Is suicide more common in M or F?

A

M:F
3:1

48
Q

What are the indication for ECT?

A

Treatment resistant depression
Life threatening, severe depression
Treatment resistant mania
Catatonia

49
Q

In what pts is ECT contraindicated?

A

In patients with cochlear implants

50
Q

What are the relative C/Is for ECT?

A
  • Increased ICP
  • Intracranial or aortic aneurysms
  • Hx cerebral haemorrhages
  • Recent MI
  • Uncontrolled arrhythmias
  • Acute respiratory infections
  • DVT
51
Q

What is the start dose and max dose of ECT?

A

Start dose 50mC

Max dose 250mC

52
Q

How many treatments will patients usually have?

A

8-12 treatments

Psych (7 decks)

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