Mood Disorders Flashcards
MDD
DSM
Symptoms cause distress or impairment in all areas of functioning
≥5 of the following during the same 2-week period. Must have depressed mood and anhedonia:
- change in weight/appetite
- change in sleep
- psychomotor retardation
- fatigue
- feelings of worthelessness or excessive guilt
- diminished ability to think/concentrate
- recurrent thoughts of death, suicidal ideation
MDD
Causes
Biological - genetic, decreased activity of 5HT, NA, DA
Psychosocial - psychodynamic, cognitive, environmental, co-morbid psychiatric diagnoses
MDD
Clinical Presentation
≥5 of the following: DEAD SWAMP Depression Energy loss/fatigue Anhedonia Death thoughts/attempts Sleep disturbances Worthlessness or excessive guilt Appetite/weight change Mentation (decreased ability to think/indecisiveness) Psychomotor retardation
Melancholia
1 of anhedonia or lack of reactivity to usually pleasurable stimuli ≥3 of: -depressed mood -depression worse in the morning -early-morning awakening -psychomotor retardation -anorexia or weight loss -inappropriate guilt
MDD
Psychological therapies
Stress management
Structured problem-solving
CBT
Interpersonal psychotherapy
SSRIs
e.g. citalopram, fluoexetine, sertraline
Inhibit the reuptake of 5HT
Safer than tricyclics
A/E: headache, nausea, vomiting, sexual dysfunction, prolonged QT (citalopram)
SNRIs
E.g. desvenlafaxine, venlafaxine
5HT and NA re-uptake inhibitors
Combined advantages of SSRIs and tricyclics.
Second line for depression
Used in people with fatigue/pain syndromes with depression or people who haven’t responded to SSRIs
A/E: Same as SSRI + HTN
Mirtazapine aka Avanza
Blocks re-uptake of 5HT and NA - similar to SNRI
A/E: sedative, increased appetite, nightmares
Tricyclics
E.g. amitriptyline, clompiramine
Block re-uptake of 5HT and NA in presynaptic terminal
Most effective but most side effects
A/E: anti-SLUD, sedation, weight gain, orthostatic hypotension, sinus tachycardia, death in overdose, prolonged QT, T wave inversion
Irreversible MAO inhibitors
Inhibits MAO A and B, increasing the synaptic concentrations of adrenaline, NA, DA and 5HT.
A/E: hard cheese effect (hypertensive crisis due to reaction with tyramine in cheeses)
ECT
Considered in psychotic depression and severe depression (e.g. melancholic)
Bipolar Disorder
Manic Episode
DSM
Period of abnormally and persistently elevated, expansive or irritable mood and increased goal-directed activity or energy, lasting ≥1 week and present most of the day, nearly every day
≥3 of the following: (GST PAID)
-inflated self-esteem
-decreased need for sleep
-more talkative than usual
-flight of ideas
-increase in goal-directed activity or psychomotor agitation
-excessive involvement in activities with a high potential for painful consequences
Bipolar Disorder
Hypomanic Episode
DSM
As for manic episode, however symptoms last ≥4 consecutive days and are not severe enough to cause marked functional impairment or to necessitate hospitalisation
Bipolar I
Clinical Presentation
Complete manic and depressive symptoms
Bipolar II
Clinical Presentation
Recurrent major depressive episodes with hypomanic symptoms.
Depression predominates
Mania
Symptoms
GST PAID Grandiosity Sleep (decreased need) Talkative Pleasurable activities, Painful consequences Activity Ideas (flight of) Distractible
Bipolar Disorder
Management
- Pharmacological management for mania: mood stabilisers (lithium, sodium valproate, carbamazepine), atypical antipsychotics
- Pharmacological management for depression
- ECT: used for refractory manic or depressive episodes. Contraindicated in use with MAOI and raised ICP
- Psychosocial therapy - psychoanalytical, family and interpersonal
Post-Natal Depression
DSM
Criteria for MDD is met
Mood episodes have their onset during pregnancy or in the 4 weeks post-partum
PND
Management
Anti-depressants during pregnancy:
SSRIs (escitalopram), TCA. Avoid MAOI
Dysthymic Disorder (Persistent Depressive Disorder) DSM
Depressed mood for most of the day, more days than not, for at least 2 years, with an absence of symptoms for no more than 2 months at a time There has never been a manic or hypomanic episode ≥2 of the following: - poor appetite or overeating - change in appetite - fatigue - low self-esteem - poor concentration - feelings of hopeflessness
Lithium
Treatment of mania
Inhibits dopamine release and enhances 5HT release
A/E: hypothyroidism, epigastric discomfort, weight gain, vertigo, tremor, acne, psoriasis, leukocytosis, polyuria, benign T wave changes, nephrotoxicity
