Mood disorders Flashcards
Describe the differences between hypomania, main without psychotic symptoms and mania with psychotic symptoms. (3)
Hypomania: persistent mild elevation of mood (>3 days); increased energy, decreased sleep, talkative, overfamiliarity, increased libido
Mania without psychotic: elevated mood (>1 week) with complete disruption of work and social life; increased energy, pressure of speech, feelings of high creativity can lead to grandiose idea s and excessive expenditure. Sexual disinhibition, reduced sleep can lead to physical exhaustion.
Mania with psychotic: as above but with mood congruent delusions (grandiose), possible auditory hallucinations.
Define bipolar disorder. (2)
At least 2 episodes, one of which must be hypomanic or manic with complete recovery between episodes.
Describe a mental state exam of a patient experiencing mania. (5)
A+B: dress inappropriate, bright. May neglect personal hygiene. Overfamiliar, increased psychomotor activity.
Speech: Loud, pressure of speech, flight of ideas, rhymes
Mood: elated but can quickly become irritated or angered
Thought: Grandiose or persecutory delusions may be present
Perceptions: auditory hallucinations often mood congruent
Cognition: Impaired attention and concentration
Insight: poor
What is the management for an acute manic episode? (2)
- Most will require hospital admission
- Lithium is mood stabiliser (3-7 days for effect); can use anti-psychotic in mean time
- Benzodiaepines can be used as adjunct
- Olanzapine can be used as mood stabiliser
- ECT
- Antidepressants can precipitate or aggravate a manic episode and should be stopped.
Name 3 medications that can be used prophylactically in bipolar disorder. (3)
Lithium and Sodium valproate can prevent both depression and mania.
Olanzapine
Carbamazepine and lamotrigine
NB contraception with sodium valproate and lithium.
Name 4 poor prognostic factors. (4)
Early onset Poor compliance Persistent depressive symptoms Severe mania Family history of non-response Co-morbid personality disorder Substance misuse Rapid cycling (>4 episodes a year)
Name 3 psychiatric differentials for an elated patient. (3)
Hypomania Mania Mania with psychotic symptoms Bipolar disorder Schizoaffective disorder Schizophrenia Acute intoxication with cocaine or amphetamines Acute and transient psychotic disorder
Name 3 medical differentials for an elated patient. (3)
Brain disorders affecting frontal lobes: space occupying lesion, dementia, HIV, syphilis Alcohol withdrawal Corticosteroids Anabolic androgenic steroids Hyperthyroidism
Name 3 psychiatric differentials for a depressed patient. (3)
Depression Severe depression with psychotic symptoms Bipolar affective disorder Anxiety disorder PTSD Schizophrenia Schizoaffective disorder Dementia Substance abuse Personality disorder
Name 3 medical differentials for a depressed patient. (3)
Hypothyroidism Cushing's syndrome Hypercalcaemia (malignancy) Infections (HIV, syphilis) MS Parkinson's Medication (sedatives, anti-convulsants, beta blockers) Bereavement
Define depression. (3)
Mood disorder characterised by a pervasive lowering of mood accompanied by psychosocial and biological symptoms.
Name 3 risk factors for developing depression. (3)
Chronic illness Divorce Unemployed Lack of confiding relationship Low self-esteem Poor social support Low social class Co-morbidity of other psychiatric problems
What symptoms are core/additional symptoms of depression? (4)
How is depression diagnosed? (3)
At least one of Core: low mood, anhedonia, fatigue
Plus: reduced concentration, reduced self-esteem, ideas of guilt , pessimistic views of future, ideas of self-harm, disturbed sleep, diminished appetite.
Symptoms over 2 weeks Mild: 2 core and 2 additional Mod: 2 core and 3 additional Sev: 3 core and 4 additional Sev with psychosis: delusion, hallucinations or stupor
Bert has depression. He needs 4 biological symptoms to diagnose him with somatic syndrome.
name 4. (4)
Anhedonia Lack of emotional reactivity Early morning wakening (>2 hours) Diurnal variation of mood Psychomotor retardation Marked loss of appetite Weight loss Marked loss of libido
What are nihilistic delusions? (2)
Belief that something ceases to exist (eg world is going to end) and are particularly associated with severe depression.
