Mood Disorders Flashcards
Biological symptoms of depression
Early morning wakening Symptoms worse in mornings Loss of appetite and weight loss Psychomotor retardation Loss of libido
Cognitive symptoms
Brain processing functions Reduced concentration and memory Poor self esteem Guilt Hopelessness Suicide or self harm
Psychotic symptoms of depression
Delusions-> worthlessness, guilt, ill health
Hallucinations-> mood congruent, defamatory, accusatory
Ahenesis
Mutism
Somatic syndrome
Markedly reduced appetite Weight loss Early morning wakening Diurnal variation Psychomotor retardation Loss of libido Marked ahedonia Lack of emotional reactivity
Diagnosis of depression
ICD AND 2 of: Decreased concentration Decreased self esteem Guilt Pessimistic Disturbed sleep Reduced appetite Self harm/suicide
Mild depression definition
> = 4 symptoms
Can maintain normal life
Moderate depression
> =5 symptoms
Great difficulty maintaining normal activities
Severe depression
> =7 symptoms
Unable to continue normal activity
Differentials of depression, psychiatric disorders
Depressive episode Recurrent depressive disorder Dysthymia Bipolar Cyclothmia Schizoaffective disorder
Medical differentials of depression
Neurological-> MS, Parkinson’s, huntingtons, trauma
Endocrine-> cushings, Addison’s, thyroid, menstrual
Infections-> hepatitis, glange, herpes, HIV, syphilis
Others-> cancer, pain, SLE, RA, vit deficiencies
Prescribed drugs which may causes depression
Antihypertensives Steroids L-dopa Opioids Anti-psychotics Interferon
Adjustment reaction
Reaction to a stressful event that lasts less than 6 months
Onset within 3 months
Significant impairment
Symptoms don’t persist long after stressor is resolved
Epidemiology of depression
M:F 1:2
10-20% life time prevalence
5% major
Prognosis of depression
50-60% recoverwithin 1 year
Chronic >2 years 10-25%
25% recurrence 1 year
75% recurrence in 10 years
Investigations of depression
Collateral history Mood diary Exclude organic causes Screen for physical aspects of neglect-> anaemia, hyponatremia Urine dip
Social management of depression
Avoid alcohol and substance use Eat healthily Exercise regularly Good sleep hygiene Social inclusion Relationships
Psychological management of depression
1st line for mild depression Psychoeducation Self help materials CBT Interpersonal therapy
Pharmacological management of depression
Moderate to severe depression SSRI's 50% respond Continue for 6m after resolution Lithium for resistant cases Antipsychotic augmentation
ECT indications in depression
Poor response to adequate antidepressants Intolerance of antidepressants Suicidal Severe psychotic features Severe self neglect Previous good response to ECT
Symptoms of mania
Decreased need for sleep not associated with fatigue Increased activity Reckless behaviour Grandiosity Poor concentration Accelerated thinking/pressure of speech Flight of ideas Disinhibition Increased sexual energy Elevated/expansile/irritable *mood congruent delusions (hallucinations) *cirumstantiality and tangentiality
Organic causes of mania
Neurological-> brain lesion, huntingtons, MS, temporal lobe epilepsy Endocrine-> Cushings, hyperthyroidism, Inflammatory-> SLE Renal failure Vit b12 deficiency
Drugs associate with mania
Anabolic steroids Anti-depressants Corticosteroids Dopamine agents Amphetamines Cocaine Hallucinogens Legal highs
Epidemiology of bipolar
1% life time risk
M:F
Average age 21 years
Aetiology of bipolar
70% genetic x 7 increase if first degree relative Increased risk of depression and schizophrenia Substance missuse Life events Interpersonal conflict
Prognosis of bipolar
90% reoccurrence
8-10 episodes in a life time
Rapid cycling has a worse prognosis
10% suicide
Reasons for relapse
Non concordance Life events Psychological stressors Circadian rhythm disruption Substance misuse Child birth
Management of acute mania
Biological -stop antidepressants -antipsychotics 1st line -lithium or valproate Psychological -psychoeducation -supportive, calm environment Social -education/job -finances -housing -social inclusion -relationships/carers
Management of bipolar depression
Biological -mood stabilisers -2nd generation antipsychotics -(antidepressants) Psychological -psychoeducation -CBT Social -education -finances -housing -social interaction -relationships
Maintenance treatment of bipolar
Treat for at least 2 years Biological -antipsychotics -mood stabilers -contraception Psychological -psychoeducation -CBT-> concordance and relapse prevention -family therapy Social -education/job -finances -housing -social inclusion -relationship
Core symptoms of depression
Depressed mood which varys little from day to day and is unresponsive to circumstances
Markedly reduced interests in usual activities with loss of pleasure
Lack of energy
