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Toni's Psych > Mood Disorders > Flashcards

Mood Disorders Flashcards

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1
Q

What cognitive symptoms might be seen in a depressive episode?

A

Reduced concentration and attention
Poor self esteem
Guilt
Hopelessness

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2
Q

What somatic/biological symptoms might be seen in a depressive episode?

A 
Anhedonia
Reduced emotional reactivity
Early am waking/initial insomnia
Diurnal variation
Psychomotor retardation/agitation
Loss of appetite/weight loss
Loss of libido
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3
Q

What factors might increase the risk of depression in women?

A

Brown and Harris

3 or more children

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4
Q

When might you consider in patient admission to assess patients with depression?

A

If evidence of:
Distressing hallucinations/delusions, psychotic phenomena
Active suicidal ideation/ planning, esp if prev attempts
Severe self neglect due to lack of motivation (dehydration/starvation)

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5
Q

What medication is used 1st line in the treatment of depression?

A 
SSRIs:
Sertraline
Paroxetine
Citalopram
Fluoxetine
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6
Q

How long are SSRIs usually prescribed for in depressive episodes

A

4 - 6 wks
From remission:
Full dose 6 months
(If recurrent depression 2 years)

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7
Q

What factors are considered when prescribing medication for depression?

A

Side effects
Prev good response
Safety in OD
Concomitant physical illness

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8
Q

What are the criteria for a depressive episode?

A

Min 2 wk duration

2/3: anhedonia, anergia, low mood

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9
Q

What are the causes of treatment failure?

A

Inadequate dose
Insufficient duration of treatment
Poor compliance

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10
Q

What are the options if a patient has not responded to a pharmacological treatment?

A 
Increase dose
Change to another antidepressant of same class
Change to another antidepressant of a different class
Consider augmentation with lithium or another antidepressant 
Consider other types of treatment e.g. Psychotherapy or ECT
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11
Q

What is CBT?

A

Identifies distorted/illogical thoughts and assumptions
Attempts to replace them with more ‘reality-based’ thinking and behaviours
Involves behaviour experiments, target setting and activity scheduling
Req betw 6-20 sessions

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12
Q

What is the role of CBT in depression?

A

Can be as effective as antidepressants in treating mod episodes
When used after medication can reduce rate of relapse

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13
Q

What are the indications for ECT in depression?

A

Poor response to adequate trials of antidepressants
Intolerance of antidepressants due to SEs
Severe suicidal ideation
Psychotic features or severe psychomotor retardation
Severe self neglect
Previous good response

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14
Q

Course and prognosis of depression

A

Self limiting
Without treatment 1st episode: 6 months -1yr
60% relapse
Risk of future relapse increases with each episode

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15
Q

Risk of suicide in depression

A

Rates of suicide 20 x greater in those with depression compared to general population

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16
Q

Why might you consider inpatient admission for assessment of a patient presenting with mania?

A

Reckless behaviour endangering themselves / others
Significant psychotic sx
Impaired judgement e.g. sex / money
Excessive psychomotor agitation, risk of self injury, dehydration, exhaustion
Thoughts of harming self/ others

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17
Q

What is the mainstay of treatment for BPAD?

A

Mood stabilisers
Lithium valproate
Valproic acid + carbamazepine

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18
Q

What pharmacological treatment is used to treat acute mania?

A 
Treatment free:
Atypical antipsychotic / mood stabiliser
With short course benzodiazepines
On treatment:
Optimise, consider adding another agent
Short course benzos
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19
Q

When is maintenance treatment for BPAD indicated?

A

Those who have had >1 episode

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20
Q

What is the prognosis in BPAD?

A

Poor
90% who have a single manic episode have future ones
Avg = 4 episodes in 10 yrs
10-15% have 4 or more in 1 yr = rapid cycling
10-15% complete suicide

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21
Q

What is the Monoamine hypothesis?

A

Depression and mania due to imbalances in
Noradrenaline
Serotonin
Dopamine
Likely oversimplification of reality however explains in part why antidepressants work

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22
Q

Are depression and BPAD heritable?

A

A combination of genes probably increase the risk of mood disorders which run in families
Adoption studies show higher risk in children of depressed parents even when raised in ‘depression free’ adoptive families

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23
Q

What childhood experiences might put someone at risk of depression?

A

Early childhood abuse
Relentless criticism
Parental loss
Perceived lack of affection

24
Q

What factors might out adults at risk of depression?

A 
Vulnerability factors can reduce resilience to adverse situations:
Unemployment
Lack of confiding relationship
Lower socio-economic status
Social isolation
25
Q

Life events increase risk of depression sixfold in the 6 months following them. Rank according to degree of stress.

A
  1. Death of spouse
  2. Divorce
  3. Marital separation
  4. Jail term
  5. Death of close relative
26
Q

What can trigger manic episodes?

A

The puerperium
Sleep deprivation
Flying across time zones

27
Q

What are organic causes of depression?

A

Cushing’s, hypothyroidism, hyperparathyroidism
Stroke, Parkinson’s, MS
Medications: beta blockers, antihypertensives

28
Q

What are organic causes of mania?

A

Cushing’s
Head injury, MS
Drugs: steroids, antidepressants, stimulants

29
Q

What is Beck’s model of depression?

A

Negative thinking -> depressed mood -> negative thoughts:
Self = worthless, guilty
Future = hopeless
World = helpless

30
Q

What is the learned helplessness model of depression?

A

Seligman 1976
Dogs repeatedly given unavoidable electric shocks
Gave up escape attempts even once freed
People learn that they cannot change their situation and give up trying

31
Q

What is the monoamine hypothesis?

A

Depression is the result of a deficiency in the following:
Noradrenaline: mood + energy
Serotonin: sleep, appetite, memory and mood
Dopamine: affects psychomotor activity

32
Q

What biochemical findings in depression support the monoamine hypothesis?

A

Decr: plasma tryptophan (5HT precursor)
Decr: CSF level 5-HIAA (5HT metabolite) in suicide victims
Decr: CSF level homovanillic acid (dopamine metabolite)

33
Q

What can the monoamine hypothesis not explain?

A

4-6 wk delay in action of antidepressants

Despite rapid chemical effects

34
Q

How does the monoamine hypothesis explain mania

A

Dopamine over activity
As drugs which increase dopamine levels can induce manic symptoms: bromocriptine, amphetamine, cocaine
Antipsychotics (dopamine receptor antagonists) treat mania

35
Q

What symptoms might you expect to see with seasonal affective disorder?

A

Predictable low mood in winter
Reversed biological symptoms: overeating, oversleeping
Treatment = light box

36
Q

What symptoms might you see in atypical depression?

A

Reverse biological symptoms: overeating + over sleeping

May retain mood reactivity

37
Q

What symptoms might you see in agitated depression?

A

Psychomotor agitation instead of retardation:
Restlessness
Pacing
Hand-wringing

38
Q

What symptoms might you see in depressive stupor?

A

Profound psychomotor retardation:
Mute
Stop eating + drinking
Stop moving

39
Q

What is the differential diagnosis in suspected cases of depression?

A

Bio: hypothyroidism, head injury, neoplastic, delirium
Adjustment disorder: mild affective sx following life event
Bereavement / normal sadness
BPAD/schizoaffective/schizophrenia: prev manic/psychotic features
Substance misuse:
Postnatal depression
Dementia

40
Q

When is grief abnormal?

A

Extremely intense: severity of depression, sx disabling
Prolonged: > 6 months without relief ? >12 now
Delayed: no sign of emotional response for >2 wks
Look for evidence of the person moving forward, get worried if grief becomes stuck

41
Q

How would you investigate a person with apparent depression?

A

Collateral history
Physical examination
FBC: anaemia, TFT:hypothyroidism, G/HBA1c: DM= fatigue
Rating scale to monitor severity/ treatment response
If suspected cerebral pathology: CT/MRI head

42
Q

What rating scales are used in depression?

A

BDI: Beck Depression Inventory
HADs: Hospital Anxiety and Depression Scale

Used to determine severity or monitor treatment response

43
Q

What are the aims of CBT in depression?

A

To challenge negative beliefs
(NATs negative automatic thoughts)
Through: discussion + behavioural experiments
Build alternative realistic beliefs
Increase daily exposure to positive stimulating activities
Activity scheduling

44
Q

What is ECT?

A

Fast life saving treatment
Electrodes used to produce generalised tonic-clinic seizure
Whilst patient is under GA

Risk = a degree of memory loss

45
Q

What are the criteria for diagnosing a manic episode?

A

Symptoms for at least 1 wk
Preventing work and ordinary social activities
If not entirely disrupting ability to function = hypomania

46
Q

What are the core symptoms of mania?

A 
Elevated mood (can be labile)
Boundless energy, overactive
Increased enjoyment and interest
47
Q

What are the cognitive symptoms in mania?

A

Inflated self-esteem and confidence
Hopeful, optimistic
Poor concentration, distractible, sometimes forgetful

48
Q

What are the biological symptoms in mania?

A 
Dramatically reduced sleep
Increased appetite 
High libido
Reckless, inappropriate, disinhibited behaviour
Drugs, alcohol, gambling, sex
49
Q

What is Type 1 BPAD

A

Manic episodes, interspersed with depressive episodes

50
Q

What is Type 2 BPAD?

A

Mainly recurrent depressive episodes

Less prominent hypomania episodes

51
Q

What is rapid cycling BPAD?

A

Four or more affective episodes/ year
More common in women
May respond better to sodium valproate

52
Q

What is the differential diagnosis in cases of suspected mania?

A

Organic cause
Schizophrenia
Cyclothymia
Postnatal disorders

53
Q

How would you investigate a person with apparent mania?

A 
Collateral history
Physical examination
FBC, TFT, CRP: rule out infection/thyroid problem
Urine drug screen
If indicated CT/MRI
54
Q

What are CIs to ECT use?

A

Complete CI: Raised ICP

Relative CI: heart disease, poor anaesthetic risk

55
Q

What are side effects of ECT?

A

Short term:
Headache, nausea, memory loss, cardiac arrhythmia
Long term:
Impaired memory

56
Q

When might ECT be used in BPAD?

A

In cases of prolonged or severe mania

57
Q

How do you differentiate mania from hypomania?

A

In mania there will be evidence of psychotic sx

Hypomania:
Elevated mood, irritable, pressured speech, flight of ideas, inattention, insomnia, loss of inhibitions, incr appetite

Toni's Psych (14 decks)

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