Mood disorders Flashcards
what are the 3 main symptoms depressive illness, and for how long should the patient be experiencing them
low mood, anhedonia, reduced energy. at least 2 of these for at least 2 weeks
features depression
decreased concentration, low self esteem, ideas of guilt and self worth, hopelessness, thoughts self harm, decr sleep or appetite
what is common in depression with regards to pattern of the depression
diurnal variation- worse on waking. early morning waking
what are the features of psychotic depression
delusions- nihilistic, hallucinations- 2nd person
what differentiates psychosis in schizophrenia and depression
the thought content in depression is mood congruent
differentials for depression
normal sadness to bereavement, schizophrenia if psychotic, alcohol/drug withdrawal
aetiology of depression
genetics, parental loss, early childhood, abuse, alcohol/drug use, severe physical illness, life event, deprivation, lack of relationship
neurochemical changes in depression
decreased monoamines- noradrenaline and serotonin.
what hormone is high in depression
cortisol
what system isn’t functioning well in depression
limbic system and prefrontal cortex
what guides the severity of the depression
no of symptoms, severity of symptoms, degree of associated distress, interference with daily life
management mild depression
self help groups, physical activity sessions, computerised CBT
management moderate depression
add antidepressant and individual CBT
management severe depression
ECT
how long to continue antidepressants for
6 months- reduced relapse
what can you give for resistant depression
combine (augment) antidepressant with lithium, atypical antipsychotic or another anti depressant
which antidepressant is the only one licensed for use in the UK for adolescents
fluoxetine
what emergency can you get from antidepressants
serotonin syndrome
what is serotonin syndrome
increased serotonin- agitation,confusion, tremor, tachycardia, hypertension
how do SSRIs work
selective serotonin reuptake inhibitor. inhibit the reuptake of serotonin
examples of SSRIs
citalopram, fluoxetine, setraline
when should you give SSRIs
once a day- in the morning
side effects SSRIs
N&V, headache, diarrhoea, dry mouth, insomnia. linked to suicidality
what is the syndrome you get when stopping SSRIs
discontinuity syndrome- shivery, dizzy, anxiety, headache, nausea, ‘electric shocks’
how long should you give antidepressants for
6 months after improvement of symptoms
what is SNRI
serotonin- noradrenaline reuptake inhibitor
example of SNRI
venlafaxine
how does venlafaxine work
block serotonin and NA reuptake. less sedation and anti muscarinic side effects. hypertension so don’t give to those prone to arrhythmia or hypertension
what is NSSA and example
noradrenergic and specific serotonin antidepressant. mirtazapine
how do MAOIs work
inhibit monoxidase A and B so increasing levels NA, dopamine, serotonin
TCAs examples
nortryptiline, amytryptilline, imipramine, clomipramine, doxepin
how do TCAs work
potentiate action of monoamines inhibiting their uptake into nerve terminals. block reuptake of both serotonin and NA
side effects TCAs
dry mouth, constipation tremor, QT prolongation, arrhythmias, convulsants, weight gain, sedation, mania
what is Becks cognitive triad
thought content often contains pessimistic thoughts- the self, the world, the future
how long should you treat the episode at full dose
4-6 weeks. takes about 2 weeks to start working so don’t change it too soon
what muscle relaxant is used in ECT
suxamethonium- to relax muscles and so intensity of movement during seizure is reduced
contraindications to ECT
absolute-incr ICP, prev MI (as HR and BP incr), aneurysm. relative- any medical problem
indications for ECT
depression- severe life threateining resistant; catatonia; mania; schizophrenia ?
how many ECTs is the usual course
12 but 7-9 usually needed to achieve remission
side effects ECT
mortality low, muscle aches, confusion, short term memory loss.
what drugs can be used to reduce relapse after ECT
nortryptilline and lithium
lifetime risk depression
10-20%, rates almost doubled in women
what can the episodes be in bipolar
depressive, manic, hypomanic, mixed
what is the difference between manic and hypomanic
hypomanic is less severe and no psychotic symptoms
what is the ICD10 definition diagnosing bipolar
at least 2 episodes including one manic/hypomanic
what is the difference between bipolar type 1 and type 2
type 1- manic, type 2-hypomanic
what is cyclothymic disorder
mod fluctuations lasting at least 2 years, with depressive and hypomanic episodes but not enough to meet diagnostic
features manic/hypomanic episode
elated or irritable. incr psychomotor activity, incr optimism, rapid thinking and speech, decr social inhibition, incr self esteem, mania only- mood congruent delusions
ddx mania
substance abuse, endocrine, schizophrenia, schioaffective, personality disorders
prevalence bipolar 1 an 2
1% 1, 1.5-2% 2
when is peak age of onset in bipolar
20s
aetiology
predisposing- genetics. precipitating- stress, life events, sleep deprivation, illict drugs, childbirth, hyperthyroidism, steroids, epilepsy
management
anti manic drugs- lithium, valproate, carbamazepine, lamotrigine. atypical antipsychotics- olanzapine etc
psychological treatment bipolar
focus on depressive symptoms, problem solving, promoting social functioning, education
prognosis
90% recurrence after single episode, worse prognosis if rapid cycling, better if type 2
