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Mood disorders Flashcards

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1
Q

what are the 3 main symptoms depressive illness, and for how long should the patient be experiencing them

A

low mood, anhedonia, reduced energy. at least 2 of these for at least 2 weeks

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2
Q

features depression

A

decreased concentration, low self esteem, ideas of guilt and self worth, hopelessness, thoughts self harm, decr sleep or appetite

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3
Q

what is common in depression with regards to pattern of the depression

A

diurnal variation- worse on waking. early morning waking

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4
Q

what are the features of psychotic depression

A

delusions- nihilistic, hallucinations- 2nd person

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5
Q

what differentiates psychosis in schizophrenia and depression

A

the thought content in depression is mood congruent

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6
Q

differentials for depression

A

normal sadness to bereavement, schizophrenia if psychotic, alcohol/drug withdrawal

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7
Q

aetiology of depression

A

genetics, parental loss, early childhood, abuse, alcohol/drug use, severe physical illness, life event, deprivation, lack of relationship

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8
Q

neurochemical changes in depression

A

decreased monoamines- noradrenaline and serotonin.

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9
Q

what hormone is high in depression

A

cortisol

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10
Q

what system isn’t functioning well in depression

A

limbic system and prefrontal cortex

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11
Q

what guides the severity of the depression

A

no of symptoms, severity of symptoms, degree of associated distress, interference with daily life

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12
Q

management mild depression

A

self help groups, physical activity sessions, computerised CBT

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13
Q

management moderate depression

A

add antidepressant and individual CBT

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14
Q

management severe depression

A

ECT

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15
Q

how long to continue antidepressants for

A

6 months- reduced relapse

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16
Q

what can you give for resistant depression

A

combine (augment) antidepressant with lithium, atypical antipsychotic or another anti depressant

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17
Q

which antidepressant is the only one licensed for use in the UK for adolescents

A

fluoxetine

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18
Q

what emergency can you get from antidepressants

A

serotonin syndrome

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19
Q

what is serotonin syndrome

A

increased serotonin- agitation,confusion, tremor, tachycardia, hypertension

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20
Q

how do SSRIs work

A

selective serotonin reuptake inhibitor. inhibit the reuptake of serotonin

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21
Q

examples of SSRIs

A

citalopram, fluoxetine, setraline

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22
Q

when should you give SSRIs

A

once a day- in the morning

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23
Q

side effects SSRIs

A

N&V, headache, diarrhoea, dry mouth, insomnia. linked to suicidality

24
Q

what is the syndrome you get when stopping SSRIs

A

discontinuity syndrome- shivery, dizzy, anxiety, headache, nausea, ‘electric shocks’

25
Q

how long should you give antidepressants for

A

6 months after improvement of symptoms

26
Q

what is SNRI

A

serotonin- noradrenaline reuptake inhibitor

27
Q

example of SNRI

A

venlafaxine

28
Q

how does venlafaxine work

A

block serotonin and NA reuptake. less sedation and anti muscarinic side effects. hypertension so don’t give to those prone to arrhythmia or hypertension

29
Q

what is NSSA and example

A

noradrenergic and specific serotonin antidepressant. mirtazapine

30
Q

how do MAOIs work

A

inhibit monoxidase A and B so increasing levels NA, dopamine, serotonin

31
Q

TCAs examples

A

nortryptiline, amytryptilline, imipramine, clomipramine, doxepin

32
Q

how do TCAs work

A

potentiate action of monoamines inhibiting their uptake into nerve terminals. block reuptake of both serotonin and NA

33
Q

side effects TCAs

A

dry mouth, constipation tremor, QT prolongation, arrhythmias, convulsants, weight gain, sedation, mania

34
Q

what is Becks cognitive triad

A

thought content often contains pessimistic thoughts- the self, the world, the future

35
Q

how long should you treat the episode at full dose

A

4-6 weeks. takes about 2 weeks to start working so don’t change it too soon

36
Q

what muscle relaxant is used in ECT

A

suxamethonium- to relax muscles and so intensity of movement during seizure is reduced

37
Q

contraindications to ECT

A

absolute-incr ICP, prev MI (as HR and BP incr), aneurysm. relative- any medical problem

38
Q

indications for ECT

A

depression- severe life threateining resistant; catatonia; mania; schizophrenia ?

39
Q

how many ECTs is the usual course

A

12 but 7-9 usually needed to achieve remission

40
Q

side effects ECT

A

mortality low, muscle aches, confusion, short term memory loss.

41
Q

what drugs can be used to reduce relapse after ECT

A

nortryptilline and lithium

42
Q

lifetime risk depression

A

10-20%, rates almost doubled in women

43
Q

what can the episodes be in bipolar

A

depressive, manic, hypomanic, mixed

44
Q

what is the difference between manic and hypomanic

A

hypomanic is less severe and no psychotic symptoms

45
Q

what is the ICD10 definition diagnosing bipolar

A

at least 2 episodes including one manic/hypomanic

46
Q

what is the difference between bipolar type 1 and type 2

A

type 1- manic, type 2-hypomanic

47
Q

what is cyclothymic disorder

A

mod fluctuations lasting at least 2 years, with depressive and hypomanic episodes but not enough to meet diagnostic

48
Q

features manic/hypomanic episode

A

elated or irritable. incr psychomotor activity, incr optimism, rapid thinking and speech, decr social inhibition, incr self esteem, mania only- mood congruent delusions

49
Q

ddx mania

A

substance abuse, endocrine, schizophrenia, schioaffective, personality disorders

50
Q

prevalence bipolar 1 an 2

A

1% 1, 1.5-2% 2

51
Q

when is peak age of onset in bipolar

A

20s

52
Q

aetiology

A

predisposing- genetics. precipitating- stress, life events, sleep deprivation, illict drugs, childbirth, hyperthyroidism, steroids, epilepsy

53
Q

management

A

anti manic drugs- lithium, valproate, carbamazepine, lamotrigine. atypical antipsychotics- olanzapine etc

54
Q

psychological treatment bipolar

A

focus on depressive symptoms, problem solving, promoting social functioning, education

55
Q

prognosis

A

90% recurrence after single episode, worse prognosis if rapid cycling, better if type 2

Psych (15 decks)

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