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Psychiatry > Mood disorders > Flashcards

Mood disorders Flashcards

1
Q

epidemiology

A

depression: F>M (2x);
10-20% gen pop lifetime prevalence; 5% (1/4 major depression; 10% of cases referred (2o care), 0.1% Ax

bipolar: lifetime risk 1%; M=F; average age 21y

more stats in notes

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2
Q

depression - aetiology

A

biological: genetics (40%; more with more severe); illness, substances, hormones (postnatal), brain changes
- brain: frontal lobe, limbic, neuroplasticity, NT (low NA/5HT/DA)

psych: negative thoughts, PDT, learned helplessness
social: stressors, isolation, breavement/loss, childhood (e.g. abuse), social adversity

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3
Q

depression - prognosis

A

50-60% recover, 10-25% chronic (>2y)

recurrence: 85% lifetime risk; 25%

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4
Q

depression - Dx criteria

A

add least 2 core symptoms

more than 2 weeks

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5
Q

depression - features

A

‘DEPRESSION’;

Core: persistent low mood; anhedonia (interest/enjoyment), anergia

cognitive: concentration, memory, motivation; self-esteem, confidence, worthless; guilt, hopeless, helpless; DSH/SI
biological: sleep (EMW, insomnia/hypersomnia, repeated waking), appetite and weight (?carbs); somatisation; diurnal (AM worse); psychomotor; libido; blunted affect

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6
Q

mania - Dx criteria

A

elevated/irritable mood >1/52 and 3+ of:

  • decreased sleep
  • grandiosity/self esteem
  • pressured speech
  • flight of ideas
  • distractible
  • psychomotor agitation/goal-directed activity
  • risky/disinhibited behaviour
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7
Q

mania - features

A

> 1/52 or Ax needed
elevated/irritable mood; labile;
increased energy, decreased sleep
disinhibition, libido, grandiosity, risky behaviour
distractible, flight of ideas, rapid thinking
impaired function

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8
Q

DSH/SI stats

depression 5-15% suicide; BAD 10%; schiz 4-10%
alcohol 15%

A

SI: leading CoD 15-44 (esp. M); hanging (M), poison (F)
peaks in spring, economic depression, prominent media coverage

DSH: F>M (2x); divorced>single>widow>married
2/3

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9
Q

DSH/SI - RF

A

fixed: male, young/old, LGBTQ, prisoner, unemployment, occupations, socioeco class, immigrant/refugee, poor support/isolation
clinical: psych/physical illness (90% of psych; 25% already known); substances; PMH (DSH 50%; 100x), FHx; stressors

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10
Q

DSH/SI - immediate Mx

A

history: before during after (intent, discovery, final acts); current MSE/plans, protective factors

Risk + MSE; ?IP/MHA
reduce access, support, modify RFs (illness, social function, crisis planning)

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11
Q

acute mania Mx

A

environment: ?Ax; less stimulating, control/structure, delay decisions
check current meds and dose/compliance: ?increase dose, ?combo (APD/MS)

bio: stop ADD, start APD (olanz best); mood stabiliser (L/V); ?BZD
psychsocial: education

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12
Q

BPS Mx

A

history/collateral, ?MHA/MCA, levels, ?tranq
location and team: CRHT, EIP, IP, CMHT
investigations

BPS approach
follow-up

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13
Q

risk assessment

A

coping mechs: alcohol and drugs;deterioration
SI/DSH/neglect; dependents
reputation, disinhibtion/impulse control, grandiosity, exhaustion
risk from others: aggravation
elderly: comorbidity, access, bereavement, support, suicide
*DSH >65yo = Ax (intention)

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14
Q

adjustment reaction

A

reaction to stressors

onset

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15
Q

bereavement?

A

phases of grief

grief counselling: facilitate progression

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16
Q

psychotic depression

A

delusions: mood congruent; nihilistic, worthless, guilt, ill health, poverty, imminent disaster, may be persecutory
hallucinations: olfactory (rotting), auditory (2nd person; defamatory/accusatory)

17
Q

depression severity

A

number of symptoms and functional impact: subthreshold 20: severe; ADD + PT

18
Q

Low mood DDx

A

organic: delirium, dementia, SOL, substances, hypothyroid, anaemia, metabolic, hyperCa, infection, meds, pain
psych: depression, dysthymia, BAD, cyclothymia, anxiety, psychosis, PD, adjustment, ED, schizoaffective

19
Q

Hypomania features

A

> 4 days
mildly elevated/irritable; distractible, ?labile
increased energy, increased libido, decreased sleep
risk taking, sociable, over-familiartity

20
Q

psychosis in mania

10% have FRS

A

delusions: mood congruent; self-esteem/ideation; grandiose; irritability and suspicious (can be persecutory)
hallucinations: less common, mood congruent 2nd person auditory

21
Q

patterns of mood

A

recurrent depression: repeated dips; otherwise normal variation
dysthymia: >2y persistent low mood, not depression
double depression: dysthymia + depression
BAD: >2 episodes, at least one manic
cyclothymia: >2y of increased variation but subthreshold
rapid cycling: >4 episodes per year

22
Q

barriers to presentation

A

masking physical illness; physical priority
communication/time/rapport
clinician awareness
substance abuse, comorbid MH

subtle mania Sx, not seen as an issue to patients, lack of insight

23
Q

NT functions

A

low NA: energy, motivation, attention, memory

low 5HT: mood, sleep, food cravings

low DA: anhedonia, cravings, compulsive behaviour

cortisol: stress; excess = toxic to hippocampus

24
Q

Bipolar - aetiology

A

biological: genetic (70%), FDR 7x, substances
psychological: PDT, negative thoughts
social: stressors, interpersonal conflict

25
Q

BAD - prognosis

A

usually 8-10 episodes in life in untreated; depp > mania (freq/duration/severity)
90% further episodes after mania (4in10y)
no cure; Rx reduces intensity and frequency; 30% residual abnormal mood in between episodes
suicide 10%
relapse: compliance, stressors, circadian rhythm, substances, childbirth, natural

26
Q

high mood DDx

A

organic: delirium, dementia, steroids, DA-agonists, substances, hyperthyroid, metabolic, SOL, seizure
psych: BAD, isolated manic episode, cyclothymia, schizophrenia/affective, PD, depression,

27
Q

Depression stepped care

A

I: all known/suspected cases; monitor, education, self-help, lifestyle
II: mild/mod; 1o; low intensity PT (incl. MF); ?meds
III: mod/severe/fail; 1o; meds and/or high intensity PT (CBT, IPT); ?2o referral
IV: severe complex/Life-threatening; 2o, combo, ?ECT, ?IP (risk)

28
Q

depression referral

A 
significant risk
uncertain diagnosis
?psychotic depression
treatment resistant (2x ADD)
complex presentation e.g. comorbidities
29
Q

depression Mx

A

biological: ADDs; augmentation (lithium, atypical APD, T3); ECT
psychological: education, self-help, CBT, IPT, mindfulness
social: lifestyle, hobbies etc.

follow-up: 2/52; drug effect/compliance at 2-4 weeks;

  • no effect: ?increase dose, ?switch
  • some effect: continue another 2-4 weeks
30
Q

BAD Mx

A

bio: mood stabiliser (L/V/C/L); APD (O/Q); ?SSRI /Q (risk of mania if no MS); ?ECT
psych: education; CBT, FIT (EE)
social: usual headings
f/u: 72h IP, 1/52 d/c, 2-4 weeks for 3/12 (relapse risk)

relapse PPx: APD + MS >2y (5y if relapse); avoid ADD; psychosocial
other: annual r/v; contraception

31
Q

assessment

A

timing, onset, duration of each episode
triggers and stressors
full range of depression Sx
any manic episodes
other symptoms/differentials incl. DH/substances
functional assessment, coping, personality, support

32
Q

Mania vs. hypomania

A

Mania: impact on function, marked change in sleep/(sex) energy, risky behaviour, flight of ideas, grandiosity; 1 week duration

hypomania: less severe mood/sleep/energy, less risky, may have pressured speech but usually no flight of ideas; 4 days duration

psychotic is always mania

Psychiatry (16 decks)

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