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Psychiatry > mood disorders > Flashcards

mood disorders Flashcards

1
Q

Core symptoms of depression (present for 2weeks, most days)

A 
Low mood
Anhedonia
Reduced energy (anergia)
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2
Q

Additional symptoms of depression (2 weeks)

A 
Reduced concentration
Reduced self-esteem
Ideas of guilt and unworthiness
Pessimism about the future
Ideas/Acts of self-harm/suicide

Disturbed sleep
Disturbed appetite

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3
Q

Somatic symptoms of depression (overlaps with DSM5)

A

Markedly reduced appetite
Weight loss (>5% of normal body weight in 1 month)
Early morning wakening (at least 2 hours before usual time)
Diurnal variation in mood (depression worse in the morning, improving through the day)
Psychomotor retardation/agitation
Loss of libido
Marked anhedonia
Lack of emotional reactivity

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4
Q

What is depression with psychosis?

A

In severe cases of depression!

Delusions:
Content congruent with low mood
Worthlessness, guilt, ill health, poverty, imminent disaster

Nihilistic delusions - belief that the self, part of the self, part of the body, other persons, or the whole world has ceased to exist
Persecutory delusions can also occur

Hallucinations:
2nd person auditory - eg. accusatory
Olfaction - eg. filth, rotting flesh

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5
Q

What are important risks for suicide in depression

A

Self-harm

Hopelessness

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6
Q

What is the suicide rate in depression?

A

5-15% completed suicide

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7
Q

What is ICD 10

A

Used to classify depression into mild, moderate and severe

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8
Q

What is a mild depressive episode according to ICD 10

A

At least 2 or 3 core symptoms
With additional symptoms overall at least 4 symptoms

With or without somatic syndrome

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9
Q

What is a moderate depressive episode according to ICD 10

A

At least 2 or 3 core symptoms
With additional symptoms overall at east 6 symptoms

With or without somatic syndrome

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10
Q

What is a severe depressive episode according to ICD 10

A

ALL 3 CORE symptoms

Plus additional symptoms giving at least 8 overall

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11
Q

What is a severe depressive episode with psychotic symptoms according to ICD 10

A

ALL3 CORE symptoms
Plus additional symptoms giving at least 8 overall

PLUS
delusions, hallucinations or depressive stupor (speechless and motionless for an extended period)

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12
Q

Psychiatric differentials for mood symptoms

A

Schizophrenia
Anxiety disorder
Eating disorder
Dementia

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13
Q

Organic differentials for mood symptoms

A 
Multiple sclerosis
Parkinsons
CVA
Head injury
Cerebral tumours

Cushing’s/Addison’s disease

Iatrogenic - L-Dopa, opiates

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14
Q

When are patients managed in hospital rather than Community (GP)

A

Severe depression
First line treatment unsuccessfull
Levels or risk escalating

Community mental health team or Crisis team may be indicated

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15
Q

Epidemiology of depression

A

M:F = 1:2
Lifetime prevalence of depressive symptoms is 10-20%
Point prevalence of major depressive illnessis 5%

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16
Q

What is the aetiology of depression

A

Biological: substance misuse, genetics, serious illness, hormonal changes

Psychological: negative thoughts, learned helplessness

Social: life events, social isolation, bereavement, loss, childhood abuse, social adversity

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17
Q

Prognosis of depression

A

50-60% will recover within a year

Chronic depression (more than 2 years) occurs in 10-25%

5-15% will die by suicide

RELAPSE is a PROBLEM:
75% will have one relapse in the next 10 years

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18
Q

Investigations for physical causes of mood disorders

A

CRP or ESR for infection

Vit B12 and folate for deficiencies

Urine drug screen

EEG - if epileptic focus or intracranial pahology suspected

Brain CT and MRI
EEG

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19
Q

List the social interventions in mood disorders

A

Support with regard to education, training, employment

Carer support

Community psychiatry nurse (CPN) and outpatient appointments to monitor symptoms, mood, mental state (for severe depression)

Support with regards to housing and benefits

Work around social inclusion

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20
Q

List the psychological treatments of depression

A

CBT
Interpersonal therapy
Psychoeducation (empower to know about disease)
Self-help materials

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21
Q

List the biological treatments of depression

A

1st line SSRIs

In treatment resistant depression, augmentation with:
2nd generation antipsychotics
Lithium
Triiodothyronine

Electroconvulsive Therapy (ECT)

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22
Q

STEP 1 of management of depression (suspected presentation)

A 
Assess
Active monitoring
Psychoeducation
Computerized CBT
Sleep hygiene
Guided self-help
23
Q

STEP 2 of management of depression (mild-moderate)

A

PRIMARY CARE

Low-intensity psychological interventions (such as self-help)
Medication -SSRIs such as citalopram, sertraline, fluoxetine, paroxetine

24
Q

STEP 3 of management of depression (moderate-severe) or treatment resistant

A

PRIMARY CARE
Medication
High-intensity psych interventions (individual CBT and IPT)
Consider referring ot secondary care

25
Q

STEP 4of management of depression (severe complex depression, life-threatening, severe self-neglect)

A

SECONDARY care

Medication - here, other agents might be considered, including drugs like:
venlafaxine (SNRI)
mirtazapine (NASSA)
imipramine (TCA)
phenelzine (MAOI)

adjunctive medications: such as antipsychotics or lithium

High-intensity psychological interventions

ECT

Crisis Resolution and Home Treatment (CRHT)
Multidisciplinary (MDT) approach
Inpatient care

26
Q

How long should pharmacotherapy be continued for after recovery from a single episode of depression

A

6 months to reduce risk of relapse

27
Q

How long should pharmacotherapy be continued for after recovery from recurrent depression

A

2 years

28
Q

Epidemiological risk factors for suicide

A

Male of any age (although younger females more
likely to self-harm)
Being lesbian, gay, bisexual, or transgender (particularly
younger people)
Prisoners (especially remand)
Being unmarried (single, widowed, divorced)
Unemployment
Working in certain occupations (farmer, vet, nurse,
doctor)
Low socioeconomic status
Living alone, social isolation

29
Q

Clinical risk factors for suicide

A

Clinical factors:
Psychiatric illness or personality disorder (see Fig. 6.2)
Previous self-harm
Alcohol dependence
Physical illness (especially debilitating, chronically
painful, or terminal conditions)
Family history of depression, alcohol dependence or
suicide
Recent adverse life-events (especially bereavement)

30
Q

Management of self-harm

A

Initial assessment of physical health, mental state, safeguarding, social circumstances and risk of repetition/suicide

Comprehensive psychosocial assessment

Monitor accordingly

Self-harmers are 66x more likely to die by suicide

31
Q

Factors predicting repetition of self-harm

A

No. of previous episodes

Personality disorder

History of violence

Alcohol misuse/dependence

Being unmarried

32
Q

Which factors indicate suicidal intent?

A 
Precautions to avoid intervention
Planning
Leaving a note
Use of violent methods
Perceived lethality by patient (did you think that it would kill you?)
33
Q

Investigations for mood disorders

A

Social: collateral info from GP, community mental health team, family
Consider home visit to assess self-care

Psychological:
Beck Depression Inventory (BDI)
Hospital Anxiety and Depression Scale (HADS)

34
Q

Action of antidepressants

A

most inhibit serotonin reuptake or noradrenaline reuptake or both

35
Q

Side effects of SSRIs

A

(fluoxetine, citalopram, sertraline, paroxetine)

Nausea
Insomnia
Apathy/fatigue
Diarrhoea
Dizziness
Sweating

Akathisia
Sexual dysfunction

Paroxetine causes cardiac defects in first trimester

36
Q

Indications and side effects of TCAs

A

Amitryptiline, Imipramine, Clomipramine

Toxic in overdose!
Anti-muscarinic side effects:
Dry mouth
Blurred vision
Constipation
Retention
Sedation
Weight gain
Dizziness
Hypotension
Delirium

Indicated in pregnancy! (not teratogenic)

37
Q

Side effects of SNRIs

A

2nd or 3rd line treatment
Venlafaxine
Duloxetine

Similar SEs as SSRI with more discontinuation symptoms (headache, distress, depression)

38
Q

Side effects of MAOI and indications

A

Phenelzine, Trancypromine

Used in treatment resistant depression and atypical depression

Risk of CHEESE Reaction (tyromine containing foods)

Anti-muscarinic side effects

39
Q

Indications for ECT

A

Treatment resistant depression
Life-threatening severe depression
Treatment resistant mania
Catatonia

40
Q

Contraindications to ECT

A

Cochlear implant (ABSOLUTE)

Raised ICP
History of stroke, MI, aortic aneurysm
Uncontrolled arrhythmias
DVT
Decompensated cardiac failure
41
Q

Side effects of ECT

A

Headache
Confusion
Impaired cognitive function

Temporary retro and anterograde amnesia
Some events in previous years can be lost

42
Q

Indications of antidepressants

A 
Depressive illness
Anxiety disorders
Neuropathic pain
Insomnia
Bulimia nervosa
Impulsivity
Migranies
IBS
Chronic fatigue syndrome
43
Q

What is Mirtazapine?

A

Noradrenaline and specific serotonergic antidepressant (Nassa)

44
Q

When is Mirtazapine used. Side effects?

A

May be superior to SSRIs in depression
Reduce anxiety
Combine with other antidepressants if treatment resistant

Sedation and/or weight gain on relatively low doses

45
Q

Interactions with St John’s Wort

A

Inducer, leading to loss of therapeutic effect:
Oral contraceptive
Digoxin
Warfarin
HIV protease inhibitor
Anticonvulsants (phenytoin, carbamazepine)

46
Q

Which antidepressants have the greatest withdrawal effects

A

paroxetine (SSRI)
venlafaxine (SNRI)

Tapering the dose down over 4 weeks can help reduce the symptoms

47
Q

Which antidepressants do not cause weight gain?

A

SSRIs

SNRIs

48
Q

Which antidepressants cause weight gain?

A

TCAs

Most caused by NaSSA

49
Q

Which antidepressant does NOT cause sedation?

A

SSRIs

50
Q

Epidemiology of self-harm

A

Male to female ratio - 1:2
Divorced > Single > Widowed > Married
Two-thirds of people who harm themselves are under 35 years of age
Overdoses and cutting are the most common methods

51
Q

Factors of self-harm

A

Predisposing
Precipitating
Perpetuating

52
Q

Indications for ECT

A

Treatment-resistant depression
Life-threatening severe depression
Treatment-resistant mania
Catatonia

A patient will typical receive between 4 and 12 sessions in a course of ECT. The sessions usually occur twice per week.

53
Q

Mechanism of ECT

A

Modulation of neurotransmitter functioning
Changes in regional blood/activity
Modulation of neuronal connectivity
Alterations of neuronal structures, including hippocampal neurogenesis

54
Q

How is ECT monitored?

A

With an EEG

Can see when the seizure has finished

Psychiatry (15 decks)

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