Mood disorders Flashcards
ICD-10: 3 core symptoms for depression
- Depressed mood
- Anhedonia
- Decreased energy/ increased fatigue
ICD-10: other non-core symptoms of depression
- decreased concentration
- decreased self-esteem, confidence
- decreased appetite
- thoughts of guilt, worthlessness
- thoughts of self-harm/ suicide
- disturbed sleep
- psychomotor changes
According to ICD-10, what is -mild -moderate -severe depression
Mild = 2 core + >2 other symptoms
Moderate = 2 core + >3 other symptoms
Severe = 3 core + >4 other symptoms
ICD-10: 7 symptoms of hypomania
4 behaviour changes, 3 habit changes
BEHAVIOUR
- ++ Activity, physical restlessness
- ++ Talkativeness
- ++ distracted
- Over-friendly
HABITS
- Decreased need for sleep
- ++ Sexual energy
- Mild overspending
ICD-10: 9 symptoms of mania
4 behaviour changes, 5 habit/ thought changes
BEHAVIOUR
- Increased activity, physical restlessness
- Increased talkativeness, pressure of speech
- Distractibility, constant change of plan
- Loss of social inhibition
HABITS/ THOUGHTS
- Flights of ideas OR subjective experience of thoughts
- Decreased need for sleep
- Inflated self esteem
- Reckless behaviour eg spending, driving
- Increased sexual energy
5 types of depression drugs
- SSRIs
- SNRIs
- Atypical antidepressants
- MAO inhibitors
- TCA
Most serious complication of MAO inhibitors
Hypertensive crisis (fatal)
Most serious complication of TCA
Overdose –> cardiac arrhythmia –> death
What are some mood stabilisers that can be used in depression
- Lithium
- Sodium valproate
- Lamotrigine
- Carbamazepine
If a woman is pregnant but needs mood stabilisers, what can be given instead
Antipsychotics (not teratogenic)
eg Olanzepine
Describe the monoamine theory of depression
- low serotonin
- low noradrenaline
What psychomotor changes might be seen in severe depression
- retardation (of speech, movement)
- agitation
- depressive stupor (sitting motionless and mute, treated with ECT)
What psychomotor changes might be seen in severe depression
- retardation (of speech, movement)
- agitation
- depressive stupor (sitting motionless and mute, treated with ECT)
What psychomotor changes might be seen in severe depression
- retardation (of speech, movement)
- agitation
- depressive stupor (sitting motionless and mute, treated with ECT)
What psychotic symptoms might be seen in severe depression
- 2nd person auditory hallucinations
- Nihilistic delusions
- Delusions of guilt, persecution, impending catastrophe
- Cotard’s syndrome (believing that part of them is dead)
What drugs can increase risk of depression?
Which is the most common cause
- STEROIDS (most common)
- Calcium channel blockers
- Beta blockers
- Digoxin
- Opiates
Define dysthymia
Chronic mild depression that doesn’t meet severity criteria for depressive episodes/ recurrent depression
(onset often in adolescence)
Define cyclothymia
- Mood swings less severe, last longer than in those with full bipolar disorder
- Potential to develop into full bipolar disorder
Define bipolar 1
- At least 1 high/manic episode, which last >1week
* May only have MANIA, or may have MANIA + depression
Define bipolar 2
- More than 1 episode of severe depression
* Only HYPOmanic episodes
If untreated, how long would mania and depression last in a bipolar person
Mania = 3-6 months Depression = 6-12 months
What bloods would you do for depression and bipolar
- FBC (check for anaemia)
- TFTs (hypothyroidism)
- Calcium (hypocalcaemia)
- BM (diabetes can cause fatigue)
- LFTs, UnEs (baseline before starting SSRIs, lithium)
What drugs can increase risk of mania?
- Steroids
- L-DOPA
- Isoniazid
- Anti-cholinergics
- Cocaine
- Amphetamine
Define mixed affective state disorder
Depressive + mania symptoms but not severe enough to diagnose either
When does maternity blues happen?
What causes it?
Starts and ends a few days after childbirth.
Caused by rapid hormonal changes
When does puerperal depression happen?
Within 1 month of childbirth
When does puerperal psychosis happen?
Within 2-14 days of childbirth
What is the normal lithium range in a blood test?
0.6-1 mmol/L
What must TFTs and UnEs be checked before starting lithium?
Lithium can cause
- hypothyroidism
- kidney failure
Which mood stabiliser can cause Steven Johnsons syndrome
Lamotrigine
How might lithium lead to lethargy and constipation
Lithium can lead to hypothyroidism
