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3a psychiatry > Mood Disorders > Flashcards

Mood Disorders Flashcards

1
Q

What are the possible causes of depression?

A
  1. genetics
  2. psychosocial factors e.g. unemployment, bereavement, childhood stress, poverty, divorce
  3. physical illness e.g. cancer, MS, dementia, COPD, chronic pain
  4. personality
  5. failure of adaptive mechanisms to stressors
  6. past head injury
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2
Q

What are the 2 core symptoms used to screen for depression?

A
  1. during the last month, have you often been bothered by feeling down, depressed or hopeless
  2. during the last month, have you been bothered by having little interest or pleasure in doing things
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3
Q

List the 9 symptoms of depression recognised by DCM5/NICE

A 
low mood/ depressed/ hopeless*
little pleasure or interest in doing things*
lack of energy , fatiguability 
lack of concentration
insomnia - difficulty sleeping
weight loss, reduced appetite 
thoughts of guilt and worthlessness
thoughts of self harm or suicide 
psychomotor agitation
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4
Q

What is the criteria for diagnosis of depression by NICE?

A

5/9 symptoms present for at least 2 weeks (1 of which must be a core symptom)

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5
Q

What is Becks cognitive triad?

A

depressive thought content:
the self
the world
the future

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6
Q

What are the features of severe depression and an increased risk of suicide?

A 
low mood/ anhedonia and >4/7 of the following:
S - suicide plans 
U- unexplained guilt 
I - inability to function
C - concentration reduced 
I - impaired appetite 
D - decreased sleep
E - energy low
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7
Q

How is depression classified?

A

sub threshold depression: <5/9 symptoms

mild depression: >5/0 symptoms causing mild functional impairment

moderate: symptoms or functional impairment marked
severe: several symptoms in excess of those required +/- psychomotor symptoms causing impaired functional ability

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8
Q

List some of the risk factors for suicide

A

SOCIAL - male, <30 y/o, elderly, single/ live alone

HISTORY- prior suicide attempt, FH of suicide, history of substance/ alcohol abuse, recently started on anti depressants

CLINICAL- anxiety/ panic attacks, psychosis, severe depression, concurrent physical illness, feeling hopeless

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9
Q

Which screening tools can be used for depression?

A
  1. Patient Health Questionaire 9 (PHQ9)
  2. Hospital Anxiety and Depression score (HAD)
  3. ICD-10 depression inventory
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10
Q

What is the pneumonic for depression history taking/ symptoms to remember?

A

D- depressive
E- energy levels
A- anhedonia
D-death thoughts

S- sleep pattern
W- worthlessness
A- appetite 
M- memory, concentration
P- psychomotor agitation
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11
Q

What are the management options for each classification of depression?

A

mild = psychological intervention through referral or self referral to IAPT

moderate = offer anti depressant and high intensity psychological intervention

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12
Q

which interventions are included in IAPT (improving access to psychological therapies)?

A
  1. individual guided self help based on CBT principles (6-8 sessions over 12 weeks)
  2. computerised CBT
  3. structured group based CBT or physical activity programme
  4. high intensity individual CBT (16-20 sessions for 3-4 months(
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13
Q

What are the possible aetiological factors for mood disorders?

A

changes in the brain - reduced serotonin, noradrenaline and dopamine
genetics
other physical health conditions e.g. dementia, stroke, hypothyroidism, brain trauma
medications e.g. corticosteroids, roaccutane, levodopa
alcohol and drug abuse

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14
Q

when would antidepressants be suitable in mild depression?

A
  1. history of moderate or severe depression
  2. sub threshold depressive symptoms that have persisted for long period (>2 years)
  3. mild depression that is complicating care of chronic physical health problem
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15
Q

how should you manage a patient with depression?

A

assess suicide risk
manage safeguarding concerns for children or vulnerable adults
manage co-morbid conditions e.g. alcohol, anxiety
active monitoring - 1 week if <30 y/o or 2 weeks after starting anti depressant

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16
Q

What are “baby blues”?

A

transient normal condition where new mothers experience a short period (2 weeks) of symptoms starting 2/3 days after birth e.g. emotional lability, crying, irritability, worries about coping with a baby

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17
Q

how is post natal depression diagnosed?

A

**same criteria for DSM-5 depression of >5/9 symptoms for >2 weeks **

e.g. hopelessness, overwhelming feelings of responsibility, feelings of guilt/ bad mother, social withdrawal, anxiety symptoms, unrealistic worrying for the baby, reluctance to hold or feed baby

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18
Q

When is post natal depression most common?

A

peaks at 3-4 weeks post part
90% lasts <1 month
concern for mother-baby bond and development of child

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19
Q

What are the risk factors for post natal depression?

A 
family history of depression or previous depression
older age
single mother 
unwanted pregnancy 
poor social support 
severe baby blues 
premature baby 
previous post part psychosis
20
Q

What is cyclothymia?

A

= persistent mood disorder with early age onset and instability throughout adult life

21
Q

What are the clinical features of cyclothymia?

A

persistent instability of mood
numerous periods of mild depression and mild elation
mood swings unrelated to life events
gradual onset and lasts for life

22
Q

What is dysthymia?

A

chronic low grade depressive symptoms e.g. depressed mood for >2 years

23
Q

What is the definition of bipolar disorder?

A

characterised by recurrent episodes of altered mood and activity, involving depressive and manic episodes

24
Q

What are possible causes of bipolar disorder?

A

genetics
brain pathology - smaller prefrontal lobes, enlarged amygdala and globus pallidus
psychosocial stressors during childhood
post partum
drugs - anti depressants, alcohol, cannabis
lack of sleep

25
Q

What are the 2 types of bipolar disorder?

A
  1. bipolar 1 disorder = mania and depression
  2. bipolar 2 disorder = hypomania and depression

(cyclothymic disorder= chronic mood fluctuations over >2 years but insufficient to meet criteria of bipolar)

26
Q

What is the difference between manic and hypomanic episodes?

A

manic = alteration in mood which is elated and expansive and characterised by intense irritability

hypomania= similar to manic episodes but to a lesser degree and do not disrupt work/ lead to social rejection and NO psychotic episodes

27
Q

Describe the symptoms and criteria of a manic episode

A

= abnormally and persistently elevated, expansive or irritable mood lasting at least 1 WEEK accompanied by >3 additional symptoms and severe enough to cause marked impairment on social/ occupation functioning +/- psychotic features (1 EPISODE OF MANIA CAN DIAGNOSE BIPOLAR)

increased energy
decreased need for sleep
flight of ideas, pressured speech, racing thoughts
distractibility, reduced attention
inflated self esteem, grandiosity
decreased social inhibition - overspending, sexual overactivity, dangerous driving, inappropriate business ideas
mood congruent delusions and hallucinations

28
Q

Describe the symptoms/ criteria of hypomania

A

similar to mania but for OVER 4 DAYS and no psychotic features and no marked functional impairment

e.g. middle elevated mood, irritable, increased energy, increase self esteem, over familiarity, increased libido, decrease need for sleep

29
Q

describe the pattern of depression in bipolar

A

5/9 symptoms of depression for > 2 weeks

30
Q

How is acute mania managed?

A

1st line= atypical anti-psychotic e.g. olanzapine,haloperidol + give 1mg lorazepam for sedation

+ urgent referral to community mental health team

NEVER GIVE ANTIDEPRESSANTS AS WORSENS MANIC SYMPTOMS UNLESS WITH A MOOD STABILISING AGENT

31
Q

What is the first line treatment for bipolar disorder?

A

LITHIUM= mood stabiliser
400-600mg at night
checked after 7 days and then every 3 months

32
Q

What is rapid cycling disorder

A

4 or more episodes of hypomania, mania or depression over 12 months

33
Q

What is cognitive behavioural therapy?

A

A type of talking therapy that aims at changing the processes underpinning the thoughts and behaviours related to a patient’s symptoms.
Can be carried out 1-to-1 with a mental health individual, in group sessions, or utilizing online platforms.

34
Q

Describe interpersonal therapy

A

Addresses issues regarding communication behaviours between people, under the belief that some depression symptoms arise due to difficult interpersonal interactions.

35
Q

Describe behavioural action therapy

A

Aims at making small changes to ones lifestyle in order to alleviate depressive symptoms, by identifying ‘depression loops’.

36
Q

Which tests should be carried out before starting lithium treatment?

A

Measure weight, blood pressure and pulse.

Ensure renal function is normal - lithium is primarily excreted by the kidney.
Measure serum creatinine AND eGFR

Check FBC, U&E, creatinine, TFT, calcium.(Plasma lithium levels are increased by sodium)

Check there is no goitre; take blood for thyroid autoantibodies where there is a family history of thyroid disorders.

Consider baseline parathyroid hormone and magnesium.

Perform baseline ECG.

37
Q

What are the ranges for each stage of chronic lithium toxicity?

A
  1. 5-1.0 mmol - therapeutic range
  2. 0-1.5 - high but shouldn’t cause symptoms
  3. 6-2.0 - mild toxicity
  4. 1-2.5 - moderate toxicity

> 2.5 - severe toxicity

38
Q

What are the symptoms of chronic lithium toxicity?

A

mild - nausea, diarrhoea, poor concentration, fine tremor

moderate- slurred speech, disorientation, visual disturbances, nystagmus, coarse tremor, flat inverted T waves

severe- muscle twitches, chorea, parkinsonism, seizures, confusion, coma, death

39
Q

when is ECT recommended?

A

catatonia
severe manic episode
severe depression - if signs of neglect e.g. not eating or drinking, risk to themselves

40
Q

What are the side effects of ECT?

A

Cardiac arrthymias
headache, nausea
memory impairment

41
Q

Describe the mental state examination findings of someone with mania?

A 
Mental state examination:
appearance = brightly coloured clothes, eccentric
behaviour= over friendly, inappropriate 
speech= fast, difficult to interrupt
mood= elated, irritable
thought= fast, increased self importance
perception= hallucinations

+cognition, insight

42
Q

how is depression in bipolar treated?

A

fluoxetine + talking therapy

43
Q

Which score if used in post natal depression

A

Edinburgh Postnatal Depression Scale - used for early identification and close monitoring in primary care

44
Q

How is postnatal depression managed?

A

1st line = psychological therapy e.g. cBT, self help CBT groups

(not antidepressants as not licensed or safe when breast feeding and during pregnancy - but ca be used if appropriate )

45
Q

Construct a bio-psycho-social plan for bipolar disorder

A

BIO - 1st line= lithium (mood stabiliser) , 2nd line = valproate

PSYCHO - psychological therapy e.g. CBT, psychoeducation, relapse prevention

SOCIAL- family carer support, employment, support with benefits, encourage to speak to family, refer to CMHT, address problems during hypo/mania (e.g. spending too much, job), the patient should inform the DVLA about his diagnosis (DVLA decision, bipolar doesn’t stop you from driving)

46
Q

Construct a bio psycho social plan for depression

A

BIO - anti depressants

PSYCHO - talking therapy e.g. CBT, refer to IAPT, group work/ self help, psychoeducation

SOCIAL- family or carer support, employment, support with engagement and benefits

3a psychiatry (9 decks)

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