Mood Disorders Flashcards
3 core symptoms of depression
Low mood, loss of energy, lack of pleasure
Somatic/Biological symptoms of depression
Early morning waking, depression worse in morning, appetite change leading to weight change, agitation, loss of libido.
Cognitive symptoms of depression
Reduced memory, reduced concentration, poor self-esteem, feeling of guilt, hopelessness, suicidal thoughts and self harm
People at risk of depression
Chronic co-morbidities (DM, COPD, chronic pain), those with other psych problems, family history of depression,, history of abuse (sexual), substance and alcohol abuse, not complaint to psych medications.
Dysthymia
Persistent (more than 2 years) sub-clinical threshold depressive symptoms
Differentials for low mood and differentiating features
-Depressive episode= >2weeks of symptoms
-Recurrent depressive disorder=more than 1 episode.
-Grief reaction=fluctuating, look to future, trigger event, capacity for pleasure.
-Dementia=memory loss, disorientation, distractibility.
-Dysthymia=sub-threshold symptoms
-Bipolar affective disorder=periods of elevated mood and mania
-Schizophrenia=delirium and psychotic symptoms
Substance misuse or ADR
Hypothyroidism
Diagnosing depression
1 of the core symptoms and 4 others. PHQ-9 questionnaire. Investigations = FBC, TSH, U&E, LFT+Gamma GT, B12&folate. Mood diary.
Types of psychological therapy
Counselling, behavioural therapy, cognitive behavioural therapy, interpersonal therapy, group therapy, cognitive analytic therapy, psychodynamic therapy, mindfulness-based.
Synonyms for Bipolar
Bipolar disorder, bipolar affective disorder, manic depressive disorder
Definition of manic episode and symptoms
Abnormal and persistent elevated and irritable mood.
At least 1 week in duration.
Can include psychotic symptoms.
Mood change is severe enough to impact of patient’s social and occupational function.
Pressure of speech, flight of ideas, poor concentration & distractibility, sexual disinhibition, grandiose delicious, auditory hallucinations, extravagant and impractical plans, risk taking behaviour, irritable, increased energy, restless, decreased need for sleep.
Definition of hypomania and symptoms
Symptoms lasting for 4 days.
Less marked impact of patient’s social and occupational functioning.
No psychotic features.
Irritable, elevated self-esteem, poor concentration, reduced sleep, increased libido, increased energy, increased performance at work, talkative, increased sociability, over-familiar.
Rapid cycling bipolar disorder
within a 12 month period the patient will experience 4 episodes of depression, mania, hypomania or mixed.
Bipolar 1 disorder
At least 1 episode of mania lasting longer than a week with or without depressive episodes.
Bipolar 2 disorder
At least 1 episode of depression and at least 1 episode of hypomania but no mania episode.
Difference between bipolar and borderline personality disorder
Borderline personality disorder = transient mood shifts in response to a stimuli. Bipolar = sustained mood changes.
Risk factors for bipolar disorder
Family history, childhood maltreatment, social exclusion, traumatic or acutely stressful events, dysfunction in hypothalamic-pituitary-adrenal axis (with abnormal secretion of cortisol)
cyclothymia
Sub-threshold symptoms of mood instability with mild elevation and mild depression over a long period of time.
Why is mixed affective state so risky
Low mood and high energy can lead to v risky bahaviours
Acute mania episode treatment
If not on a mood stabilisers give an antipsychotic e.g Haloperidol, Olanzapine.
If they are on a mood stabiliser check serum levels. And either increase the mood stabiliser dose to BNF max (esp for valproate) or add an antipsychotic (esp if on Lithium).
Long term management of bipolar disorder
Lithium or sodium valproate.
Psychological therapies - CBT, interpersonal therapy.
Involve carers and create plan for crisis event, advanced wishes of patient stated, lasting power of attorney advice. Follow-up DNA appointments.
Mental health review topics to be discussed
Symptom control and medicine compliance.
Early warning signs of a relapse.
Advice on preventing relapse - stop smoking, avoid caffeine, avoid alcohol and recreational drugs, get into routine in morning, avoid shift work, adequate sleep. Social needs review.
Symptoms and signs of borderline personality disorder/emotionally unstable PD
Instability in relationships.
Fear of abandonment or rejection.
Impulsivity - actions may be damaging (spending, sex, binge eating substance abuse, reckless driving)
Fluctuation of confidence and self-image.
Intense anger.
Reactivity in mood (mood changes are quick, last hours)
Self-harm and suicidal behaviour.
Can have delusions and hallucinations.
Co-morbidities in borderline personality disorder
COMMON!!
Depression, anxiety, eating disorders,PTSD, alcohol and drug misuse, bipolar disorder
Management of acute crisis in borderline personality disorder
Assess risk to self and others.
Assess need for referral to crisis team.
Consult a pre-made crisis plan for individual.
Short-term drug use e.g. sedative antihistamine
Arrange follow up
Management of diagnosed borderline personality disorder
Refer to community mental health team for diagnosis.
Educate patient on disease and treatment options.
Information on good sleep hygiene.
Optimise co-morbidity management.
Create a care plan including plan for a crisis event.
Psychotherapy e.g. DIALETCITAL BEHAVIOURAL THERAPY! CBT, cognitive-analytical, psychodynamic.
NO NICE supported pharmacological therapies.
Cluster A personality disorders
Odd/eccentric
Paranoid - suspicious.
Schizoid - emotionally cold or indifferent.
Schizotypal - eccentric, odd behaviour or perceptions
Cluster B personality disorders
Dramatic, emotional and erratic.
Borderline/emotionally unstable
Antisocial/dissocial - aggressive, reckless, irresponsible
Histrionic - dramatic, attention seeking, shallow.
Narcissistic - self-importance
Cluster C personality disorders
Anxious an fearful
Dependent - clinging, excessive need for others
Avoidant/anxious - hypersensitive, fear of inadequate
Obsessive-Compulsive - worry of orderliness, pedantic, perfectionist
Aetiology of personality disorders
Genetics.
Cluster A = common in FHx of Schizophrenia
Cluster B = common in people who have experienced social adversity e.g. parental drug abuse
Child abuse or neglect (poor attachment)
Sexual abuse
Citalopram monitoring
ECG, QT interval prolongation
Side effect of tricyclic
urinary retention
SSRI discontinuation syndrome
restlessness difficulty sleeping unsteadiness sweating gastrointestinal symptoms: pain, cramping, diarrhoea, vomiting paraesthesia
