Mood Disorders

Question 1

3 core symptoms of depression

Answer 1

Low mood, loss of energy, lack of pleasure

Question 2

Somatic/Biological symptoms of depression

Answer 2

Early morning waking, depression worse in morning, appetite change leading to weight change, agitation, loss of libido.

Question 3

Cognitive symptoms of depression

Answer 3

Reduced memory, reduced concentration, poor self-esteem, feeling of guilt, hopelessness, suicidal thoughts and self harm

Question 4

People at risk of depression

Answer 4

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.

Question 5

Dysthymia

Answer 5

Persistent (more than 2 years) sub-clinical threshold depressive symptoms

Question 6

Differentials for low mood and differentiating features

Answer 6

-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

Question 7

Diagnosing depression

Answer 7

1 of the core symptoms and 4 others. PHQ-9 questionnaire. Investigations = FBC, TSH, U&E, LFT+Gamma GT, B12&folate. Mood diary.

Question 8

Types of psychological therapy

Answer 8

Counselling, behavioural therapy, cognitive behavioural therapy, interpersonal therapy, group therapy, cognitive analytic therapy, psychodynamic therapy, mindfulness-based.

Question 9

Synonyms for Bipolar

Answer 9

Bipolar disorder, bipolar affective disorder, manic depressive disorder

Question 10

Definition of manic episode and symptoms

Answer 10

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.

Question 11

Definition of hypomania and symptoms

Answer 11

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.

Question 12

Rapid cycling bipolar disorder

Answer 12

within a 12 month period the patient will experience 4 episodes of depression, mania, hypomania or mixed.

Question 13

Bipolar 1 disorder

Answer 13

At least 1 episode of mania lasting longer than a week with or without depressive episodes.

Question 14

Bipolar 2 disorder

Answer 14

At least 1 episode of depression and at least 1 episode of hypomania but no mania episode.

Question 15

Difference between bipolar and borderline personality disorder

Answer 15

Borderline personality disorder = transient mood shifts in response to a stimuli. Bipolar = sustained mood changes.

Question 16

Risk factors for bipolar disorder

Answer 16

Family history, childhood maltreatment, social exclusion, traumatic or acutely stressful events, dysfunction in hypothalamic-pituitary-adrenal axis (with abnormal secretion of cortisol)

Question 17

cyclothymia

Answer 17

Sub-threshold symptoms of mood instability with mild elevation and mild depression over a long period of time.

Question 18

Why is mixed affective state so risky

Answer 18

Low mood and high energy can lead to v risky bahaviours

Question 19

Acute mania episode treatment

Answer 19

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).

Question 20

Long term management of bipolar disorder

Answer 20

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.

Question 21

Mental health review topics to be discussed

Answer 21

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.

Question 22

Symptoms and signs of borderline personality disorder/emotionally unstable PD

Answer 22

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.

Question 23

Co-morbidities in borderline personality disorder

Answer 23

COMMON!!

Depression, anxiety, eating disorders,PTSD, alcohol and drug misuse, bipolar disorder

Question 24

Management of acute crisis in borderline personality disorder

Answer 24

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

Question 25

Management of diagnosed borderline personality disorder

Answer 25

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.

Question 26

Cluster A personality disorders

Answer 26

Odd/eccentric
Paranoid - suspicious.
Schizoid - emotionally cold or indifferent.
Schizotypal - eccentric, odd behaviour or perceptions

Question 27

Cluster B personality disorders

Answer 27

Dramatic, emotional and erratic.
Borderline/emotionally unstable
Antisocial/dissocial - aggressive, reckless, irresponsible
Histrionic - dramatic, attention seeking, shallow.
Narcissistic - self-importance

Question 28

Cluster C personality disorders

Answer 28

Anxious an fearful
Dependent - clinging, excessive need for others
Avoidant/anxious - hypersensitive, fear of inadequate
Obsessive-Compulsive - worry of orderliness, pedantic, perfectionist

Question 29

Aetiology of personality disorders

Answer 29

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

Question 30

Citalopram monitoring

Answer 30

ECG, QT interval prolongation

Question 31

Side effect of tricyclic

Answer 31

urinary retention

Question 32

SSRI discontinuation syndrome

Answer 32

restlessness
difficulty sleeping
unsteadiness
sweating
gastrointestinal symptoms: pain, cramping, diarrhoea, vomiting
paraesthesia