Mood Disorders Flashcards
Up to 1/3 of stroke PTx have major depression. T or F
T
65% of PTx post MI have depressive symptoms. T or F
T
Which area of the brain has a decreased volume in depression?
hippocampus
Typical depression has a _____ variation, and it worse in the _____
diurnal
morning
Is memory effected in depression?
yes it can be
What psychotic symptoms can depression cause?
2nd person auditory hallucinations
delusions (eg. hypochondriasis, poverty, guilt, nihilism)
How would someones mood be in depression in a MSE?
flat, unhappy, empty
How would someones affect be in depression in a MSE?
depressed, decreased range, decreased reactivity
Depression can cause ____ retardation, ____ weight, and patients ____ have insight
Depression can cause psychomotor retardation, decreased weight, and patients do have insight
How long must depression be present for a dx?
most of the time, every day for 2 weeks
What conditions should you be careful to exclude when diagnosing depression?
bipolar, thyroid disorder
Many of the side effects from antidepressants are transient. T or F
true
In the Mx of depression, if a drug is not providing adequate response, what are the possible explanations?
wrong Dx
wrong dose
wrong drug
compliancy
What is the 1st line Mx in depression if a patient isn’t eating or drinking
ECT
What is the 1st line Mx in depression if a patient has a very high suicide risk?
ECT
What area of the brain does ECT stimulate?
hippocampus
ECT induces a _____ lasting _____
seizure
15-20 seconds
What are the side effects of ECT?
tension HA
short term cognitive dysfunction / amnesia
myalgia
tooth damage
What are the contraindications to ECT?
phaeochromocytoma
MI last 3mth
recent CVA
brain SOL
What type of depression causes anhedonia, decreased reactivity, wake 2hr early, worse morning wakening, psychomotor disturbance, <5% wt and a loss of libido?
Somatic depression
Atypical depression causes a mood thats ____ following a positive event, _____ sleeping, _____ paralysis and _____ weight
Atypical depression causes a mood thats better following a positive event, increased sleeping, leaden paralysis and increased weight
_____ syndrome is a form of psychotic depression that occurs in the ____ age group. an example would be “I can’t eat because my bowel’s have turned to dust”
Cotard syndrome
elderly
Postnatal depression affects ____ women
1 in 10
How long postpartum does postnatal depression occur?
1-4wks postpartum
What type of psychotherapy stems around changing your behaviour & you’ll change your thoughts, to combat ‘thinking errors’?
CBT cognitive behavioural therapy
What type of psychotherapy focuses on lifestyle changes, the importance of having therapy etc.? It should be a part of every consultation
psychoeducation
What is bipolar disorder with mixed features?
patients exhibit symptoms of mania/ hypomania at the same time as depressive symptoms
What is cyclothymia?
milder form of bipolar disorder where patients have alternating periods of elevated and low moods
What is rapid cycling bipolar disorder?
patients rapidly switch between episodes of mania and depression (i think - double check this)
What is the peak age range for diagnosis of bipolar disorder?
17-25 years
How long does hypomania last in bipolar disorder? (without Tx)
4+ days
How long does mania last in bipolar disorder? (without Tx)
> 1 week
What is the difference in presentation between mania and hypomania?
hypomania has no psychotic symptoms and patients will likely still be functioing
Is insight present in mania and hypomania?
no
What psychiatry term describes speech in mania?
pressure of speech
Describe someone’s mood in mania
expansive
elevated
irritable
What drug class should you try and avoid in the management of bipolar disorder?
antidepressants
In the management of acute mania in bipolar disorder, should you stop their maintenance antipsychotic?
no, increase dose
Which antipsychotics are 1st line in the management of acute mania in bipolar disorder?
PO olanzapine, quetiapine, risperidone
Which drugs are 2nd line in the management of acute mania in bipolar disorder?
lithium, valproate, carbamazepine
What is the management of agitation in acute mania in bipolar disorder?
benzo
What is the 1st line Mx of depressive symptoms in bipolar disorder? And what is the adjunct therapy?
antipsychotic quetiapine or olanzapine +- fluoxetine SSRI
also lamotrigine
What are the advantages and disadvantage of lamotrigine in the Mx of depressive symptoms in bipolar disorder?
slow to produce effect
less transient SEs
What is the 1st choice of maintenance medication in the Mx of bipolar disorder?
atypical (2nd gen) antipsychotic OR lithium
What must you monitor in prescribing Lithium?
U+Es, TFTs, Ca
What drugs that aren’t antipsychotics can be tried as maintenance medication in the management of Tx resistant bipolar disorder?
lamotrigine and valproate (both AEDs)
