Mood disorders Flashcards
Depression diagnosis criteria:
- At least one of what 2 core symptoms
- And at least how many symptoms in total?
- Mnemonic: A SAD FACES
a) Persistent sadness or low mood; anhedonia
b) 5 in total
c) 9 symptoms in DSM-IV: •A = Appetite (Weight Change) •S = Sleep (Insomnia / Hypersomnia) •A = Anhedonia •D = Depressed mood •F = Fatigue •A = Agitation / Retardation •C = Concentration Diminished •E = Esteem (Low) / Guilt •S = Suicide / Thoughts of Death
Dysthymia
Dysthymia is a chronic depressive state of more than two years in duration, which does not meet full criteria for major depression and is not the consequence of a partially resolved major depression.
Who should be screened for depression?
think PMHx, risk factors, other conditions, symptoms
- Past history of depression
- significant physical illness or disability
- other mental health problems
- Parkinson’s disease
- Dementia
- The puerperium - prevalence around 13%
- Alcoholism and drug abuse - it may be difficult to decide if depression is the cause or effect of substance abuse but it may be desirable to treat both.
- Victims of abuse.
- Chronic pain
- Stressful home environments.
- The elderly.
- Social isolation.
- Unexplained symptoms.
Screening for depression
a) Tool : uses the DSM-IV criteria (A SAD FACES)
b) 2 initial screening Qs
c) If yes to either, 3 follow up questions
a) PHQ-9
b) •During the last month have you been feeling down, depressed or hopeless?
•During the last month have you often been bothered by having little interest or pleasure in doing things?
c) During the last month…
•Feelings of worthlessness?
•Poor concentration?
•Thoughts of death?
Grading depression.
a) Number of symptoms required for diagnosis
b) Mild, moderate and severe
c) Management of each
a) At least 5
b) Mild - no functional impairment
- Moderate - some functional impairment
- Severe - marked functional impairment +/- psychosis
c) Mild - watchful waiting, IAPT
Mod - IAPT + antidepressant
Severe - psychiatry referral, consider ECT
When may antidepressants be considered in the context of mild depression
- If mild depression persists after other interventions, or is associated with psychosocial and medical problems.
- In mild depression complicating the care of physical health problems.
- When a patient with a history of moderate or severe depression presents with mild depression.
- With sub-threshold depressive symptoms present for at least two years or persisting after other interventions
When should moderate depression be treated with high-intensity CBT/IPT alone (rather than with antidepressant combined) ?
For an individual with a chronic health problem and moderate depression, this should be high-intensity psychological treatment alone in the first instance
Indications for psychiatric referral in depression
a) At diagnosis
b) After treatment
a) - active suicidal ideas or plans
- is putting themselves or others at immediate risk of harm
- is psychotic
- severely agitated
- self-neglecting
b) - inadequate response to 2 interventions
- comorbid organic disorder or substance abuse
- possible bipolar disorder
- recurrence of depression within 1 year
What drug class are the following:
a) Citalopram, Fluoxetine, Sertraline
b) Duloxetine, Venlafaxine
c) Phenelzine, Hydrazine, Moclobemide
d) Mirtazapine
e) Reboxetine, Atomoxetine
f) Clomipramine, imipramine, amitryptilline
g) Agomelatine
a) SSRI
b) SNRI
c) MAOI
d) Tetracyclic antidepressant
e) NRI
f) TCA
g) A melatonin receptor agonist and a selective serotonin-receptor antagonist (does not affect reuptake)
Risk factors for depression recurrence
- ≥3 episodes of major depression.
- High prior frequency of recurrence.
- An episode in the previous 12 months.
- Residual symptoms during continuation treatment.
- Severe episodes - eg, ‘suicidality’, psychotic features.
- Long previous episodes.
- Relapse after drug discontinuation
Mania vs hypomania
a) Speech
b) Psychosis
c) Energy
d) Risk taking
e) Functioning
f) Insight
g) Duration
a) Pressured speech vs. talkativeness
b) Psychosis vs. no psychosis
c) Hyperactivity vs increased energy
d) Very risky vs. moderate risk
e) Mania - lose functioning
f) Mania - lose insight
g) Mania = 1 week; hypomania < 4 days
Mania
a) Characterised by what things
b) Give 3 types of mood ‘elevation’
c) Mnemonic: DIG FAST
d) Causes
e) vs hypomania
a) Elevated mood, increased energy, loss of insight/functioning, with or without psychosis
b) Euphoric, irritable, angry
c) Distractibility,
Inhibition lost (spending spree, sexual frivolity)
Grandiosity (+/- other psychotic features)
Flight of ideas,
Activity increased (and psychomotor agitation)
Sleep decreased,
Talkativeness (pressured speech)
d) Bipolar disorder
- Drugs: steroids (and Cushing’s), cocaine
e) - Functional ability
- Psychosis
- Length of episode (7+ days for mania)
‘Rapid cycling’ in bipolar
Four or more cycles of depression and mania in a year, with no intervening asymptomatic episodes
Mnemonic:
LITHIUM
Leukocytosis Insipidus Tremors Hypercalcaemia Increased weight Underactive thyroid Mums beware: teratogen (Ebstein's anomaly)
MSE for patient with psychotic depression
a) Appearance
b) Behaviour
c) Speech
d) Mood and affect
e) Thought form
f) Thought content
g) Cognition
h) Insight
a) Dishevelled, neglect, somnolent, slouched
b) Psychomotor retardation, poor eye contact
c) Latency, slow, soft, poverty of speech
d) Depressed, blunted affect
e) Linear, goal-directed
f) Suicidal, mood-congruent 3rd/2nd person AHs (often COMMAND), paranoid/persecutory/nihilistic delusions
g) Alert, poor recall, poor concentration, poor co-operation
h) May be present
