Mood disorders Flashcards
What are the classifications of severity of depression?
Mild: 2 from typical 2 from core symptoms
Moderate: 2 from typical 3 from core symptoms
Severe: 3 from typical 4 from core symptoms
What are the psychological screening tools which may be used for depression?
Becks depression inventory
Becks anxiety inventory
MMSE- because individuals have reduced concentration and memory
What are the investigations used in depression (clue think about differentials)
FBC(anaemia), U and Es, LFT’s (alcohol), TFT’s (hypo/hyperthyroidism), glucose, Calcium (hyperparathyroidism), B12/folate, ESR (SLE)
What are the psychotic symptoms of depression?
Delusions- mood congruent ie poverty, personal inadeuqancy, responsibility over world events, nihlistic delusions, persecutory delusions
Hallucination- secondary auditory hallucinations (cries for help etc, screaming voices), visual hallucinations (demons, dead bodies etc), olfactory hallucinations (rotting food, bad smells)
Depressive stupor
Thought insertion/withdrawal
What are the features of atypical depression? What treatment indicated
Hypersomnia >10 hours a day 3 times a week
Hyperphagia and weight gain
Phobic anxiety
Monoamine oxidase inhibitors such as Phenelzine
What is dysthymia?
Longstanding chronic mild depressive symptoms for more than 2 years which are not severe enough to meet the criteria for depression- can have sueprimposed major depressive symptoms on top
What time of day should you prescribe an SSRI and what else should be prescribed alongside an SSRI?
In the morning- disturbs amount of REM sleep
- ECG- check QT prolongation if concerns, in elderly or - NSAIDS or aspirin prescribe PPI because causes gastric bleeding
- Review within 2 weeks because increased suicide
What class of drug is Mirtazapine?
Noradrengeric and specific seroternergic antidepressant (NaSSAs)
Examples of tricyclic antidepressants and when they should never be prescribed?
Amitryptilline and Lofepramide
In suicidal patients
What is the 1st and 2nd line management of psychotic depression? eg depressive stupor
1st- ECT
2nd line- Second gen antipsychotic eg Quitipanine or Olnazapine with antidepressant
What is treatment resistant depression and how do you manage it?
Failure to respond to treatment with 2 or more antidepressants, or 1 antidepressant and ECT
- Combination antidepressant
- Augment with lithium or t3 tryptophan
What is maintenance period of successful antidepressants?
- 6moths to 1 year
- if recurrent depression (ie episodes <3 years) or suicidal episodes then every 5 years
Over what time period must antidepressants be withdraw over?
Over a 4 week period
What is prognosis of depression in terms of mortality, and definition of chronic depression?
- 50% increased mortality- CVS disease or suicide
- Chronic depression symptoms occurring for more than 2 years
What time period does post-partum depression occur in?
6 months
What does most post partum psychosis occur by?
2 weeks
What is the ICD-10 diagnosis of mania?
3 or more clin features of mania occuring for more than a week which impair social and occupational functioning with or without psychotic symptoms
What is the ICD-10 diagnosis of hypomania?
3 or more clinical features of mania occurring for more than 4 days but not severe enough to impair social functioning
What are the broad categories of symptoms for mania?
Mood
Increased energy
Increased self esteem
Engaging in dangerous behaviours
What is the ICD10 defintion of bipolar I affective disorder?
2 episodes of which one is major depression and 1 either mania/hypomania or mixed episode
What is defintion of bipoalr II, who is it more common in and what is it more associated with?
Major depressive episodes are more predominant with only mild hypomanic episodes
More common in females
Bipolar II has more rapid cycling ie >4 episodes per year
Bipolar depression associated with greater suicide risk
What is criteria for mixed episode and how may it present?
Depressive and manic/hypomanic symptoms present for every day for at least one week
Depression with pressure of speech
Mania with agitation or reduced energy/libido
Rapid/ultrarapid cycling (over hours or days)
What happens to the course of illness as patients get older?
Cycling increases with age, with period between episodes decreasing
What are poor prognostic factors for recovery?
Drug alcohol abuse
Psychotic symptoms
depression in between episodes
