Mood disorders

Question 1

What are the classifications of severity of depression?

Answer 1

Mild: 2 from typical 2 from core symptoms
Moderate: 2 from typical 3 from core symptoms
Severe: 3 from typical 4 from core symptoms

Question 2

What are the psychological screening tools which may be used for depression?

Answer 2

Becks depression inventory
Becks anxiety inventory
MMSE- because individuals have reduced concentration and memory

Question 3

What are the investigations used in depression (clue think about differentials)

Answer 3

FBC(anaemia), U and Es, LFT’s (alcohol), TFT’s (hypo/hyperthyroidism), glucose, Calcium (hyperparathyroidism), B12/folate, ESR (SLE)

Question 4

What are the psychotic symptoms of depression?

Answer 4

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

Question 5

What are the features of atypical depression? What treatment indicated

Answer 5

Hypersomnia >10 hours a day 3 times a week
Hyperphagia and weight gain
Phobic anxiety

Monoamine oxidase inhibitors such as Phenelzine

Question 6

What is dysthymia?

Answer 6

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

Question 7

What time of day should you prescribe an SSRI and what else should be prescribed alongside an SSRI?

Answer 7

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

Question 8

What class of drug is Mirtazapine?

Answer 8

Noradrengeric and specific seroternergic antidepressant (NaSSAs)

Question 9

Examples of tricyclic antidepressants and when they should never be prescribed?

Answer 9

Amitryptilline and Lofepramide

In suicidal patients

Question 10

What is the 1st and 2nd line management of psychotic depression? eg depressive stupor

Answer 10

1st- ECT

2nd line- Second gen antipsychotic eg Quitipanine or Olnazapine with antidepressant

Question 11

What is treatment resistant depression and how do you manage it?

Answer 11

Failure to respond to treatment with 2 or more antidepressants, or 1 antidepressant and ECT

• Combination antidepressant
• Augment with lithium or t3 tryptophan

Question 12

What is maintenance period of successful antidepressants?

Answer 12

• 6moths to 1 year

- if recurrent depression (ie episodes <3 years) or suicidal episodes then every 5 years

Question 13

Over what time period must antidepressants be withdraw over?

Answer 13

Over a 4 week period

Question 14

What is prognosis of depression in terms of mortality, and definition of chronic depression?

Answer 14

• 50% increased mortality- CVS disease or suicide

- Chronic depression symptoms occurring for more than 2 years

Question 15

What time period does post-partum depression occur in?

Answer 15

6 months

Question 16

What does most post partum psychosis occur by?

Answer 16

2 weeks

Question 17

What is the ICD-10 diagnosis of mania?

Answer 17

3 or more clin features of mania occuring for more than a week which impair social and occupational functioning with or without psychotic symptoms

Question 18

What is the ICD-10 diagnosis of hypomania?

Answer 18

3 or more clinical features of mania occurring for more than 4 days but not severe enough to impair social functioning

Question 19

What are the broad categories of symptoms for mania?

Answer 19

Mood
Increased energy
Increased self esteem
Engaging in dangerous behaviours

Question 20

What is the ICD10 defintion of bipolar I affective disorder?

Answer 20

2 episodes of which one is major depression and 1 either mania/hypomania or mixed episode

Question 21

What is defintion of bipoalr II, who is it more common in and what is it more associated with?

Answer 21

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

Question 22

What is criteria for mixed episode and how may it present?

Answer 22

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)

Question 23

What happens to the course of illness as patients get older?

Answer 23

Cycling increases with age, with period between episodes decreasing

Question 24

What are poor prognostic factors for recovery?

Answer 24

Drug alcohol abuse
Psychotic symptoms
depression in between episodes

Question 25

When is ECT used in bipolar spectrum disorder?

Answer 25

Used in the treatment of mania when pharmacological treatments failed or when contriandicated ie cardiac disease and pregnancy