Mood disorders Flashcards by Emma Nunn

Depression lifetime risk and male:female

About 17 %, 1:2

How well did you know this?

Not at all

Perfectly

Mood disorder course is generally…

Relapsing and remitting

How well did you know this?

Not at all

Perfectly

Bipolar affective disorder lifetime risk and male:female

About 3%, 1:1

How well did you know this?

Not at all

Perfectly

BPAD and depression genetic link

Depressed relatives => increased risk depression

Bipolar relatives => increased risk bipolar AND depression

How well did you know this?

Not at all

Perfectly

Childhood experiences associated with later depression

Early childhood abuse
Relentless criticism
Parental loss
Perceived lack of affectio

How well did you know this?

Not at all

Perfectly

Vulnerability factors for depression in adults

Unemployment
Lack of confiding relationship
Lower socioeconomic status
Social isolation
Women - at home with 3+ children

These decrease resilience to adverse situations.

How well did you know this?

Not at all

Perfectly

Life events related to depression

Death of spouse, divorce, separation, jail, death or relative

Risk of depression increases 6 fold in 6 months following events

How well did you know this?

Not at all

Perfectly

Life events precipitating mania

Can be negative or positive

Triggers get less important over time

How well did you know this?

Not at all

Perfectly

Manic episodes can be triggered by…

Puerperium
Sleep deprivation
Flying across time zones

How well did you know this?

Not at all

Perfectly

Physical illnesses which directly cause depression …

Cushiness syndrome
Hypothyroidism
Stroke
Parkinson's disease
Multiple Sclerosis
Hyperparathyroidism

How well did you know this?

Not at all

Perfectly

Pharmacological causes of depression

Beta-blockers
Anti hypertensives
Stimulants (eg cocaine)

How well did you know this?

Not at all

Perfectly

Physical causes of mania

Cushing’s syndrome
Head injury
Multiple sclerosis
Steroids, antidepressants, stumulant

How well did you know this?

Not at all

Perfectly

Learned helplessness model of depression

Seligman’s studies
Dogs given unavoidable electric shocks gave up trying to escape
Even when conditions were changed
Depressed people ‘learn’ they can’t change their situation

How well did you know this?

Not at all

Perfectly

Psychoanalytical theories of depression

Early experience and relationships determine risk

Mental states as ‘internal drama’

How well did you know this?

Not at all

Perfectly

Monoamine theory of depression - deficiency in…

Noradrenaline
Serotonin (5-HT)
Dopamine

How well did you know this?

Not at all

Perfectly

Noradrenaline affects

Mood and energy

How well did you know this?

Not at all

Perfectly

Serotonin affects

Sleep, appetite, energy, mood

How well did you know this?

Not at all

Perfectly

Dopamine affects

Psychomotor activity

Findings in depression (monoamines)

Decreased plasma tryptophan (5-HT precursor)
Decreased CSF 5-HIAA (5-HT metabolite) in suicide victims
Decreased CSF dopamine metabolite

Suggesting monoamines deficiency in depression

Reserpine…

Depletes monoamines

Can cause depression

Mania and monoamines

May be related to dopamine overactivity
Amphetamine, cocaine increase DA, can induce mania
Antipsychotics - DAr antagonists - can treat mani

Cortisol and mental health

May mediate between stressful life events and biological changes in depression
? Via damaging hippocampal neurons?
Failure of cortisol suppression in depression, mania, schizophrenia, old age

Diagnosis of depression

Two core symptoms

Two weeks

Core symptoms of depression

Low mood
Anergia
Anhedonia

Cognitive symptoms of depression

Worthless, useless, guilty, hopeless, pessimistic, poor concentration, memory impairment can resemble dementia

Biological symptoms depression

``` Initial insomnia Early morning waking Decreased appetite for food and sex Diurnal - worse in morning Psychomotor retardation Physical symptoms = aches, pains ```

Psychotic symptoms

Very severe depression Auditory hallucinations - degoratory voices Rare visual hallucinations eg evil spirits Nihilistic delusions Persecutory delusions 'deserve' persecution/punishment

Depression grading

Mild, moderate, severe, severe with psychotic symptoms

Seasonal Affective Disorder

Low mood in winter Often reversed biological symptoms Overeating, oversleeping

Atypical depression

Reversed biological symptoms | May retain mood reactivity

Agitated depression

Depression with psychomotor agitation, not retardation | Restlessness, pacing

Depressive stupor

Psychomotor retardation so profound that become, mute. No eating, drinking, moving

DD - Physical causes (depression)

Hypothyroidism, head injury, cancer, 'quiet' delirium

DD - Adjustment disorder

Mild affective symptoms following life event | Not enough to diagnose depression

DD - bereavement

Normal response to loss | Abnormal if v.intense, prolonged (>6 months) or delayed

Substance misuse and depression

Alcohol / drugs may be a form of self medication or cause depression

Dementia - differential

Dementia can begin with affective changes | Or - depression can effect memory = pseudo-dementia

Investigations - depression

Collateral history Physical examination Blood tests - TFT, FBC, HbA1c (diabetes and anaemia cause fatigue) CT / MRI NOT routine, use if suspected head injury Rating scales for monitoring

Psychological treatment in depression

First step to treat mild depression Ideally involved in moderate and severe also CBT, psychodynamic therapy, interpersonal therapy

Cognitive Behavioural Therapy

Help patient notice negative automatic thoughts (NATs) Which result in poor mood/behaviour Thought, mood, behaviour are mutually reinforcing Target thoughts and behaviour, so knock on effect on mood

CBT in depression

Worthlessness belief effects behaviour and mood eg withdrawal Challenge NATs, expose to positive activities Made aware of common thinking errors Build more realistic belief set

Psychodynamic psychotherapy

Patient transfers beliefs etc onto relationship with therapist Eg 'I will be rejected' Put words to these feelings so pt can recognise and challenge hidden beliefs

Electro convulsive therapy in depression

Acts fast - severe / psychotic depression Anaesthetised, generalised tonic-clinic seizure Can be some memory loss

Depression prognosis

About 50% will have another episode Episodes last 8-9 months Treatment can decrease this to 2-3 months Psychotic depression poorer prognosis, ECT helps Up to 15% with major depression take their own lives