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Psychiatry > Mood disorders > Flashcards

Mood disorders Flashcards

1
Q

What are the two broad categories of mood disorder?

A

Depressive disorders

Bipolar disorders

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2
Q

What are six disorders that can involve depression?

A 
Unipolar depression
Dysthymia
Seasonal affective disorder
Atypical depression
Postnatal depression
Psychotic depression
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3
Q

What are some general symptoms of depression?

A

Mood- Depressed/irritable
Talk- Slow and impoverished
Energy- Lethargic
Ideas- Futility, guilt, unworthiness
Cognition- Impaired learning
Physical- Insomnia, poor appetite, loss of libido
Behaviour- Agitation, lack of movement/expression
Hallucinations- Auditory, often hostile
Endocrine- Increased ACTH, cortisol and TRH secretion

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4
Q

How do you diagnose depression

A

Clinical

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5
Q

How long do you need symptoms to diagnose depression?

A

2 weeks

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6
Q

What must you not have for it to be depression?

A

No hypo/mania

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7
Q

What are the three categories of core depression symptoms?

A

Mood
Enjoyment
Energy

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8
Q

How does mood change in depression?

A

Depressed to abnormal for most of day and uninfluenced by circumstances

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9
Q

How does enjoyment change in depression?

A

Loss of interest/pleasure in normally pleasurable activities

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10
Q

How does energy change in depression?

A

Lack of energy

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11
Q

What are some additional symptoms in depression?

A 
Loss of confidence
Excessive guilt
Suicidal thoughts/behavior
Reduced concentration/indecisiveness
Psychomotor changes- agitation or retardation
Sleep disturbances
Appetite and weight changes
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12
Q

What are the three severities of unipolar depression?

A

Mild
Moderate
Severe

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13
Q

What features do you need for mild depression?

A

2 core

2 additional

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14
Q

What features do you need for moderate depression?

A

2 core

4 additional

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15
Q

What features do you need for severe depression?

A

3 core

5 additional

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16
Q

How do you treat mild depression?

A

Self-resolve
CBT
Psychosocial interventions

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17
Q

How do you treat moderate depression?

A

CBT
Psychosocial interventions
Antidepressants

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18
Q

How do you treat severe depression?

A

CBT
Psychosocial interventions
Antidepressants
Electroconvulsive therapy

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19
Q

What is dysthymia?

A

Mild/moderate loss of tiredness, low mood and low self-esteem

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20
Q

What is the time scale of dysthymia?

A

> 2 years

Several weeks well then longer periods of depression

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21
Q

What is Seasonal affective disorder?

A

Recurrent episodes of depressive illness occurring during the winter months in the northern hemisphere

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22
Q

What are some symptoms of seasonal affective disorder?

A

Hypersomnia
Increased appetite
Fatigue

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23
Q

How do you treat seasonal affective disorder?

A

Bright light in the mornings

SSRI

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24
Q

What is atypical depression?

A

Depression but with mood brightness in response to positive events.

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25
Q

What are some symptoms of atypical depression?

A
  • Increased appetite or significant weight gain
  • Hypersomnia (excessive sleepiness)
  • Leaden paralysis (heavy, leaden feeling in arms or legs)
  • Long standing pattern of interpersonal rejection sensitivity (not limited to episodes of mood disturbance) that results in significant social or occupational impairment
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26
Q

What are some forms of postnatal depression?

A

Maternity blues
Postpartum psychosis
Non-psychotic postnatal depressive disorders

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27
Q

Describe maternity blues

A 
2-3 days post partum
Resolve in a few days
Emotional lability
Irritability
Tearfulness
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28
Q

Describe postpartum psychosis

A

Onset <2 weeks postpartum
Psychosis- May attempt to kill child or self
Confusion
Disorientation

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29
Q

Describe Non-psychotic postnatal depressive disorders

A

Occurs in first year post parum
Risk factors: First pregnancy, Poor relationship
Can cause lack of mother/baby bonding

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30
Q

How do you treat postnatal depression?

A

Most self-resolve however treat anyway

Short term: CBT, Fluoxetine

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31
Q

How can psychotic depression present?

A

Often paranoid or hypochondria

Can be nihilistic

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32
Q

What other conditions can cause depression?

A 
Recurrent depressive disorder
 Bipolar disorder
 Schizo-affective disorder
 Schizophrenia 
 Dementia 
 Delirium 
 Substance misuse
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33
Q

What are some differentials for depression?

A 
Alcohol
Amphetamines
Borderline personality disorder
Dementia
Delirium
Schizophrenia
Grief
Cushing's syndrome
Thyroid disease
Hyperparathyroidism
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34
Q

What are some non-pharma treatments for depression?

A 
Exercise
Electroconvulsive therapy
CBT
Interpersonal psychotherapy
Couples and family therapy
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35
Q

What are the indications for electroconvulsive therapy?

A

Not responding to treatment
Psychotic
Need for swift control of symptoms: Very suicidal, Not drinking

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36
Q

How does electroconvulsive therapy work?

A

Induce epileptic fit

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37
Q

How often is electroconvulsive therapy given?

A

Twice a week for 3-6 weeks

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38
Q

What are some side effects of electroconvulsive therapy?

A

Transient headache
Transient confusion
Transient amnesia

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39
Q

What must you inform patients of before administering electroconvulsive therapy?

A
  • Minor memory loss (lasts up to a few days)
  • Tachycardia
  • Increased BP
  • Small risk of MI, PE, cerebral haemorrhage
  • It is done twice a week, for a period of 6-8 weeks. -Should notice change in 2-5 weeks
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40
Q

What does CBT target?

A

Negative thoughts associated with: self, situation and future

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41
Q

How does CBT work?

A

Combat/question negative thoughts

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42
Q

When is CBT given?

A

All depression

As good as antidepressants in mild unipolar depression

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43
Q

Is CBT better in groups or individually?

A

Individually

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44
Q

What is interpersonal psychotherapy good for?

A

Mild/moderate depression

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45
Q

Who does interpersonal psychotherapy work?

A

Focus on patients interpersonal relationships that affect illness

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46
Q

What should you stop in depression?

A

Alcohol

Recreational drugs

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47
Q

What should you reduce in depression?

A

Depression causing prescriptions such as steroids

48
Q

Give six classes of antidepressants

A 
SSRI
TCA
SNRI
Noradrenergic and specific serotonergic antagonists (NSSA)
Noradrenaline reuptake inhibitor (NaRI)
Monoamine oxidase inhibitors (MAOIs)
49
Q

Give three examples of SSRIs

A

Citalopram
Fluoxetine
Sertraline

50
Q

What are some side effects of SSRIs?

A 
'Hangover'- N+V, diarrhea, dry mouth, headache
Insomnia
Agitation on starting
Erectile dysfunction/loss of libido
Hyponatremia- Rare
51
Q

What are some side effects of sudden withdrawal of an SSRI?

A 
Shivering
Anxiety
Dizziness
'Electric shocks'
Headache
Nausea
52
Q

What are some benefits of SSRIs?

A

Given once daily

Fewer side effects

53
Q

How do SSRIs work?

A

Inhibit 5-HT reuptake therefore increase conc.

54
Q

How do TCAs work?

A

Inhibit reuptake of monoamines: NA and serotonin

55
Q

Give some examples of TCAs

A

Amitriptyline

Clomipramine

56
Q

Give some examples of TCA side effects

A
  • Weight gain
  • Antimuscarinic: Dry mouth, Constipation, Tremor, Blurred vision, Urinary retention
  • Cardiovascular: QT prolongation, Arrhythmias, Postural hypotension
  • Lowers seizure threshold
  • Mania
57
Q

Should TCA be given to those with suicidal intentions?

A

Not directly as toxic in OD.

Give to responsible 3rd party

58
Q

Give an example of an SNRI

A

Venlafaxine

59
Q

What are some benefits of venlafaxine?

A

Once daily
Less muscarinic effects
Less sedation

60
Q

What are some side effects of venlafaxine?

A

Nausea
Hypertension
Do NOT give to those with hypertension or arrhythmias

61
Q

Give an example of a Noradrenergic and specific serotonergic antagonists (NSSA)

A

Mirtazapine

62
Q

What are some side effects of mirtazapine?

A

Sedation

Agranulocytosis

63
Q

Give an example of an Noradrenaline reuptake inhibitor (NaRI)

A

Reboxetine

64
Q

What are some side effects of reboxerine?

A 
Dry mouth
Insomnia
Constipation
Urine hesitance
Tachycardia
65
Q

What does monoamine oxidase do?

A

Metabolise monoamines: NA and serotonin

66
Q

What is a major side effect of Monoamine oxidase inhibitors (MAOIs)?

A 
Dangerous hypertension when consume tyramine or dopamine:
  Cheese
  Pickled herring
  Yeast
  Game
  Broad beans
67
Q

What is a dangerous condition associated with a combination of some antidepressants?

A

Toxic hyperserotonergic state

68
Q

What can cause Toxic hyperserotonergic state?

A

Can be caused by 2+ drugs that increase serotonin levels

69
Q

What are some symptoms of toxic hyperserotonergic state?

A 
Agitation
Confusion
Tremor
Diarrhoea
Tachycardia
Hypertension
Hyperthermia
Support
70
Q

How should antidepressant dose be altered in the elderly?

A

Half the dose

71
Q

How should antidepressant dose be altered in pregnancy/breastfeeding?

A

Avoid as far as possible

If needed TCA best

72
Q

What herbal medication should be avoided when taking antidepressants?

A

St John’s Wort

73
Q

What is bipolar disorder?

A

Two or more episodes in which the patient’s mood and activity levels are significantly elevated.

74
Q

Give five forms of bipolar disorder

A 
Bipolar 1
Bipolar 2
Rapid cycling
Mixed affective state
Cyclothymia
75
Q

What is Cyclothymia?

A

Hypomania and mild depression not serious enough to be classed as bipolar

76
Q

What is bipolar 1?

A

Mania and depression

77
Q

What is bipolar 2?

A

Hypomania and depression

78
Q

Which is more common: bipolar 1 or 2?

A

Bipolar 2

79
Q

How long does untreated mania tend to last?

A

~2 months

80
Q

How long must mania be sustain to diagnose?

A

Must be maintained for 7 days or be hospitalized to diagnose

81
Q

Give some symptoms of mania

A

-Mood- Elevated or irritable
-Speech- fast, pressurized, flight of ideas
-Energy- Excessive
-Ideas- Grandiose, self-confident, delusions of wealth, power, influence or religious significance, sometimes persecutory
-Cognition- Disturbance of registration of memories
-Physical- Insomnia, mild to moderate weight loss, increased libido
-Behaviour- Disinhibition, increased sexual activity, excessive drinking or spending
-Hallucinations- Fleeting auditory
Lack insight

82
Q

How long must hypomania be sustained to diagnose?

A

4 days

83
Q

Give some symptoms of hypomania

A

Same as mania but less severe and maintain insight or psychosis

84
Q

What is rapid cycling?

A

Frequent swings from one mood state to another

85
Q

What is mixed effective state?

A

Features of mania and depression in same episode

86
Q

What serious condition can bipolar increase?

A

Suicide

87
Q

What is the differential for bipolar?

A

Intoxication
Long term cannabis use
Cushing’s syndrome- Can cause mania
Dopamine agonists

88
Q

What is the pathology of bipolar?

A

Strong genetic link
Serotonin increases in mania
Tricyclic antidepressants can cause manis

89
Q

What should you do in a first hypo/manic presentation?

A

CT head
EEG
Drug screen

90
Q

How should you treat acute mania?

A

Stop antidepressants

Give antipsychotics: Sodium valproate, Li, Olanzapine

91
Q

How do you treat acute hypomania?

A

Valproic acid

92
Q

Describe prophylaxis for bipolar?

A

Mood stabilisers

93
Q

Give some examples of mood stabilisers

A

Li Carbonate
Olanzapine
Valproic acid

94
Q

How is Li Carbonate absorbed?

A

GI

95
Q

How is Li Carbonate excreted?

A

Renal

96
Q

What should you screen for before starting Li Carbonate?

A

Thyroid disease

Renal disease

97
Q

What are you looking for when screening for thyroid disease?

A

TSH
fT4
Thyroid antibodies

98
Q

Why must you screen for thyroid disease before starting Li Carbonate?

A

Because because it can cause hypothyroidism

99
Q

Why must you screen for renal disease before starting Li Carbonate?

A

Because it can cause:
Reduced glomerular function
Nephrogenic DI

100
Q

What are you looking for when screening for renal function?

A

Serum urea and creatinine

101
Q

What is the therapeutic range for Li Carbonate?

A

0.5-1mmol/l

102
Q

What is the toxic threshold for Li Carbonate?

A

1.5mmol/l

103
Q

What are some symptoms of Li Carbonate toxicity?

A

Drowsiness
N+V
Blurred vision

104
Q

What can Li Carbonate interact with?

A

NSAIDs

Diuretics

105
Q

What are some side effects of Li Carbonate?

A 
N+D
Tremor
Polyurea and polydipsia
Increased appetite
Mania if abrupt stop
106
Q

What can happen if you abruptly stop Li Carbonate?

A

Mania

107
Q

How long should you treat a first presentation of depression for?

A

6-12 months after resolution

108
Q

How long should you treat a second presentation of depression for?

A

12-24 months after resolution

109
Q

How long should you treat a third presentation of depression for?

A

Indefinitely

110
Q

What is the definition of non-response to antidepressants?

A

No or inadequate response in 6 weeks

111
Q

How do cortisol levels change in unipolar depression?

A

Raised

112
Q

Why are cortisol levels raised in unipolar depression?

A

No negative feedback of cortisol

113
Q

What do the increased levels of cortisol in depression do?

A

Increased flight or fight

Brain damage

114
Q

What test can you do for cortisol in depression?

A

Dexamethasone test

115
Q

What does dexamethasone do in depression?

A

Sweet fuck all

116
Q

What happens to the adrenal glands in depression?

A

Hypertrophy

117
Q

What is another name for mood disorders?

A

Affective disorders

Psychiatry (22 decks)

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