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Mood disorders Flashcards

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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
What are some symptoms of atypical depression?
- 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
26
What are some forms of postnatal depression?
Maternity blues Postpartum psychosis Non-psychotic postnatal depressive disorders
27
Describe maternity blues
``` 2-3 days post partum Resolve in a few days Emotional lability Irritability Tearfulness ```
28
Describe postpartum psychosis
Onset <2 weeks postpartum Psychosis- May attempt to kill child or self Confusion Disorientation
29
Describe Non-psychotic postnatal depressive disorders
Occurs in first year post parum Risk factors: First pregnancy, Poor relationship Can cause lack of mother/baby bonding
30
How do you treat postnatal depression?
Most self-resolve however treat anyway | Short term: CBT, Fluoxetine
31
How can psychotic depression present?
Often paranoid or hypochondria | Can be nihilistic
32
What other conditions can cause depression?
``` Recurrent depressive disorder Bipolar disorder Schizo-affective disorder Schizophrenia Dementia Delirium Substance misuse ```
33
What are some differentials for depression?
``` Alcohol Amphetamines Borderline personality disorder Dementia Delirium Schizophrenia Grief Cushing's syndrome Thyroid disease Hyperparathyroidism ```
34
What are some non-pharma treatments for depression?
``` Exercise Electroconvulsive therapy CBT Interpersonal psychotherapy Couples and family therapy ```
35
What are the indications for electroconvulsive therapy?
Not responding to treatment Psychotic Need for swift control of symptoms: Very suicidal, Not drinking
36
How does electroconvulsive therapy work?
Induce epileptic fit
37
How often is electroconvulsive therapy given?
Twice a week for 3-6 weeks
38
What are some side effects of electroconvulsive therapy?
Transient headache Transient confusion Transient amnesia
39
What must you inform patients of before administering electroconvulsive therapy?
- 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
40
What does CBT target?
Negative thoughts associated with: self, situation and future
41
How does CBT work?
Combat/question negative thoughts
42
When is CBT given?
All depression | As good as antidepressants in mild unipolar depression
43
Is CBT better in groups or individually?
Individually
44
What is interpersonal psychotherapy good for?
Mild/moderate depression
45
Who does interpersonal psychotherapy work?
Focus on patients interpersonal relationships that affect illness
46
What should you stop in depression?
Alcohol | Recreational drugs
47
What should you reduce in depression?
Depression causing prescriptions such as steroids
48
Give six classes of antidepressants
``` SSRI TCA SNRI Noradrenergic and specific serotonergic antagonists (NSSA) Noradrenaline reuptake inhibitor (NaRI) Monoamine oxidase inhibitors (MAOIs) ```
49
Give three examples of SSRIs
Citalopram Fluoxetine Sertraline
50
What are some side effects of SSRIs?
``` 'Hangover'- N+V, diarrhea, dry mouth, headache Insomnia Agitation on starting Erectile dysfunction/loss of libido Hyponatremia- Rare ```
51
What are some side effects of sudden withdrawal of an SSRI?
``` Shivering Anxiety Dizziness 'Electric shocks' Headache Nausea ```
52
What are some benefits of SSRIs?
Given once daily | Fewer side effects
53
How do SSRIs work?
Inhibit 5-HT reuptake therefore increase conc.
54
How do TCAs work?
Inhibit reuptake of monoamines: NA and serotonin
55
Give some examples of TCAs
Amitriptyline | Clomipramine
56
Give some examples of TCA side effects
- Weight gain - Antimuscarinic: Dry mouth, Constipation, Tremor, Blurred vision, Urinary retention - Cardiovascular: QT prolongation, Arrhythmias, Postural hypotension - Lowers seizure threshold - Mania
57
Should TCA be given to those with suicidal intentions?
Not directly as toxic in OD. | Give to responsible 3rd party
58
Give an example of an SNRI
Venlafaxine
59
What are some benefits of venlafaxine?
Once daily Less muscarinic effects Less sedation
60
What are some side effects of venlafaxine?
Nausea Hypertension Do NOT give to those with hypertension or arrhythmias
61
Give an example of a Noradrenergic and specific serotonergic antagonists (NSSA)
Mirtazapine
62
What are some side effects of mirtazapine?
Sedation | Agranulocytosis
63
Give an example of an Noradrenaline reuptake inhibitor (NaRI)
Reboxetine
64
What are some side effects of reboxerine?
``` Dry mouth Insomnia Constipation Urine hesitance Tachycardia ```
65
What does monoamine oxidase do?
Metabolise monoamines: NA and serotonin
66
What is a major side effect of Monoamine oxidase inhibitors (MAOIs)?
``` Dangerous hypertension when consume tyramine or dopamine: Cheese Pickled herring Yeast Game Broad beans ```
67
What is a dangerous condition associated with a combination of some antidepressants?
Toxic hyperserotonergic state
68
What can cause Toxic hyperserotonergic state?
Can be caused by 2+ drugs that increase serotonin levels
69
What are some symptoms of toxic hyperserotonergic state?
``` Agitation Confusion Tremor Diarrhoea Tachycardia Hypertension Hyperthermia Support ```
70
How should antidepressant dose be altered in the elderly?
Half the dose
71
How should antidepressant dose be altered in pregnancy/breastfeeding?
Avoid as far as possible | If needed TCA best
72
What herbal medication should be avoided when taking antidepressants?
St John's Wort
73
What is bipolar disorder?
Two or more episodes in which the patient’s mood and activity levels are significantly elevated.
74
Give five forms of bipolar disorder
``` Bipolar 1 Bipolar 2 Rapid cycling Mixed affective state Cyclothymia ```
75
What is Cyclothymia?
Hypomania and mild depression not serious enough to be classed as bipolar
76
What is bipolar 1?
Mania and depression
77
What is bipolar 2?
Hypomania and depression
78
Which is more common: bipolar 1 or 2?
Bipolar 2
79
How long does untreated mania tend to last?
~2 months
80
How long must mania be sustain to diagnose?
Must be maintained for 7 days or be hospitalized to diagnose
81
Give some symptoms of mania
-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
How long must hypomania be sustained to diagnose?
4 days
83
Give some symptoms of hypomania
Same as mania but less severe and maintain insight or psychosis
84
What is rapid cycling?
Frequent swings from one mood state to another
85
What is mixed effective state?
Features of mania and depression in same episode
86
What serious condition can bipolar increase?
Suicide
87
What is the differential for bipolar?
Intoxication Long term cannabis use Cushing's syndrome- Can cause mania Dopamine agonists
88
What is the pathology of bipolar?
Strong genetic link Serotonin increases in mania Tricyclic antidepressants can cause manis
89
What should you do in a first hypo/manic presentation?
CT head EEG Drug screen
90
How should you treat acute mania?
Stop antidepressants | Give antipsychotics: Sodium valproate, Li, Olanzapine
91
How do you treat acute hypomania?
Valproic acid
92
Describe prophylaxis for bipolar?
Mood stabilisers
93
Give some examples of mood stabilisers
Li Carbonate Olanzapine Valproic acid
94
How is Li Carbonate absorbed?
GI
95
How is Li Carbonate excreted?
Renal
96
What should you screen for before starting Li Carbonate?
Thyroid disease | Renal disease
97
What are you looking for when screening for thyroid disease?
TSH fT4 Thyroid antibodies
98
Why must you screen for thyroid disease before starting Li Carbonate?
Because because it can cause hypothyroidism
99
Why must you screen for renal disease before starting Li Carbonate?
Because it can cause: Reduced glomerular function Nephrogenic DI
100
What are you looking for when screening for renal function?
Serum urea and creatinine
101
What is the therapeutic range for Li Carbonate?
0.5-1mmol/l
102
What is the toxic threshold for Li Carbonate?
1.5mmol/l
103
What are some symptoms of Li Carbonate toxicity?
Drowsiness N+V Blurred vision
104
What can Li Carbonate interact with?
NSAIDs | Diuretics
105
What are some side effects of Li Carbonate?
``` N+D Tremor Polyurea and polydipsia Increased appetite Mania if abrupt stop ```
106
What can happen if you abruptly stop Li Carbonate?
Mania
107
How long should you treat a first presentation of depression for?
6-12 months after resolution
108
How long should you treat a second presentation of depression for?
12-24 months after resolution
109
How long should you treat a third presentation of depression for?
Indefinitely
110
What is the definition of non-response to antidepressants?
No or inadequate response in 6 weeks
111
How do cortisol levels change in unipolar depression?
Raised
112
Why are cortisol levels raised in unipolar depression?
No negative feedback of cortisol
113
What do the increased levels of cortisol in depression do?
Increased flight or fight | Brain damage
114
What test can you do for cortisol in depression?
Dexamethasone test
115
What does dexamethasone do in depression?
Sweet fuck all
116
What happens to the adrenal glands in depression?
Hypertrophy
117
What is another name for mood disorders?
Affective disorders

Psychiatry (22 decks)

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