Mood Disorders Flashcards
Definition of a Mood Disorder
Psychological disorder, characterised by the elevation/lowering of someones mood
Examples of Mood Disorders
Major Depressive Disorder Bipolar affective disorder Seasonal affective disorder Environmental Depression Premenstrual dysphoric disorder Cyclothymic disorders
Who are more affected by mood disorders and by how much
Females, 2:1 to males
What is the relative risk of getting a mood disorder if a 1st degree relative has it
2-3x
what age does a mood disorder most commonly come on in
12-24 or >65
Aetiology of Depression
mostly unknown, multi-factorial, although certain life events, stress and gender can play a part
Prognosis of depression
1/3 recurrence rate within 1 year
50% lifetime recurrence
87% of recurrence is within 15 years
Clinical features of Depression
3 Core symptoms:
Anhedonia
Anergy
Low mood
7 Other: Disturbed sleep Poor concentration psychomotor agitation/slowing low self-confidence changes to appetite guilt/self-blame suicidal ideation
Diagnostic criteria and classification for depression
Symptoms must be present most days, most of the time for at least 2 weeks
Mild - 4 symptoms (at least 2 core symptoms)
Moderate - 6 (at least 2 core symptoms)
Severe - 8 (has to be present for >4 weeks, with every symptom present for most of every day, at least 2 core symptoms)
Severe +Psychosis - all features of severe + psychosis
Differentials for Depression
Bipolar Schizophrenia Grief reaction Dementia Anxiety Hypothyroidism Vit B12 deficiency ADR Sleep apnoea Cushings MS Parkinsons Infection
How do you investigate suspected depression
Thorough Mental health history asking about all the symptoms of depression - (questionnaire PHQ-9)
Bloods - FBC, TFT, metabolic screen, 24-hr cortisol, folic acid, Tox screen, B12, fasting glucose
collateral history
What is somatic syndrome
Physical or biological symptoms of depression
Symptoms of somatic syndrome
decreased appetite weight loss early morning waking diurnal variation in mood -wose in morning decreased libido psychomotor retardation emotional reactivity
How does the presence of a mood disorder modulate the risks of self harm
vastly increased
36-90% of suicides are by people with depression
5-15% of patients with a diagnosis of depression die from suicide
what gender more commonly self harms and by how much
F>M 2:1
How does marital status affect self harming
Divorced > single > widowed > married
what age is self harm most common in
2/3 <35 y/o
what is the most popular form of self harm
cutting or overdose
what factors predispose to repeated self harming
Personal History Personality disorder diagnosis history of violence alcohol/drug misuse being unmarried
What factors indicate intent to commit suicide
isolation planning leaving a note settling debts, leaving a will use of violent methods perceived lethality by patient
What gender commits suicide more commonly and by how much
M>F 3:1
What are some vulnerable groups for suicide
LGBTQ+ Prisoners Asylum seekers Veterans Mental health patients
What is the options for BioPsycoSocial management for depression
BIO antidepressants (1st line bio approach) atypical antipsychotics lithium T3 augmentation ECT
PSYCHO
psychoeducation
CBT
interpersonal therapy
SOCIAL support for education, training and employment housing support carers CPN social inclusion
What is the guideline for treating mild/moderate depression
1st line antidepressant + low intensive (e.g. self help) psychotherapy + social support
2nd line - alternative antidepressant
3rd line St Johns wort monotherapy
keep in primary care as long as not getting worse
what is the guideline for treating moderate/treatment resistant mild depression
Still keep primary care for the meantime
Antidepressant + High-intensity psychotherapy (psychologist-led CBT)
consider a secondary care referral
what is the guideline for treating severe/psychotic depression/severe self-neglect
Admission + Medication +high intensity psychosocial intervential + MDT approach + Crisis resolution at home treatment
ECT if extremely treatment-resistant
Epidemiology of bipolar affective disorder
1%
M=F
occurs in late teens - early 20s usually
how long do manic/depressive episodes last in bipolar affective disorder generally
6 months
how many people with bipolar affective disorder go on to have a further episode of mood disturbance after an episode
90%
how many episodes over 25 years does the average person with bipolar affective disorder have
10
what is the increase in suicide risk for someone with bipolar affective disorder
20-30x
what are the features of hypomania
increased or unstable mood increased energy mild overspending increased sociability increased distractibility increased sexual energy decreased sleep
present for at least 4 days and at least 3 of these
what are the features of mania
irritable, increased mood increased activity reckless behavior disinhibition marked distractibility increased sexual energy absent/severely impaired sleep grandiosity flight of ideas (jumps from thought to thought but there is a link between them)
present for at least 7 days OR severe enough for admission
how do you diagnose bipolar affective disorder
At least 2 episodes of mood disturbance, mania, hypomania or depression, recurrent mania/hypomania can only be BAD
what are some common mimics of bipolar affective disorder
normal mood variation recurrent depressive disorder cyclothymia dysrhythmia depression in dysthymia
What are the features of mania with psychosis
Mania + delusions + Hallucinations
Delusions are mood-congruent
hallucinations are 2nd person and mood-congruent
10% suffer 1st rank symptoms of schizophrenia
How do you manage acute mania
stop any antidepressants
consider lithium/vaproate/lamotrigine as mood stabiliser
consider benzo as behaviour modification
offer antipsychotics
mental health act assessment
consider IPC
try and avoid making serious decisions whilst unwell
Bipolar Depression treatment
mood stabilisers (lithium/valproate/lamotrigine)
antidepressant (only alongside antimanic agent)
atypical antipsychotic
CBT (esp. if mild/moderate)
psychoeducation
social support
what drug is first line in pregnancy for treating bipolar affective disorder
anti-psychotics (aripiprazole, olanzipine etc)
what monitoring is required for lithium
weekly lithium level bloods after initiating and after dose changes
then every 3 months after
then U+E and TFT every 6 months
contraception required
