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Psychiatry > Mood Disorders > Flashcards

Mood Disorders Flashcards

1
Q

Definition of a Mood Disorder

A

Psychological disorder, characterised by the elevation/lowering of someones mood

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2
Q

Examples of Mood Disorders

A 
Major Depressive Disorder 
Bipolar affective disorder
Seasonal affective disorder
Environmental Depression 
Premenstrual dysphoric disorder 
Cyclothymic disorders
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3
Q

Who are more affected by mood disorders and by how much

A

Females, 2:1 to males

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4
Q

What is the relative risk of getting a mood disorder if a 1st degree relative has it

A

2-3x

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5
Q

what age does a mood disorder most commonly come on in

A

12-24 or >65

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6
Q

Aetiology of Depression

A

mostly unknown, multi-factorial, although certain life events, stress and gender can play a part

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7
Q

Prognosis of depression

A

1/3 recurrence rate within 1 year
50% lifetime recurrence
87% of recurrence is within 15 years

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8
Q

Clinical features of Depression

A

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
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9
Q

Diagnostic criteria and classification for depression

A

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

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10
Q

Differentials for Depression

A 
Bipolar
Schizophrenia
Grief reaction
Dementia
Anxiety
Hypothyroidism
Vit B12 deficiency 
ADR
Sleep apnoea 
Cushings
MS
Parkinsons
Infection
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11
Q

How do you investigate suspected depression

A

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

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12
Q

What is somatic syndrome

A

Physical or biological symptoms of depression

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13
Q

Symptoms of somatic syndrome

A 
decreased appetite
weight loss
early morning waking
diurnal variation in mood -wose in morning 
decreased libido
psychomotor retardation 
emotional reactivity
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14
Q

How does the presence of a mood disorder modulate the risks of self harm

A

vastly increased

36-90% of suicides are by people with depression
5-15% of patients with a diagnosis of depression die from suicide

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15
Q

what gender more commonly self harms and by how much

A

F>M 2:1

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16
Q

How does marital status affect self harming

A

Divorced > single > widowed > married

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17
Q

what age is self harm most common in

A

2/3 <35 y/o

18
Q

what is the most popular form of self harm

A

cutting or overdose

19
Q

what factors predispose to repeated self harming

A 
Personal History 
Personality disorder diagnosis 
history of violence 
alcohol/drug misuse
being unmarried
20
Q

What factors indicate intent to commit suicide

A 
isolation
planning
leaving a note
settling debts, leaving a will 
use of violent methods 
perceived lethality by patient
21
Q

What gender commits suicide more commonly and by how much

A

M>F 3:1

22
Q

What are some vulnerable groups for suicide

A 
LGBTQ+ 
Prisoners 
Asylum seekers
Veterans 
Mental health patients
23
Q

What is the options for BioPsycoSocial management for depression

A 
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
24
Q

What is the guideline for treating mild/moderate depression

A

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

25
Q

what is the guideline for treating moderate/treatment resistant mild depression

A

Still keep primary care for the meantime
Antidepressant + High-intensity psychotherapy (psychologist-led CBT)
consider a secondary care referral

26
Q

what is the guideline for treating severe/psychotic depression/severe self-neglect

A

Admission + Medication +high intensity psychosocial intervential + MDT approach + Crisis resolution at home treatment

ECT if extremely treatment-resistant

27
Q

Epidemiology of bipolar affective disorder

A

1%
M=F
occurs in late teens - early 20s usually

28
Q

how long do manic/depressive episodes last in bipolar affective disorder generally

A

6 months

29
Q

how many people with bipolar affective disorder go on to have a further episode of mood disturbance after an episode

A

90%

30
Q

how many episodes over 25 years does the average person with bipolar affective disorder have

A

10

31
Q

what is the increase in suicide risk for someone with bipolar affective disorder

A

20-30x

32
Q

what are the features of hypomania

A 
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

33
Q

what are the features of mania

A 
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

34
Q

how do you diagnose bipolar affective disorder

A

At least 2 episodes of mood disturbance, mania, hypomania or depression, recurrent mania/hypomania can only be BAD

35
Q

what are some common mimics of bipolar affective disorder

A 
normal mood variation
recurrent depressive disorder
cyclothymia
dysrhythmia
depression in dysthymia
36
Q

What are the features of mania with psychosis

A

Mania + delusions + Hallucinations
Delusions are mood-congruent
hallucinations are 2nd person and mood-congruent
10% suffer 1st rank symptoms of schizophrenia

37
Q

How do you manage acute mania

A

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

38
Q

Bipolar Depression treatment

A

mood stabilisers (lithium/valproate/lamotrigine)
antidepressant (only alongside antimanic agent)
atypical antipsychotic
CBT (esp. if mild/moderate)
psychoeducation
social support

39
Q

what drug is first line in pregnancy for treating bipolar affective disorder

A

anti-psychotics (aripiprazole, olanzipine etc)

40
Q

what monitoring is required for lithium

A

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

Psychiatry (13 decks)

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