Mood disorders Flashcards
Name some examples of mood disorders
- manic episode
- bipolar affective disorder (BPAD)
- depressive episode
- recurrent depressive disorder
- other mood disorders: cyclothymia and dysthymia
3 main domains of treatment options for mood disorders (in general)
Biological: Medications such as antidepressants and mood
stabilisers, but can include ECT as a last line treatment
Psychological: Talking therapies, CBT, Mindfulness, Counselling, keeping Mood Diaries, Family Work
Social: All manner of social support depending on what social problems the mood disorder has contributed to – financial support, housing support, family work, employment, re-housing
Mnemonic for clinical features of depression
Management of depression
- Bio: SSRIs are first line, but other anti-depressive medication is used – SNRIs/TCAs/NaSSA – very rarely MAOIs
- Psycho: CBT, Mindfulness, Counselling, Psychotherapy can all help
- Social: depends on the individual but help with financial problems, housing issues, employment, family problems etc
Aetiology for maniac phase of bipolar disorder
Trigger factors for inducing a manic phase can be a mixture of events:
- stress
- over excitement
- using ‘stimulant’ substances such as amphetamines, cocaine and caffeine
- while using anti-depressants for depressive episode
- It can occur idiopathically in people who are predisposed to changes in mood
What to be aware of/careful about while treating a depressive episode in a person with the bipolar affective disorder?
- if someone with BPAD is recovering from a depressive episode using antidepressant medication → monitor this closely
- the mood-elevating properties of the medication → potential to trigger a manic episode
Mnemonic for features of mania
People who would DIG FAST
DDistracted (unable to concentrate)
I Irritable and Increased energy
G Grandiose ideas (if deluded a common delusion)
F Flight of Ideas (thoughts jump from topic to topic)
A Accelerated behaviour
S Spending and Sex (spending sprees and increased libido common)
T Talkative (Pressure of speech and logorrhea = “talkativeness”)
Are talking therapies effective for a person in a maniac phase?
- highly likely → no insight and in high risk → hospitalization, often under the MHA is common
- it’s difficult to rationally converse with someone who is manic → talking therapies are usually ineffective at this stage
Management of Manic phase
- usually hospitalisation under MHA (due to lack of insight during manic episode)
- Bio: Antipsychotic medication and benzodiazepines are first-line (known as rapid tranquillisation), a mixture of Haloperidol (AP) and Lorazepam (BZD) are given, usually as IM injection until the person is calmer and less agitated/energized
- Psycho/Social: Risk Assessment and risk management is essential. Family support and ensuring the person doesn’t have access to credit cards/car keys etc in a manic state
Types of Bipolar Affective Disorder
DSM (The American Psychiatric Association classification system):
- Type I → Classic ‘manic-depression’ episodes of mania and depression
- Type II → More frequent episodes of depression are reported and elevated mood is hypomania (so not full manic phases)
- Rapid Cycling → 4 or more episodes of mania or depression are experienced in a 12 month period
*ICD just have Bipolar as a classification, with specific current types i.e. mania/depressed/in remission etc
Biological management of Bipolar Affective Disorder
Mood Stabilisers → first line
There are 3 different classes of medication that have mood-stabilizing properties.
- Lithium: sedating and mood stabilising effects. Lithium Carbonate is the most commonly used type
- Anticonvulsants: Sodium Valproate, Carbamazepine and Lamotrigine all have mood stabilising properties
- Atypical Antipsychotics: Olanzapine, Quetiapine and other Atypicals are used for mood stabilising effects as well as being used as antipsychotics
Psycho-social management of Bipolar Affective Disorder
- Psycho: CBT; Keeping mood diaries is very helpful as it can help people and their family record mood changes so hopefully detect the future onset of depression/mania, so hopefully receive help quickly before the change in mood escalates/deteriorates into a major problem
- Social: Would depend on the individual but highly likely to include help with financial problems, housing issues, employment and the social fallout of behaviours undertaken when depressed or manic.
What’s cyclothymia?
- milder, less severe form of bipolar disorder
Aetiology of cyclothymia
- Unknown
- It is probably part of a spectrum of mood disorders such as bipolar and depression – so the factors that contribute to those conditions will also contribute to cyclothymia
Clinical features of cyclothymia
- may start in early life
- the key diagnostic criteria: the mood variations are not severe or prolonged enough to warrant a diagnosis of BPAD or recurrent depressive disorders
What’s dysthymia?
- a chronic depression of mood which
- does not currently fulfil the criteria for recurrent depressive disorder, mild, moderate or severe
- usually have periods of days or weeks when they describe themselves as well, but most of the time (often for months or years) they feel tired and depressed
- can normally cope with the basic demands of life (which is why this isn’t classed as mild depression) but describe feeling mostly unhappy
Aetiology and treatment of dysthymia
- the same as for depression
- combination of medication and talking therapy → SSRI/CBT probably the most effective
