Mood Disorders Flashcards
What is circumstentiality?
‘over-inclusive speech’- speech that is delayed in reaching its final goal because of the over-inclusion of details and unnecessary asides and diversions; however, the speaker, if allowed to finish, does eventually connect the original starting point to the de- sired destination
Degrees of normal
What s tangentiality
Sees the speaker diverting from the initial train of thought but never returning to the original point, jumping tangentially from one topic to the next
More indicative of psychopathology
Describe bipolar disorder
- Psychiatric illness characterized by episodes of mania (or hypomania) and major depression, interspersed with periods of normal mood and functioning
- Patients who present with a manic or hypomanic episode will have experienced a previous episode of mood disturbance. They should be labelled as bipolar
- Episodes of mania and depression can occur anytime but are usually linked to environmental triggers
What are the different types of bipolar disorder?
- Bipolar I
o At least one episode of mania; major depressive episodes usually occur but are not required for diagnosis - Bipolar II
o At least one episode of hypomania and one major depressive episodes. NO episodes of mania – distinguishing feature from Bipolar I
how would you manage an acute manic episode?
o General principles
Reduce external stimuli.
Assess for possible contributing substances (e.g. drugs and alcohol
Limit access to cars, bank accounts/credit cards, cell phones, etc., because of the potential for reckless behaviour
o Mild-moderate mania
Lithium monotherapy or an atypical anti-psychotic
o Severe mania
Mood stabiliser (lithium or sodium valproate)
Plus antipsychotic
o Antipsychotics are preferred initial therapy in agitated patients as they have a rapid onset
How long do you treat a patient with bipolar for?
1 year following a single manic episode
2 or more episodes – consider life long therapy
What are the core features of depression
Low mood +/- andedonia +/- fatigue every day for at least 2 weeks
Name some clinical features of depression, considering how you would break these down
• Biological o Diurnal variation o Insomnia o Decreased appetite o Weight loss o Loss of libido o Constipation o Amenorrhoea • Cognitive o Decreased concentration o Unable to sustain attention o Slow and negative thinking o Loss of self-esteem o Guilt o Hopelessness • Psychosis o Delusions. These are mood congruent Guilt, poverty, persecutory Cotard's syndrome o Hallucinations Auditory 2nd person
How would you assess someone with depression?
Clinical history Risk assessment MSE (mental state exam) Physical exam Baseline bloods
What model of treatment is used to treat depression?
Biopsychosocial
What is the hallmark of a manic episode?
an elevated or irritable mood
Name some common evidence of mania that you would look out for while doing your assessment
- Decreased need for sleep (81%),
- Grandiosity (78%),
- Racing thoughts (71%),
- Distractibility (68%)
- Sexual disinhibition (57%).
Name the three degrees of manic episode
- Hypomania (lesser degree, not severe disruption of work / social rejection)
- Mania without psychotic symptoms
- Mania with psychotic symptoms
Differentiate between mania and hypomania
- Hypomania is a less severe form of mania
- Hypomania typically lasts for a short period: a few days
- Mania lasts at least a week and will result in significant dysfunction
how long would you initially prescribe a patient depressants for ?
for single episode depression: 4-6 months after resolution of symptoms. Anderson rules
how do TCAs work?
pre-synaptic blockade of both noradrenaline and serotonin reuptake pumps
how do SSRIs work?
presynaptic blockade of serotonin reuptake pumps
how do SNRIs work and give an example
Presynaptic blockade of both noradrenaline (norepinephrine) and serotonin reuptake pumps (also dopamine in high doses) but with negligible effects on muscarinic, histaminergic or a-adrenergic receptors (in contrast to TCAs)
Venlafaxine
name some side effects of SSRIs
o GI
Common: Nausea, appetite loss, dry mouth, diarrhoea, constipation, dyspepsia.
Uncommon: vomiting, weight loss.
o CNS
Common: insomnia, dizziness, anxiety, fatigue, tremor and somnolence.
Uncommon: EPS, seizures and mania
o Other
Common: sweating, delayed orgasm and anorgasmia.
Uncommon: hyponatraemia and alopaecia.
