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Yr4 - Psych > Mood Disorders > Flashcards

Mood Disorders Flashcards

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1
Q

Core symptoms of depression

A

Continuous low mood for at least 2 weeks
Lack of energy
Lack of enjoyment/interest (anhedonia)

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2
Q

Somatic symptoms of depression

A 
Sleep changes - early morning waking, insomnia
Appetite and weight changes
Diurnal variation of mood 
Psychomotor retardation/agitation
Loss of libido
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3
Q

Cognitive symptoms of depression

A 
Low self esteem
Guilt/self blame
Hopelessness
Hypochondriacal thoughts
Poor concentration/attention
Suicidal thoughts
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4
Q

Severity of depression

A

Mild - 2 core + 2 others
Moderate - 2 core + 3/4 others
Severe - 3 core + at least 4 others
- can also have severe with psychotic symptoms

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5
Q

Features of postnatal depression

A

1-2 months postpartum
Usual symptoms of depression
- worries about baby’s health or ability to cope with baby

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6
Q

Risk factors for postnatal depression

A 
PHx or FHx of depression
Older age
Single mother
Unwanted pregnancy
Poor social support
Previous PND
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7
Q

Symptoms of hypomania

A

Several of following features with considerable interference with work/social activity for at least several days

  • mildly elevated, expansive or irritable mood
  • increased energy/activity
  • increased self esteem
  • sociability, talkativeness, over familiarity
  • increased sex drive
  • reduced need for sleep
  • difficulty focussing on one task alone
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8
Q

Symptoms of mania

A 
Elevated/expansive/irritable mood (at least 1 week)
Can occur with or without psychotic symptoms
Increased energy/activity
Grandiosity/increased self-esteem
Pressure of speech
Flight of ideas/racing thoughts
Distractible
Reduced need for sleep
Increased libido
Social inhibitions lost
Psychotic symptoms
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9
Q

Define bipolar affective disorder

A

Alternating periods of abnormal mood elevation and depression associated with change or impairment in functioning

  • manic episode
  • hypomanic episode
  • depressive episode
  • mixed episode
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10
Q

Types of persistent mood disorders

A 
Cyclothymia
- mild periods of elation/depression
- early onset/chronic course
- common in relative of BPD
Dysthymia
- chronic low mood not fulfilling the criteria of depression
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11
Q

Define cyclothymia

A

Period of at least 2 years of instability of mood involving several periods of both depression and hypomania with or without intervening periods of normal mood

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12
Q

Define dysthymia

A

Period of at least 2 years of contestant or constantly recurring depression mood

  • intervening periods of normal mood rarely last longer than a few weeks
  • no episodes of hypomania
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13
Q

Define mixed affective episode

A

Episode characterised by mixture or rapid alternation of hypomanic, manic and depressive symptoms
- usually within a few hours

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14
Q

ICD 10 classification of bipolar disorder

A

Requires at least 2 episodes

- one of which must be hypomanic, manic or mixed episode

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15
Q

Differential diagnosis of mood disorders

A 
Normal fluctuations in mood
Adjustments disorders/bereavement
PTSD
Dementia and other brain disorders
Personality disorders
Anxiety disorders
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16
Q

Causes of mood disorders

A 
Biological
- genetic
- brain illness
- physical illness
Psychological
- childhood experiences
- view of yourself and the world
- personality traits
Social
- work, housing, finance
- relationships/support
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17
Q

Treatment of mood disorders

A

Biological

  • pharmacological
  • ECT - electroconvulsive therapy
  • rTMS - repetitive transcranial magnetic stimulation
  • tDCS - transcranial direct current stimulation
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18
Q

Pharmacological treatment of depression

A 
Antidepressants
- SSRIs
- SNRIs
- TCAs
- NASSAs
- MAOIs
- Melatonin receptor agonist
- NRI
- SARI
Mood stabilisers
- Lithium
- Valproate
- Carbamazepine
- Lamotrigine
Combination therapies
19
Q

Features of monoamine hypothesis

A

Neurotransmitter change seen depression

- in particular nor-adrenaline and serotonin

20
Q

Indications for ECT

A 
Severe depressive illness - where other treatments not affective
Life-threatening illness
Prolonged and severe manic episode
Catatonia
High suicide risk
Stupor
Severe psychomotor retardation
21
Q

Features of pharmacological treatment of bipolar disorder

A

Mood stabilisers
Antipsychotics
- avoid antidepressants

22
Q

Psychological treatment of mood disorders

A 
Psychoeducation - about illness, relapse signatures, medication
CBT
IPT
Psychodynamic
Mindfulness
23
Q

Social interventions for mood disorders

A 
Targeted interventions
- family
- housing
- finance
- employment
General coping strategies
- importance of regular structured activities
24
Q

Define mood

A

Patient’s sustained, experienced emotional state over a period of time

25
Q

Define affect

A

Transient flow of emotion in response to a particular stimulus

26
Q

Define mood disorder

A

Condition characterised by distorted, excessive or inappropriate moods or emotions for a sustained period of time

27
Q

ICD-10 types of mood disorders

A 
Manic episode
Bipolar affective disorder
Depressive episode
Recurrent depressive disorder
Persistent mood disorders
28
Q

Types of mood disorders

A

Primary
- does not result from another medical or psychiatric condition
Secondary
- results from another medical or psychiatric condition

29
Q

Define depressive disorder

A

Affective mood disorder characterised by persistent low mood, loss of pleasure and/or lack of energy accompanied by emotional, cognitive and biological symptoms

30
Q

Monoamine hypothesis for depression

A

Deficiency of monoamines (noradrenaline, serotonin and dopamine) causes depression
Over-activity of HPA axis

31
Q

Predisposing factors for depressive disorder

A 
Biological
- Female gender (2:1) 
- Postnatal period 
- Genetics - family history 
- Neurochemical: ↓ serotonin, ↓ noradrenaline, ↓ dopamine 
- Endocrine: ↑ activity of HPA axis 
- Physical co-morbidities 
- Past history of depression
Psychological
- Personality type 
- Failure of effective stress control mechanisms 
- Poor coping strategies 
- Other mental health co-morbidities (e.g. dementia)
Social
- Stressful life
- Lack of social support
- Asylum seeker and referee population
32
Q

Precipitating factors for depression

A 
Biological
- Poor compliance with medication
- Corticosteroids
Psychological
- Acute stressful life events - personal injury, loss of loved one, bankruptcy
Social
- Unemployment
- Poverty
- Divorce
33
Q

Perpetuating factors for depression

A 
Biological
- Chronic health problems - diabetes, COPD, CCF, chronic pain
Psychological 
- Poor insight
- Negative thoughts about self, the world and future
Social
- Alcohol and substance misuse
- Poor social support
- Low social status
34
Q

Investigations for depression

A

Diagnostic questionnaire - PHQ-9
Bloods - FBC, TFTs, U+Es, LFTs, calcium levels, glucose
Imaging - MRI or CT scan

35
Q

Other depressive disorders

A

Recurrent depressive disorder
Seasonal affective disorder - depressive episodes recurring annually at same time of year
Masked depression - depressed mood not particularly prominent
Atypical depression - mild-moderate depression with reversal of symptoms
Dysthymia - depressive state for at least 2 years which does not meet criteria for mild depression
Cyclothymia - chronic mood fluctuations over at least a 2 year period with episodes of elation and depression which are insufficient to meet criteria for hypomanic or depressive disorder

36
Q

Management of depression

A 
Biological
- antidepressants
- adjuvants - antipsychotics
- ECT
Psychological
- psychotherapies
- self-help programmes
- physical activity
Social
- social support groups
37
Q

Treatment of mild-moderate depression

A 
Watchful waiting - reassess in 2 weeks
Antidepressants - not 1st line unless
- lasted long time
- past history of moderate-severe depression
- failure of other interventions
- depression complicates care of other physical health problems
Self-help programmes
CBT
Physical activity programme
Psychotherapies
38
Q

Management of moderate-severe dpression

A 
Suicide risk assessment
Psychiatry referral
- high suicide risk
- severe depression
- recurrent depression
- unresponsive to initial treatment
Mental health act
Antidepressant - 1st line = SSRIs
Adjuvants - lithium or antipsychotics
Psychotherapy
Social support
ECT
- acute treatment of severe life-threatening depression
- rapid response required
- psychotic features
- severe psychomotor retardation
- failure of other treatments
39
Q

ICD-10 criteria for mania

A

3/9 symptoms present

  • grandiosity/inflated self-esteem
  • decreased sleep
  • pressure of speech
  • flight of ideas
  • distractibility
  • psychomotor agitation
  • reckless behaviour
  • loss of social inhibitions
  • marked sexual energy
40
Q

ICD-10 criteria for bipolar

A

At least 2 episodes in which a person’s mood and activity levels are significantly disturbed
- one of which must be mania or hypomania

41
Q

Investigations for bipolar

A

Self-rating scales - mood disorder questionnaire
Blood tests - FBC, TFTs, U+Es, LFTs, glucose, calcium
Urine drug test
CT head - space occupying lesions

42
Q

Management of bipolar

A

Full risk assessment
Ask about driving
Mental health act - hospitalisation required if
- reckless behaviour causing risk to patient or others
- significant psychotic symptoms
- impaired judgement
- psychomotor symptoms
For bipolar depression offer CBT
ECT - severe uncontrolled mania
Mood stabilisers, benzodiazepines, antipsychotics

43
Q

Pharmacological management of bipolar

A

First line = antipsychotics - olanzapine, risperidone, quetiapine
Mood stabilisers - lithium
Benzodiazepines
Rapid tranquilisation - haloperidol or lorazepam
Antidepressants for depressive episode
Long term management = lithium
- consider valproate

Yr4 - Psych (13 decks)

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