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Year 4 Psychiatry > Mood Disorders > Flashcards

Mood Disorders Flashcards

1
Q

Define Mood

A

Patient’s sustained emotional state over a period of time

Can be Dysthymic (Low), Euthymic (Normal) or Elevated

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2
Q

Define Affect

A

Transient flow of emotion in response to a particular stimulus

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3
Q

Define Mood Disorder

A

Condition characterised by distorted/excessive/inappropriate moods for a sustained period of time

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4
Q

State the ICD10 class 1-7 for mood disorders

A 
1 - Manic Episode (inc Hypomania)
2 - BPAD
3 - Depressive Episode
4 - Recurrent Depressive Episode
5 - Persistent Mood Disorders (Dysthymia, Cyclothymia)
6 - Other Mood Disorders
7 - Unspecified Mood Disorders
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5
Q

State the two classifications of Mood Disorder and give examples

A

Unipolar - Depressive Disorders, Dysthymia

Bipolar - Cyclothymia, BPAD

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6
Q

State three causes of Secondary Mood Disorders

A

Physical Disorders (Hypothyroid, Cushing)

Psychiatric Disorders (Schizophrenia, Dementia)

Drug Induced

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7
Q

Define Depressive Disorder

A

Affective mood disorder characterised by persistent low mood, loss of pleasure and lack of energy

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8
Q

Give a Bio, Psycho, and Social PREDISPOSING factor for Depressive Disorder

A

Bio - Female
Psycho - Failure of effective stress control
Social - Lack of support

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9
Q

Give a Bio, Psycho, and Social PRECIPITATING factor for Depressive Disorder

A

Bio - Poor Medication Compliance
Psycho - Acute stressful life event
Social - Unemployment

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10
Q

Give a Bio, Psycho, and Social PERPETUATING factor for Depressive Disorder

A

Bio - Chronic Health Problems
Psycho - Poor Insight
Social - Alcohol and Substance Misuse

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11
Q

Other than the three core symptoms, give two cognitive symptoms of Depressive Disorder

A

Lack of Concentration

Excessive Guilt

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12
Q

Other than the three core symptoms, give two biological symptoms of Depressive Disorder

A

Diurnal Variation

Loss of Appetite

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13
Q

What is Becks Triad?

A

Negative thoughts about Self, World and Future

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14
Q

State the ICD10 classification of Mild, Moderate and Severe Depressive Disorder respectively

A

Mild - 2 core symptoms and 2 other symptoms
Mod - 2 core symptoms and 3-4 other symptoms
Severe - 3 core symptoms and >4 other symptoms

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15
Q

Outline the expected Appearance, Behaviour, Speech and Mood of a patient with Depressive Disorder (MSE)

A

Appearance - Self neglect, unkempt
Behaviour - Poor Eye Contact, Slow Responses
Speech - Slow, Reduced Volume and Tone
Mood - Low (Subjectively) and Depressed (Objectively)

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16
Q

Describe the expected Thought, Cognition and Insight of a patient with Depressive Disorder (MSE)

A

Thought - Guilt, Worthless
Cognition - Impaired Concentration
Insight - Usually Good

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17
Q

Name three diagnostic questionnaires for Depressive Disorder

A

PHQ9
HADS
Becks

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18
Q

Other than questionnaires, name two other investigations you could do for Depressive Disorder

A

Bloods (FBC, TFTs, Glucose)

Head CT/MRI (SOL)

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19
Q

What is Seasonal Affective Disorder?

A

Where mood is severely affected by change in seasons

Mood normally lowest in Winter months

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20
Q

What is Masked Depression

A

Depressed mood not prominent, but other features of depression are

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21
Q

What is Atypical Depression?

A

Presenting with the opposite of the typical features - such as Overeating and Hypersomnia

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22
Q

Define Dysthymia and Cyclothymia

A

Dysthymia - Depressive state for two years not meeting threshold

Cyclothymia - Chronic Mood Fluctuation for two years, insufficient to meet threshold

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23
Q

The normal management aim for Mild to Moderate Depression is to ‘Watchful Wait’. What is this?

A

Reviewing the patient again in two weeks

24
Q

Give four non Pharmacological mainstay treatments of Depression

A

Self Help Programmes
CBT
Physical Activity Programmes
Psychotherapies

25
When would you use Antidepressants in Mild to Mod Depression?
Lasted a long time History of Mod - Severe Failure of other interventions
26
What is the first step in management of a Mod to Severe depressed patient?
Suicide Risk Assessment
27
When would you refer a Depressed patient to Psychiatry?
Suicide Risk High Severe Depression Recurrent Depression Unresponsive to Initial Meds
28
Describe the pharmacological therapy of Mod to Severe Depression
SSRIs first line (continued for 6m after symptom resolution for first episode, or 2y if second) Adjuvants with Lithium or Antipsychotics
29
Describe the non pharmacological management of Mod to Severe Depression
Psychotherapy (CBT, IPT) | Social Support
30
When could ECT be recommended for a Depressed patient?
If acutely life threatening Depression with Psychotic Symptoms Severe Psychomotor Retardation
31
Define Bipolar Affective Disorder
Chronic episodic mood disorder characterised by at least one episode of Mania/Hypomania, followed by a further episode of Mania/Depression (Includes patients who at presentation have only suffered Mania as all will eventually develop depression)
32
Describe three potential Biological causes of BPAD
Genetic (40-70% Monozygotic Concordance) Neurochemical (Increased Dopamine, Increased Serotonin) Endocrine (Increased Cortisol, Increased Aldosterone, Increased Thyroid)
33
Give three non biological risk factors for BPAD
Early 20s Substance Misuse Stressful Life
34
Describe the clinical features of Mania in BPAD Hint: I DIG FASTER
Irritability, Distracted, Insight Impaired, Grandiose Delusions, Flight of Ideas, Appetite increased, Sleep decreased, Talkative, Elated mood, Reckless 3 symptoms required for diagnosis
35
What should you always screen for in a Depressed patient?
Mania
36
What is Hypomania?
Mildly elevated/irritable mood for present for at least four days Interruption of life but not disruption May have partial insight
37
Define Mania without Psychosis
Similar to Hypomania but to a greater extent, with symptoms present for at least a week Grandiose Ideas, Sexual Disinhibition
38
Define Mania with Psychosis
Severely elevated mood with Hallucinations and Delusions
39
What is the difference between Bipolar I and Bipolar II?
Bipolar I - Periods of severe mood episodes from Mania to Depression Bipolar II - Milder form of mood elevation, Hypomania alternating with Depression
40
What is Rapid Cycling in BPAD?
More than four mood swings in a 12 month period with no intervening asymptomatic periods Poor prognosis
41
Describe the ICD10 classification of BPAD
1) Currently Hypomanic 2) Currently Manic 3) Currently Depressed 4) Mixed Disorder 5) In Remission
42
Describe the expected Appearance, Behaviour, Speech and Mood of a patient with BPAD (MSE)
Appearance - Flamboyant, Heavy makeup/jewellery Behaviour - Disinhibited, Distractable Speech - Loud, Fast, High Volume, Puns, Neologisms Mood - Elated
43
What are Neologisms?
Creating new words
44
Describe the expected Thought, Perception, Cognition and Insight of a patient with BPAD (MSE)
Thought - optimistic, pressure of speech, circumstantiality, delusions Perception - usually don’t have hallucinations, although may have mood congruent auditory hallucinations Cognition - fully orientated but cognition impaired Insight - Poor
45
Name 5 blood tests you would want to carry out if you suspected BPAD
``` FBC TFTs (for hypo or hyper) U&Es (baseline for starting Lithium) LFTs (Baseline for mood stabilisers) Calcium ```
46
Other than bloods, give three other investigations for BPAD
Mood Disorder Questionnaire Urine Illicit Drug Test CT head to rule out SOL
47
Give three differentials for BPAD
Depression Schizophrenia Drug Related
48
When would you hospitalise someone with BPAD?
Reckless behaviour causing risk to self or others Significant Psychotic Symptoms Impaired Judgement
49
How would you pharmacologically manage the ‘Manic’ phase of BPAD?
1) Antipsychotics 2) Mood Stabilisers +/- Benzodiazepines
50
How would you manage the Acute Depressed phase of BPAD?
1) Antipsychotics (normally Olanzepine, either alone or combined with Fluoxetine) 2) Mood Stabilisers NO ANTIDEPRESSANTS
51
What is the long term pharmacological management of BPAD?
Start it 4 weeks after acute episode resolves Lithium is first line, can add Valproate (the combination is first line for rapid cycling)
52
The management of BPAD can be described with the mnemonic CALMER. Define it
``` CBT Antipsychotic Lorazepam Mood Stabiliser ECT Risk Assessment ```
53
What is a Pseudodementia?
When depression appears like dementia
54
How could you ask about mood?
Rate on a scale of 1-10
55
What are the three components of risk?
Risk to self Risk to others Risk from others

Year 4 Psychiatry (12 decks)

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