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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
Q

When would you use Antidepressants in Mild to Mod Depression?

A

Lasted a long time
History of Mod - Severe
Failure of other interventions

26
Q

What is the first step in management of a Mod to Severe depressed patient?

A

Suicide Risk Assessment

27
Q

When would you refer a Depressed patient to Psychiatry?

A

Suicide Risk High
Severe Depression
Recurrent Depression
Unresponsive to Initial Meds

28
Q

Describe the pharmacological therapy of Mod to Severe Depression

A

SSRIs first line (continued for 6m after symptom resolution for first episode, or 2y if second)

Adjuvants with Lithium or Antipsychotics

29
Q

Describe the non pharmacological management of Mod to Severe Depression

A

Psychotherapy (CBT, IPT)

Social Support

30
Q

When could ECT be recommended for a Depressed patient?

A

If acutely life threatening

Depression with Psychotic Symptoms

Severe Psychomotor Retardation

31
Q

Define Bipolar Affective Disorder

A

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
Q

Describe three potential Biological causes of BPAD

A

Genetic (40-70% Monozygotic Concordance)
Neurochemical (Increased Dopamine, Increased Serotonin)
Endocrine (Increased Cortisol, Increased Aldosterone, Increased Thyroid)

33
Q

Give three non biological risk factors for BPAD

A

Early 20s
Substance Misuse
Stressful Life

34
Q

Describe the clinical features of Mania in BPAD

Hint: I DIG FASTER

A

Irritability, Distracted, Insight Impaired, Grandiose Delusions, Flight of Ideas, Appetite increased, Sleep decreased, Talkative, Elated mood, Reckless

3 symptoms required for diagnosis

35
Q

What should you always screen for in a Depressed patient?

A

Mania

36
Q

What is Hypomania?

A

Mildly elevated/irritable mood for present for at least four days

Interruption of life but not disruption

May have partial insight

37
Q

Define Mania without Psychosis

A

Similar to Hypomania but to a greater extent, with symptoms present for at least a week

Grandiose Ideas, Sexual Disinhibition

38
Q

Define Mania with Psychosis

A

Severely elevated mood with Hallucinations and Delusions

39
Q

What is the difference between Bipolar I and Bipolar II?

A

Bipolar I - Periods of severe mood episodes from Mania to Depression
Bipolar II - Milder form of mood elevation, Hypomania alternating with Depression

40
Q

What is Rapid Cycling in BPAD?

A

More than four mood swings in a 12 month period with no intervening asymptomatic periods
Poor prognosis

41
Q

Describe the ICD10 classification of BPAD

A

1) Currently Hypomanic
2) Currently Manic
3) Currently Depressed
4) Mixed Disorder
5) In Remission

42
Q

Describe the expected Appearance, Behaviour, Speech and Mood of a patient with BPAD (MSE)

A

Appearance - Flamboyant, Heavy makeup/jewellery
Behaviour - Disinhibited, Distractable
Speech - Loud, Fast, High Volume, Puns, Neologisms
Mood - Elated

43
Q

What are Neologisms?

A

Creating new words

44
Q

Describe the expected Thought, Perception, Cognition and Insight of a patient with BPAD (MSE)

A

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
Q

Name 5 blood tests you would want to carry out if you suspected BPAD

A 
FBC
TFTs (for hypo or hyper)
U&Es (baseline for starting Lithium)
LFTs (Baseline for mood stabilisers)
Calcium
46
Q

Other than bloods, give three other investigations for BPAD

A

Mood Disorder Questionnaire
Urine Illicit Drug Test
CT head to rule out SOL

47
Q

Give three differentials for BPAD

A

Depression
Schizophrenia
Drug Related

48
Q

When would you hospitalise someone with BPAD?

A

Reckless behaviour causing risk to self or others
Significant Psychotic Symptoms
Impaired Judgement

49
Q

How would you pharmacologically manage the ‘Manic’ phase of BPAD?

A

1) Antipsychotics
2) Mood Stabilisers

+/- Benzodiazepines

50
Q

How would you manage the Acute Depressed phase of BPAD?

A

1) Antipsychotics (normally Olanzepine, either alone or combined with Fluoxetine)
2) Mood Stabilisers

NO ANTIDEPRESSANTS

51
Q

What is the long term pharmacological management of BPAD?

A

Start it 4 weeks after acute episode resolves

Lithium is first line, can add Valproate (the combination is first line for rapid cycling)

52
Q

The management of BPAD can be described with the mnemonic CALMER. Define it

A 
CBT
Antipsychotic 
Lorazepam
Mood Stabiliser
ECT
Risk Assessment
53
Q

What is a Pseudodementia?

A

When depression appears like dementia

54
Q

How could you ask about mood?

A

Rate on a scale of 1-10

55
Q

What are the three components of risk?

A

Risk to self
Risk to others
Risk from others

Year 4 Psychiatry (12 decks)

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