Mood Disorders Flashcards
What are affective (mood) disorders?
Illnesses that affect the way you think and feel, symptoms can be quite severe and the most common are BIPOLAR and DEPRESSION
What is the definition for depression?
An affective mood disorder, which is characterised by: a persistent low mood, anhedonia, lack of energy.
What are the risk factors for depression?
Female gender Post natal period FHx Chronic health conditions Increased activity of co morbidities Lack of social support
What are the symptoms of depression?
Core: continous low mood, anhedonia, lack of energy
Biological: DVM, early morning waking, appetite and weight changes, psychomotor retardation/ agitation/ loss of libido
Cognitive: low self esteem, guilt or self blame, hopelessness, suicidal thoughts, poor concentration
What investigations may you do for depression?
Not always needed, do if your thinking of an organic cause
Diagnostic questionares used: PHQ-9, BECKS, HADS
Bloods: FBC (infection), U and Es, LFTS, Ca2+, TFTS, glucose (anergia)
Imaging: CT/MRI if suspecting a cranial lesion
What is the ICD-10 classification of depression?
Mild= 2 core symptoms present and 2 others
Moderate= 2 core symptoms and 3-4 other symptoms
Severe= 3 core symptoms + > or equal to 4 other symptoms
Severe with psychosis= the above + psychosis
What is psychotic depression?
Major depressive episode which is accompanied by psychotic symptoms
What are the 5 types of hallucinations you can get in psychotic depression?
Auditory Visual Olfactory Somatosensory (touch) Gustatory (taste)
What is a hallucination?
An experience involving the apparent
perception of something not present
What is a delusion?
A belief which is clearly false and indicates an abnormality in the affected persons content of thought
What is post natal depression?
Type of mood disorder which is associated with childbirth
What are the risk factors for post natal depression?
Personal/FH of depression Older age Single mother Unwanted pregnancy Poor social support Previous PND
What is bipolar?
This is a chronic episodic mood disorder, it is characterised by at least one episode of mania and a further episode of mania or depression
What is meant by mania?
A mental illness which is characterised by periods of great excitement/ euphoria/delusions/ over activity
What are the symptoms of mani?
Elevated/expansive/irritable mood Increased energy/ activity Grandiosity/ increased self esteem Pressure of speech Flight of ideas/ racing thoughts Distractible Reduced need for sleep Increased libido Loss of social inhibitions Psychotic symptoms
What is the pathophysiology of bipolar?
Monoamine hypothesis
Dysfunction of the HPA axis
Strong heritability
Stressful/ significant life events may precipitate the onset of the first manic episode
What are the clinical features of BPAD?
Can be remembered by ‘IDIGFASTER’ I= irritability D= distractibility I= insight impaired/ increased libido G= grandiose delusions F= flight of ideas A= activity/appetite increased S= sleep decreased T= talkative (pressure of speech) E= elevated mood/energy increased R= reduced concentration and reckless behaviour/ spending
What are the different types of mania?
1= hypomania 2= mania without psychosis 3= mania with psychosis
What is hypomania?
Mildly elevated or irritable mood for more than or equal to 4 days. Symptoms of mania are to a lesser extent than true mania. You get considerable interference with work and social life but not a severe disruption. Partial insight may be preserved.
What is mania without psychosis
As with hypomania but to a greater extent. Symptoms are present for >1 week with complete disruption of work and social activities. They may have grandiose ideas and excessive spending which could lead to debts.
What is mania with psychosis?
Severely elevated or suspicious mood with the addition of psychotic features ie: grandiose or persecutory delusions and auditory hallucinations that are mood congruent. Patient may show signs of aggression.
What are the different classifications of bipolar?
Bipolar 1= one or more manic episodes or mixed episodes with or without one or more depressive episodes.
Bipolar 2 is where there is 1 or more depressive episodes with at least 1 hypomanic episode.
What is the management of bipolar?
CALMER Consider hospitalisation/CBT A= antipsychotics L= lorazepam M= mood stabilisers E= electroconvulsion R= risk assesment
What can be offered for a bipolar depressive episode?
Atypical antipsychotics (onlanzapine) Mood stabilisers- lamotrigine
What is the long term management of BPAD?
Lithium
If lithium isn’t affective then consider adding valproate
Alternative options- onlanzapine or Quetiapine
What are the side effects of lithium?
Polydipsia, polyuria, fine tremor, weight gain, oedema, hypothyroidism, impaired renal function, memory problems and teratogenicity in first trimester.
Before starting a bipolar patient on treatment what should be checked?
U and Es (lithium has a renal excretion), TFTs, pregnancy status, ECG (check for prolonged QT syndrome). Lithium has a very narrow therapeutic window and therefore drug levels should be closely monitored and patients should be informed of potential side effects and toxicity.
