mood disorders Flashcards
what %of mood disorders start before 30
50%
what % of mental disorders start before 14
50%
how long do depressive episodes have to occur for before meeting depression criteria
2 weeks
what are the 3 core features of depression
- Depressed mood -
- loss of interest or pleasure - anhedonia
- decreased energy -anergia
how many core symptoms must be present ?
2 core and 4 additional
what are examples of additional depressive symptoms
loss of confidence, guilt, suicidal, concentration trouble, agitation, sleep disturbance, appetite changes
how many core and additional features must be present to class as moderate depression
2 core and 4 others
how many core and additional features must be present to class as severe depressive episodes
3 core and 5 others
what is psychotic depression
sub type of depression , occassionally paranoid adn typically mood- congruent eg people put to get me , ive got cancer
what syndrome is an example of psychotic depression
cottards syndrome
what type of bipolar is more common 1 or 2
Bipolar 2
what is bipolar 1
met criteria for mania and depression
what is bipolar 2
hypomanis and depression
what is bipolar 3
hypomanic episodes occur following use of anti-depressants following depression
how long must mood elevation be sustained to class as hypomania
4 days
how long must elevated mood be sustained in order to class as mania
1 week
when does bipolar affective disorder usually present
late teens-early 20s
whats commoner depression or mania in BPAD
depression
what mental illness has the highest lifetime suicide risk
BPAD 4-8%
in terms of hydro and lipo philic/phobic what kinds cross the BBB
hydrophobic and liophilic
what are monoamine neurotransmitters
serotonin, noradrenaline dopamine
are monoamines increased or decreased in depression
decreased
what are serotonin and noradrenaline oxidised by
monoamine oxidase
what nuclei do serotonergic pathways extend from
raphe nuclei
what part of the midbrain is the orgin of most noradrenaline pathways in the brain
locus coerulus
give example of monoamine oxidase inhibitors
Phenelzine- irreversible
Moclobemide - reversible
what are side effects of MAO’s
cheese reaction - ingestion of foods with high tyramine. tyramine oxidised by monoamine oxidase so MAO’s can lead to hypertensive crisis as tyramine raises BP
insomnia
postural hypo
peripheral oedema
TCA drug class?
monoamine reuptake inhibitors
5-HT and noradrenaline receptors
examples of TCAS
imipramine, dosulepin, amitriptyline, lofepramine
side effects of TCA
Anti- cholinergic - blurred vision, dry mouth, constipation, urinary retention
weight gain
sedation
CV- postural hypo, tachy, arrhythmias
examples of SSRI’s
fluoxetine, citalopram, escitalopram , sertraline , paroxetine
side effects of SSRI’s
nausea, headache, worsening anxiety, transient increase in self harm( if under 25), sweating, vivid dreams, sexual dysfunction, hyponatreamia in elderly
examples of SNRI’s
duloxetine, venlafaxine
examples of atypical anti-depressants
mirtazapine
side effects of mirtazepine
weight gain and sedation
in cases of SSRI side effects what should be added on to block side effects
Mirtazapine
first line treatment in bipolar
lithium- given as lithium carbonate
how long after giving first dose of lithium must bloods be taken
12 hours
target range for lithium
0.4-1 mol/l
side effects of lithium
strange taste/dry mouth polydipsia/polyuria tremor hypothyroid nephrotoxic weight gain
symptoms of lithium toxicity
D&V ataxia/tremour, drowsiness, convulsions, coma
why would dehydration cause lithium toxicity
lithium and sodium indistinguishable to kidneys therefore sodium reabsorption in dehydration causes lithium reabsorption
what anti-convulsants can be used as mood stabilisers
sodium valproate, lamotrigene and carbamazepine
side effects of lamotrigene
stevens johnson syndrome
side effects of valproate and carbamzepine
drowsy ataxia CV effects , induces liver enzymes ana Na Valproate is tetrogenic
2nd line in BPAD
anti convulsant or anti psychotic
anti-psychotic drug class
dopamine and serotonin antag
side effects of anti psychotics
wgt gain , sedation , metabolic syndrome
examples of anti psychotics
quetiapine, olanzapine, aripiprazol, rispiridone and lurasidone
how long after starting an anti-depressant should you review someone
1-2 weeks
if someones had one depressive episode how long should they be on anti-depressants for
min 6 months without reducing dose
if someones had 2 or more depressive episodes how long should they be on anti-depressants before reducing dose
1-2 years
first line treatment in acute mania of bpad
anti psychotic
first line treatment of acute depression in bpad
anti psychotic
What should be monitored in a patient on lithium and how often
Li, U &E, ECG, TFTS, Ca (renal and cardio toxic )
monitored frequently to begin with and then 3-6 months later on
if someone treated with ECT how often is it delivered and for how may times
delivered 2x weekly and 6-12 treatments
