Mood disorders (bipolar and depression) Flashcards by katie louise

What is the timeframe for follow up for commencing <25 year old on sertraline?

1 week due to higher risk of suicidal ideation in first week

despite SSRI taking 4 weeks to be effective

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For how long do you need depressive symptoms to be diagnosed with depression?

2 weeks

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What is a quick way to screen for depression?

The following two questions can be used to screen for depression
‘During the last month, have you often been bothered by feeling down, depressed or hopeless?’
‘During the last month, have you often been bothered by having little interest or pleasure in doing things?’

A ‘yes’ answer to either of the above should prompt a more in depth assessment.

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How would you know if someone is manic or hypomanic?

with mania, there is severe functional impairment or psychotic symptoms for 7 days or more
hypomania describes decreased or increased function for 4 days or more
from an exam point of view the key differentiation is psychotic symptoms (e.g.delusions of grandeur or auditory hallucinations) which suggest mania

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Acronym to diagnose/screen for symptoms depression?

SADFACES

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What are the components of SADFACES?

A = Appetite (Weight Change)
S = Sleep (Insomnia / Hypersomnia)
A = Anhedonia
D = Dysophria
F = Fatigue
A = Agitation / Retardation
C = Concentration Diminished
E = Esteem (Low) / Guilt
S = Suicide / Thoughts of Death

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What is an acronym/mneumonic for screening for suicidality?

SADPERSONS
S: Male sex
A: Age (<19 or >45 years)
D: Depression
P: Previous attempt
E: Excess alcohol or substance use
R: Rational thinking loss
S: Social supports lacking
O: Organized plan
N: No spouse/support
S: Sickness

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State two examples of negative symptoms of psychosis

anhedonia
amotivation
social withdrawal
blunt affect

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List two positive symptoms of psychosis

delusions
hallucinations
thought disorder
disorganised behaviour

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What are the three types of bipolar disorder?

bipolar 1= 1:1 depression and mania
bipolar 2= depression 5:1 mania
rapid cycling bipolar >4 mania + depression episodes

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Why is it important to distinguish rapid cycling bipolar from bipolar disorder?

different treatment

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Why is it important to distinguish rapid cycling bipolar from bipolar disorder?

different treatment

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Is the treatment for bipolar and depression the same?

no!!!

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List three factors that can precipitate bipolar event

life factors that lead to early morning waking
positive life events
negative life events
pregnany
steroids
stimulants
alcohol
cannabis
thyroid disease

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list three clinical features of bipolar

mania
hypomania
irritable mood
increased feelings of self worth
inappropriate social behavior
delusions and hallucinations
heightened sense of abilities
altered perceptions

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difference between mania and hypomania?

mania- psychotic symptoms 1–2 weeks
hypomonia- no psychotic symptoms >4 days

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How is bipolar disorder diagnosed?

elated or irritable mood for >one week PLUS 3 of:
Inflated self esteem
Decreased need for sleep
Accelerated speech
Racing thoughts / flight of ideas
Distractibility (reported or observed)
Increased goal directed activity or psychomotor agitations
Excessive activity
Impaired social or occupational functioning
Episode not due to substance misuse or other organic cause

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Differential diagnosis for bipolar?

depression
schizophrenia
BPD
Organic causes of mania

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List three organic causes of mania

endocrine- thyroid and adrenal disorders
neuro- epilepsy, tumour, MS, CVA
Drugs- antidepressants, steroids, stimulants

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What is the management of manic episode?

atypical antipsychotic- olanzapine, risperidone, clozapine

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What is a serious complication of atypical antipsychotic?

agranulocytosis

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What is the management of depressive episode in bipolar?

AVOID antidepressants!!!!!!??
atypical antipscyhotic- olanzapine
+ lithium or lamotrigine

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Why are antidepressants avoided in depressive bipolar disorder?

they can induce rapid cycling mood

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List three symptoms of mania

abnormally elevated mood
restlessness/increased activity
increased energy levels, no sleep without fatigue
poor concentration
impulsive behaviour
delusions
auditory hallucinations

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which type of delusion is typically present in mania

grandiose

How long do symptoms need to persist for to diagnose mania

7 days

What is the management of acute mania?

stop any antidepressant medication atypical antipscyhotic add lithium

What must you assess before commencing antipsychotic

weight and BMI pulse and BP Fasting blood glucose Hba1C lipid profile ECG for QTc

What is the long term treatment of bipolar disorder?

lithium

How is lithium extreted?

kidneys

When should you measure lithium levels?

1 week after starting lithium (12 hours post dose) measure 1 week after dose change

What is the monitoring for lithium?

FBC U+Es TFTs caclium ECG

Once lithium levels are stable, do you need to measure levels still?

measure once a month and then every 3 months also need TFTs urea calcium every 6 months

List two side effects of lithium

GI upset fine tremor hypothyroidism peripheral oedema metallic taste in mouth thirst polyuria weight gain tiredness

Two signs of lithium toxicity?

confusion visual disturbances loss of appetite seizures coarse tremor ataxia paraesthesia

Name one drug that interacts with lithium and can lead to toxicitity

NSAIDs and ACEi

How should you stop lithium/how to ween off?

reduce dose gradually 4weeks- 3months. Close monitoring after weened off lithium for mania

Which birth defect is associated with lithium?

ebstein's anomaly= congenital heart defect

Aside from lithium and antipsychotics, name one other drug in the treatment of bipolar disorder

sodium valproate lamotrigine

What to look out for in appearance section of MSE for depressed patient

self harm scars weight personal hygiene clothing

Behaviour?

engagement and rapport eye contact movement/postures restlessness or agitation

How to assess thought content?

are you worried about anything? do you have thoughts that life isn't worth living? do you feel that people are out to harm you? do you have thoughts that others don't share with you?

What are the three core symptoms of depression?

anhedonia low mood reduced energy

For how long must depressive symptoms be present for to be diagnosed?

two weeks

State one somatic symptom of depression

sleep disturbance loss of appetite or weight loss loss of libido

List two cognitive symptoms of depression

decreased concentration impaired memory nihilistic thinking suicidal thoughts pessimistic thinking feelings of worthlessness

List three differentials for depression

anxiety depressive episode of bipolar disorder premenstrual dysphoric disorder organic: anaemia, alcohol use, cushing's syndrome, hypothyroidism

What is the treatment for mild depression

group CBT avoid antidepressants low intensity psychosocial intervention

What is the treatment for moderate depression?

antidepressant and high psychological intervention

Which antidepressants should be avoided in history of overdose?

TCA and venlafaxine

What is the first line antidepressant?

SSRI

Two examples of SSRI

sertraline, fluoxetine, citalopram

Name two side effects of SSRIs

nausea vomiting insomnia increased risk of suicidality in young loss of libido

What is a major complication of SSRI use

serotonin syndrome

what are the features of serotonin syndrome

confusion agitation sweating diarrhoea muscle twitching

Features of severe serotonin syndrome?

fever seizures arrhythmia loss of consciousness myoclonus

Treatment for serontonin syndrome

stop all medication IV fluids propranolol cryheptadine- block serotonin production

What is MOA of venlafaxine?

SNRI

Example of TCA

amitriptyline imipramine

What are the side effects of TCAs?

dry mouth constipation confusion in elderly tachy hypotension arrhtyhmias prolonged QTc toxic in overdose

Which antidepressants are not toxic in overdose?

SSRIs- generally safe in overdose

Which antidepressants are toxic in overdose?

TCAs and SNRI (venlafaxine)

Which antidepressants can cause hypertensive reaction?

MAOIs

Why does hypertensive reaction arise?

MAOIs inhibit tyramine breakdown

Which foods are rich in tyramine?

cheese, smoked or pickled fish

List two indications for ECT

life threatening depression- not eating or drinking resistant depressive disorder following failure with antidepressants catatonia

List three risk factors for suicide

previous suicide active mental illness male unemployed lives alone unmarried drug/alcohol dependence