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1 Psychiatry > Mood disorders (bipolar and depression) > Flashcards

Mood disorders (bipolar and depression) Flashcards

1
Q

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

A

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

despite SSRI taking 4 weeks to be effective

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2
Q

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

A

2 weeks

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3
Q

What is a quick way to screen for depression?

A

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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4
Q

How would you know if someone is manic or hypomanic?

A

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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5
Q

Acronym to diagnose/screen for symptoms depression?

A

SADFACES

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6
Q

What are the components of SADFACES?

A

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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7
Q

What is an acronym/mneumonic for screening for suicidality?

A

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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8
Q

State two examples of negative symptoms of psychosis

A

anhedonia
amotivation
social withdrawal
blunt affect

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9
Q

List two positive symptoms of psychosis

A

delusions
hallucinations
thought disorder
disorganised behaviour

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10
Q

What are the three types of bipolar disorder?

A

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

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11
Q

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

A

different treatment

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12
Q

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

A

different treatment

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13
Q

Is the treatment for bipolar and depression the same?

A

no!!!

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14
Q

List three factors that can precipitate bipolar event

A

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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15
Q

list three clinical features of bipolar

A

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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16
Q

difference between mania and hypomania?

A

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

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17
Q

How is bipolar disorder diagnosed?

A

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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18
Q

Differential diagnosis for bipolar?

A

depression
schizophrenia
BPD
Organic causes of mania

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19
Q

List three organic causes of mania

A

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

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20
Q

What is the management of manic episode?

A

atypical antipsychotic- olanzapine, risperidone, clozapine

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21
Q

What is a serious complication of atypical antipsychotic?

A

agranulocytosis

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22
Q

What is the management of depressive episode in bipolar?

A

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

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23
Q

Why are antidepressants avoided in depressive bipolar disorder?

A

they can induce rapid cycling mood

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24
Q

List three symptoms of mania

A

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

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25
Q

which type of delusion is typically present in mania

A

grandiose

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26
Q

How long do symptoms need to persist for to diagnose mania

A

7 days

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27
Q

What is the management of acute mania?

A

stop any antidepressant medication
atypical antipscyhotic
add lithium

28
Q

What must you assess before commencing antipsychotic

A

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

29
Q

What is the long term treatment of bipolar disorder?

A

lithium

30
Q

How is lithium extreted?

A

kidneys

31
Q

When should you measure lithium levels?

A

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

32
Q

What is the monitoring for lithium?

A

FBC
U+Es
TFTs
caclium
ECG

33
Q

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

A

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

34
Q

List two side effects of lithium

A

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

35
Q

Two signs of lithium toxicity?

A

confusion
visual disturbances
loss of appetite
seizures
coarse tremor
ataxia
paraesthesia

36
Q

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

A

NSAIDs and ACEi

37
Q

How should you stop lithium/how to ween off?

A

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

38
Q

Which birth defect is associated with lithium?

A

ebstein’s anomaly= congenital heart defect

39
Q

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

A

sodium valproate
lamotrigine

40
Q

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

A

self harm scars
weight
personal hygiene
clothing

41
Q

Behaviour?

A

engagement and rapport
eye contact
movement/postures
restlessness or agitation

42
Q

How to assess thought content?

A

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?

43
Q

What are the three core symptoms of depression?

A

anhedonia
low mood
reduced energy

44
Q

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

A

two weeks

45
Q

State one somatic symptom of depression

A

sleep disturbance
loss of appetite or weight loss
loss of libido

46
Q

List two cognitive symptoms of depression

A

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

47
Q

List three differentials for depression

A

anxiety
depressive episode of bipolar disorder
premenstrual dysphoric disorder

organic: anaemia, alcohol use, cushing’s syndrome, hypothyroidism

48
Q

What is the treatment for mild depression

A

group CBT
avoid antidepressants
low intensity psychosocial intervention

49
Q

What is the treatment for moderate depression?

A

antidepressant and high psychological intervention

50
Q

Which antidepressants should be avoided in history of overdose?

A

TCA and venlafaxine

51
Q

What is the first line antidepressant?

A

SSRI

52
Q

Two examples of SSRI

A

sertraline, fluoxetine, citalopram

53
Q

Name two side effects of SSRIs

A

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

54
Q

What is a major complication of SSRI use

A

serotonin syndrome

55
Q

what are the features of serotonin syndrome

A

confusion
agitation
sweating
diarrhoea
muscle twitching

56
Q

Features of severe serotonin syndrome?

A

fever
seizures
arrhythmia
loss of consciousness
myoclonus

57
Q

Treatment for serontonin syndrome

A

stop all medication
IV fluids
propranolol
cryheptadine- block serotonin production

58
Q

What is MOA of venlafaxine?

A

SNRI

59
Q

Example of TCA

A

amitriptyline
imipramine

60
Q

What are the side effects of TCAs?

A

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

61
Q

Which antidepressants are not toxic in overdose?

A

SSRIs- generally safe in overdose

62
Q

Which antidepressants are toxic in overdose?

A

TCAs and SNRI (venlafaxine)

63
Q

Which antidepressants can cause hypertensive reaction?

A

MAOIs

64
Q

Why does hypertensive reaction arise?

A

MAOIs inhibit tyramine breakdown

65
Q

Which foods are rich in tyramine?

A

cheese, smoked or pickled fish

66
Q

List two indications for ECT

A

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

67
Q

List three risk factors for suicide

A

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

1 Psychiatry (20 decks)

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