Mood Disorders Book Flashcards
How is mood described?
Subjectively in own words.
Objectively as euthymic, dysthymic or elated.
What is a mood disorder?
Affective disorder
Impaired ADLs.
Distorted, excessive and inappropriate moods for a sustained period
What is the difference between primary and secondary mood disorders?
Primary doesn’t result as a cause of another psychiatric disorder I.e. unipolar depression or bipolar disorder.
Secondary is as a result of a psychiatric condition
What are the types of secondary mood disorders?
Physical disorder I.e. cushings, addisons, hypothyroidism etc
Psychiatric disorder I.e. schizophrenia, dementia, alcoholism
Drug induced I.e. beta blockers, corticosteroids, digoxin etc
What is a depressive disorder?
Low mood >2wks
Lack of energy
Anhedonia
What is the pathophysiology of depression?
Monoamine hypothesis
Due to lack of serotonin, noradrenaline and dopamine.
Overactivity of the HPA
Personality type, poor stress control mechanism, stressful life events, chronic health problems, poverty, unemployment, divorce.
What are the RF for depression?
FF, AA PP, SS
Female Family Hx Alcohol Adverse events Past depression Physical co-morbidities Low social support Low socioeconomic status
What are the clinical features of depressive disorder?
DEAD SWAMP
Depressed mood Energy loss Anhedonia Death thoughts (suicide) Sleep disturbance (EMW- waking up 2hrs earlier than premorbidly) Worthlessness/guilt Appetite or weight change Mentation (reduced concentration) Psychomotor retardation (slow movement and speech) Low libido
Usually have diurnal variation in mood I.e. low mood is more pronounced in the morning.
Can also get negative thoughts (Becks triad- of oneself, of the world, of the future)
Psychotic depression- hallucinations (usually 2nd person auditory), delusions (nihilistic, guilt, poverty, hypochondriac, persecutory)
How is depression classified?
Mild- 2 core + 2 other
Moderate- 2 core + 4 other
Severe- 3 core + >/=4 others
Severe depression with psychosis- 3 core + >/=4 other + psychosis
How is depression diagnosed and investigated?
Explore core symptoms I.e. how has your mood been over the last two weeks?
Explore the cognitive symptoms I.e. how do you see things unfolding in the future?
Explore the biological symptoms I.e. do you find your mood particularly worse at certain times of the day?
Investigations are only useful when ruling out organic causes.
Diagnostic questionnaire I.e. PHQ-9, HADS and Becks depression inventory
Blood tests- FBC (anaemia), TFTs (hypothyroidism), U+Es, LFTs, Ca (biochemical cause), glucose (diabetes can cause lack of energy)
MRI/CT if atypical presentation I.e. sudden personality change.
What are the differential diagnosis of depression?
Other mood disorders I.e. bipolar affective disorder,
Secondary to physical condition I.e. hypothyroidism
Secondary to psychoactive substance abuse
Secondary to psychotic disorder i.e. dementia, eating disorders, personality disorder etc.
Normal bereavement
What is the biopsychosocial management of depression?
Biological-
Anti-depressants
Adjuvants I.e. antipsychotics
ECT
Psychological-
Psychotherapists
Self-help programmes
Physical activity
Social-
Social support groups
What are the types of psychotherapies used to manage depression?
CBT- allows people to identify and tackle negative thoughts.
IPT- identify and solve relationship problems
Behavioural activation- encourages development of positive behaviours and activities usually avoided.
Counselling- explore problems and symptoms
Psychodynamic therapy- explore and understand difficulties which may have occurred in the patients life, starting from childhood.
How is mild-moderate depression managed?
Watchful waiting- reassess in 2wks.
Antidepressants- not recommended in mild depression unless- episode has lasted a long time, has had previous moderate-severe depression, other management is not effective, the depression complicates the care of other physical health problems.
Self help programmes- works with a healthcare professional, through self help manuals.
Computerised CBT
Physical activity programmes
Psychotherapies
How is moderate to severe depression managed?
Suicide risk assessment
Psychiatry referral if high suicide risk, severe depression, recurrent depression, unresponsive to initial therapy.
Can implement Mental Health Act if necessary
Antidepressants-
SSRIs I.e. citalopram are first line. Also fluoxetine, sertraline
Others include TCAs, SNRIs and MAOIs (MAOIs only prescribed by specialists)
Adjuvants I.e. lithium, antipsychotics
Psychotherapy- CBT, IPT
Social support- either engaging in community activities the patient is avoiding or attending social support groups
ECT- indicated as an acute treatment of severe depression which is life threatening, if rapid response is required, if depression with psychotic features, if severe psychomotor retardation or stupor, if failure of other treatment.
