Mood Disorders - Depression, Bipolar, Mania

Question 1

What are the core symptoms of depression?

Answer 1

Persistent low mood
Anhedonia
Low energy
Have to have at least 1 for >2wk duration

Question 2

List 4 other symptoms of depression

Answer 2

disturbed sleep 
poor concentration or indecisiveness
low self-confidence
poor or increased appetite
suicidal thoughts or acts
agitation or slowing of movements
guilt or self-blame

Question 3

Define mild, moderate and severe depression

Answer 3

Mild: 4 symptoms
Moderate: 5-6 symptoms
Severe: >6 symptoms, with or without psychotic symptoms. Symptoms should be present for >month and every symptom should be present for most of every day

Question 4

What does SADPERSONS stand for? (Risk assessment tool)

Answer 4

SADPERSONS
S: Sex - male 
A: Age <19, >45
D: Depression
P: Previous attempted suicide
E: Excessive alcohol
R: Rational thinking loss
S: Loss off SUPPORT
O: Organised plan for suicide
N: No significant other
S: Sickness

Question 5

What is the Stepped Care Model?

Answer 5

Treat Depression:
Step 1: Assessment, support, psychoeducation, monitoring and referral
Step 2: Low intensity psychosocial interventions and medication
Step 3: Medication, high intensity psychosocial intervention
Step 4: Medication, high intensity psychosocial intervention, ECT, crisis service, inpatient management

Question 6

Name 3 SSRIs

Answer 6

Sertraline, Citalopram, Fluoxetine

Question 7

Name 2 SNRIs

Answer 7

Venlafaxine, Duloxetine

Question 8

Name a TCA

Answer 8

Amitriptyline

Question 9

Side effects of SSRIs

Answer 9

Nausea/vomiting, diarrhoea/constipation, weight loss, sleeping problems, low sex drive/reduced orgasms

Question 10

Define Bipolar disorder

Answer 10

2 or more episodes of which the patients mood and activity levels are significantly disturbed

Question 11

Name 3 symptoms during the manic phase of bipolar disorder

Answer 11

Grandiose speech
Increased energy levels
Racing thoughts
Needing little sleep
Reckless with money
Sexual disinhibition

Question 12

How many symptoms do you need to confirm mania?

Answer 12

3.

(Grandiose speech
Increased energy levels
Racing thoughts
Needing little sleep
Reckless with money
Sexual disinhibition)

Question 13

Pharmacological management of mania in Bipolar

Answer 13

Stop antidepressants
Common drugs - Haloperidol, Olanzepine, Quetiapine, Risperidone
If at maximum dose - add lithium or valproate

Question 14

Pharmacological management of depression in Bipolar

Answer 14

Quetiapine, or both fluoxetine and olanzapine

If no response, lamotrigene