Mood disorders-ILA Flashcards
What are the differentials for someone presenting as manic?
Secondary to drug use (acute or withdrawal) eg levodopa, steroids, antidepressants, amphetamines or cocaine
Psychosis
Bipolar
Schizoaffective
Organic cause eg infection, neoplasm, hyperthyroid
Hypomania – lasts four days and retain function
Cyclothymia- mood swings with subclinical features
What are the mood symptoms of mania?
Increased mood and energy –euphoria, labile mood, Irritable
What are the cognitive symptoms of mania?
flight of ideas, grandiose, poor concentration, lack insight
What are the behavioual symptoms of mania?
Decreased sleep, rapid speech, hyperactive, increased libido, risky behaviour- irresponsible spending and gambling
How do we differntiate between mania and hypomania?
Hypomania has less impact on funnctioning and lasts 4+ days presenting with:
Elevated mood (can be euphoric / dysphoric/ angry)
Increased energy
Increased talkativeness
Poor concentration
Mild reckless behaviour e.g. overspending
Sociability/ overfamiliarity
Increased libido/ Sexual disinhibition
Increased confidence
Decreased need sleep
Change in appetite
Mania presents with 1 week of: Extreme elation - uncontrollable Over activity Pressure of speech Impaired judgement Extreme risk taking behaviour e.g spending spree Social disinhibition Inflated self-esteem, grandiosity With psychotic symptoms Mood congruent/ incongruent
What is the management of mania?
Stop antidepressants
1st line: lithium – if U+Es, ECG and T4 normal
2nd line: quetiapine or sodium valproate or carbamazepine
CBT
Psychoeducation (good for any psych condition)
Family therapy
Name some organic causes of depression
drugs:
Β-blockers Nifedipine Clonidine Opioids Methyldopa Digoxin Steroids Antipsychotics Anti-parkinsonian BDZ
metabolic:
Anaemia B12/folate def. ↑Ca ↓T4 Cancer Cushings ↑/↓Na ↑/↓K
infective:
Post-viral Neurosyphillis Post-viral Brucellosis UTI
inflammatory:
Temporal arteritis
intracranial:
Post-stroke Subdural haem. PD Head injury
Delirium SOL Dementia
Name some differentials for depression
Bipolar Schizophrenia Anorexia Anxiety Dysthymia Substance misuse Organic cause Dementia Medication Insomnia
What is needed for a diagnosis of depression?
Symptoms oresent for two weeks without use of alcohol or recent bereavement.
Need two of core symptoms and 2+ of other symptoms.
What are the core symptoms of depression?
low mood, anhedonia, low energy
What are the other symptoms of depression?
Low self-esteem and confidence, feelings of guilt, worthlessness and hopelessness. Unvaried mood. Poor concentration. Suicide ideation.
What are the somatic symptoms of depression?
wake early in morning, feel lower in mood in morning, psychomotor retardation, appetite and weight decreases, loss libido
What is the diagnosis classification for mild, moderate and severe depression?
2 +2 other symptoms are mild
2+ 3+ is moderate
2 + 5+ is severe- includes psychotic and suicide ideation
What is the management for mild depression?
Mild- self-help and mindfulness. Watch and wait.
What is the management for moderate depression?
Moderate- combine anti-depressant (SSRI) and CBT
