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Psychiatry > Mood Disorders: Intro & Depression > Flashcards

Mood Disorders: Intro & Depression Flashcards

1
Q

Define Mood - like the climate

A

Patient’s sustained, experienced emotional state over a period of time

Can be Dysthymic (Low), Euthymic (Normal) or Elevated

fluctuations in mood are a normal part of human experience - only a disturbance when mood is severe enough to cause impairment in the activities of daily living

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2
Q

Define Affect - like the weather

A

Transient flow of emotion in response to a particular stimulus

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3
Q

Define Mood Disorder (aka affective disorder)

A

Condition characterised by distorted/excessive/inappropriate moods for a sustained period of time

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4
Q

State the ICD10 class 1-7 for mood disorders

A

1 - Manic Episode (inc Hypomania)
2 - BPAD
3 - Depressive Episode
4 - Recurrent Depressive Episode
5 - Persistent Mood Disorders (Dysthymia, Cyclothymia)
6 - Other Mood Disorders
7 - Unspecified Mood Disorders

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5
Q

State the two classifications of primary Mood Disorder and give examples of each

A

Unipolar - Depressive Disorders, Dysthymia

Bipolar - Cyclothymia, BPAD

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6
Q

State three causes of Secondary Mood Disorders

A

Physical Disorders (Hypothyroid, Cushing, malignancy, anaemia, addisons’s, MS, parkinsons)

Psychiatric Disorders (Schizophrenia, Dementia)

Drug Induced

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7
Q

Define Depressive Disorder

A

Affective mood disorder characterised by persistent low mood, loss of pleasure and lack of energy accompanied by emotional, cognitive and biological symptoms

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8
Q

Give Bio, Psycho, and Social PREDISPOSING factor for Depressive Disorder

A

Bio - Female, postnatal, genetics, neurochemical, endocrine, physical co-morbidities, PMHx of depression

Psycho - Failure of effective stress control, poor coping strategies, personality type, co-morbidities ie dementia

Social - Lack of support, stressful life events, asylum seeker or refugee

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9
Q

Give a Bio, Psycho, and Social PRECIPITATING factor for Depressive Disorder

A

Bio - Poor Medication Compliance, corticosteroids
Psycho - Acute stressful life event,
Social - Unemployment, divorce, poverty

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10
Q

Give a Bio, Psycho, and Social PERPETUATING factor for Depressive Disorder

A
  • *Bio** - Chronic Health Problems
  • *Psycho** - Poor Insight, becks triad
  • *Social** - Alcohol and Substance Misuse, poor social status, low social status
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11
Q

what are the 3 core symptoms of depressive disorder?

A

anhedonia - lack of interest in things which were previously enjoyable to the pt

low mood for at least 2 weeks

lack of energy aka anergia

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12
Q

what are the cognitive symptoms of depressive disorder?

A
  • Lack of concentration
  • Negative thoughts - becks cognitive triad
  • Excessive guilt
  • Suicidal ideation
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13
Q

what are the biological symptoms of Depressive Disorder?

A

Diurnal Variation in mood - often feel worse in the morning

Loss of Appetite

early morning wakening

loss of libido

psychomotor retardation - slow speech and movement

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14
Q

State the ICD10 classification of Mild, Moderate and Severe Depressive Disorder respectively

A

Mild - 2 core symptoms and 2 other symptoms

Moderate - 2 core symptoms and 3-4 other symptoms

Severe - 3 core symptoms and >4 other symptoms

severe depression with psychosis = 3 core symptoms + >4 others + psychosis

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15
Q

Outline the expected Appearance, Behaviour, Speech and Mood of a patient with Depressive Disorder (MSE)

A

Appearance - Self neglect, unkempt
Behaviour - Poor Eye Contact, Slow Responses
Speech - Slow, Reduced Volume and Tone
Mood - Low (Subjectively) and Depressed (Objectively)

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16
Q

Describe the expected Thought, Cognition and Insight of a patient with Depressive Disorder (MSE)

A

Thought - Guilt, Worthless
Cognition - Impaired Concentration
Insight - Usually Good

17
Q

Name three diagnostic questionnaires for Depressive Disorder

A

PHQ9
HADS
Becks depression inventory

18
Q

what blood tests are often done to exclude organic causes of depressive disorder and why?

A

FBC - anaemia

TFTs - hypothyroidism

U&Es, LFTs, calcium levels - biochemical abnormalities may cause physical symptoms which can mimic depressive symptoms

glucose - diabetes can cause anergia

19
Q

What is Seasonal Affective Disorder?

A

Where mood is severely affected by change in seasons

Mood normally lowest in Winter months

20
Q

What is Masked Depression

A

Depressed mood not prominent, but other features of depression are

21
Q

What is Atypical Depression?

A

mild–moderate depression with reversal of symptoms e.g. overeating, weight gain and hypersomnia. There is a relationship between atypical depression and seasonal affective disorder.

22
Q

Define Dysthymia and Cyclothymia

A

Dysthymia - Depressive state for two years not meeting threshold and is not the result of a partially-treated depressive illness

Cyclothymia - Chronic Mood Fluctuation for two years, with episodes of elation and depression, insufficient to meet threshold for hypomanic or depressive disorder

23
Q

The normal management aim for Mild to Moderate Depression is to ‘Watchful Wait’. What is this?

A

Reviewing the patient again in two weeks

24
Q

Give four non Pharmacological mainstay treatments of Depression

A
  • *Self Help Programmes** - Patient works through a self-help manual with a healthcare professional providing support and checking progress.
  • *CBT**
  • *Physical Activity Programmes** and group exercise classes
  • *Psychotherapies**
25
Q

When would you use Antidepressants in Mild to Moderate Depression?

A
  1. Lasted a long time
  2. History of Moderate - Severe depression
  3. Failure of other interventions
  4. depression complicates the care of other physical health problems
26
Q

What is the first step in management of a Moderate to Severe depressed patient?

A

Suicide Risk Assessment

27
Q

When would you refer a Depressed patient to Psychiatry?

A
  1. Suicide Risk High
  2. Severe Depression
  3. Recurrent Depression
  4. Unresponsive to Initial treatment
28
Q

Describe the pharmacological therapy of Moderate to Severe Depression

A

SSRIs first line (continued for 6m after symptom resolution for first episode, or 2y if second, long term in individuals who have had multiple severe episodes)

other antidepressants - tricyclic antidepressants, serotonin noradrenaline reuptake inhibitors, monoamine oxidase inhibitors

Adjuvants with Lithium or Antipsychotics

29
Q

Describe the non pharmacological management of Mod to Severe Depression

A

Psychotherapy (CBT, IPT)
Social Support

30
Q

When could ECT be recommended for a Depressed patient?

A
  1. acute treatment of severe depression which is life-threatening
  2. rapid response required
  3. depression with psychotic features
  4. severe psychomotor retardation or stupor
  5. failure of other treatments
31
Q

how can mood disorders be classified?

A

primary and secondary

32
Q

what is Beck’s triad?

A

negative views about oneself

negative views of the world

negative views of the future

33
Q

what are the psychotic symptoms of depressive disorder?

A

hallucinations - usually second person auditory hallucinations

delusions - usually hypochondrical, guilt, nihilistic or persecutory in nature

34
Q

what imaging can be done where presentation/examination may be atypical or where there is suspicion of an intracranial lesion

A

MRI

CT

35
Q

what are some differentials for depressive disorder?

A

bipolar affective disorder, other depressive disorders, physical condition such as hypothyroidism, secondary to psychoactive substance abuse, secondary to an other psychiatric disorder (such as psychotic or anxiety disorders, adjustment disorder, personality disorder, eating disorders, dementia), normal bereavement

36
Q

what is recurrent depressive disorder?

A

recurrent episode refers to when a patient has another depressive episode after their first

37
Q

describe how psychotherapies used to manage depression

A

Psychiatry (18 decks)

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