Mood Disorders - Lecture Flashcards
1
Q
Types of mood disorder
A
- Depressive disorder - single or recurrent episodes
- Bipolar disorder - mania, hypomania, mixed - likely to recurr
- Persistent mood disorder - cyclothymia, dysthymia
2
Q
Types of symptoms of depression
A
- Core
- Biological (somatic)
- Cognitive symptoms
3
Q
Cluster groups of depressive episode - ICD-11 criteria
A
- Affective cluster
- Cognitive-behavioural cluster
- Neurovegetive cluster
4
Q
Core symptoms depression
A
- Continious low mood for at least 2 weeks
- Lack energy
- Lack enjoyment/interest
5
Q
Affective cluster - ICD-11
A
- Depressed mood reported or as observed (tearful, defeated appearance) - must be for 2 weeks at least
- Markedly diminished interest or pleasure in activities esp those normally found to be enjoyable to individual - can include reduced sexual desire - anhedonia
6
Q
Cognitive behavioural cluster symptoms ICD-11
A
- Reduced ability to concentrate and sustain attention
- Beliefs of low self worth or excessive/inappropriate guilt
- Hopelessness
- Recurrent thoughts of death (not just fear of dying) or recurrent suicidal ideation
Always ask re self harm and suicide
7
Q
Neurovegetivive cluster symptoms - ICD-11
A
- Significantly disrupted sleep (under 25 seem to sleep more when disrupted)
- Significant change appetite - eat more (under 25) or less
- Psychomotor agitation or retardation - difficult to converse, struggle to go to toilet
- Reduced energy, fatigue or marked tiredness
8
Q
Diagnosis of depression criteria
A
- Concurrent presence of at least 5 symptoms occurring most of the day, nearly every day for a period of at least 2 weeks
- At least one symptom from affective cluster
- Assessment of presence or absence of symptoms should be made relative to typical functioning of individual - eg in their role, look at it in context of their job etc
*ICD needs two from lack energy, anhedonia and low mood and another 2 symptoms for diagnosis
9
Q
Mild depression - ICD-11
A
- None symptoms present to intense degree
- Distressed by symptoms and has some difficulty continuing to function
- No psychotic symptoms
- ICD 10 says two-three symptoms
10
Q
Moderate depressive episode - ICD-11
A
- Several symptoms present to marked degree or large number of symptoms of lesser severity
- Considerable difficulty functioning in multiple domains - struggle to work etc
- Delusions, hallucinations with psychotic symptoms
- ICD 10 says 4 or more symptoms and does not include psychotic symptoms
11
Q
Severe depressive episode
A
- Many or most symptoms marked degree or smaller number and manifest as intense degree
- Serious difficulty continuing to function in most domains
- Delusions/hallucinations
- ICD10 says can be with or without psychotic symptoms, suicidal thoughts and acts are common
12
Q
Post-natal depression
A
- 10-15% of women usually within 1-2 months post partum but can appear later in some women
- Thought content may include worries about babys health or her ability to cope with the baby
13
Q
RF for post-natal depression
A
- Personal or FH depression
- Older age
- Single mother
- Unwanted pregnancy
- Poor social support
- Previous PND
14
Q
Epidemiology of depression
A
- 2nd ranked global burden of disease
- 2-3x more common if chronic physical health problems
- More common females (1:2)
15
Q
Symptoms of mania
A
- Elevated/expansive/irritable mood - 1 week
- Increased energy/activity (inc agitation)
- Grandiosity/increased self esteem
- Pressure of speech
- Flight of ideas/racing thoughts - jumping around different ideas
- Distractable - can’t pay attention
- Reduced need for sleep
- Increased libido
- Social inhibitions lost - can be insulting
- Psychotic symptoms - Grandiose delusions eg they are the king
16
Q
Symptoms of hypomania
A
- Mildly elevated, expansive or irritable mood
- Increased energy/activity
- Increased self esteem
- Sociability, talkativeness, over-familiarity
- Increased sex drive
- Reduced need for sleep
- Difficulty in focusing on one task alone
People like their hypomania state - productive and happy
17
Q
What are PMD? - persistent mood disorders
A
Do not fit criteria for disorders - milder
18
Q
Cyclothymia
A
- Mild periods of elation/depression
- Early onset/chronic course
- Common in relatives of BAD
19
Q
Dysthymia
A
- Chronic low mood not fulfilling criteria of depression
20
Q
What is mixed episode or mixed affectuve state?
A
- Mixture or rapid alternation (within few hours) of hypomanic, manic and depressive episodes
- Have to have had episode before
21
Q
Bipolar I vs II
A
- Bipolar I - 1 or more manic episodes or mixed episodes +/- 1 or more depressive episodes
- Bipolar II - 1 or more depressive episodes with at least 1 hypomanic episodes
- ICD needs at least 2 epidosed, one must be hypomanic, manix or mixed
22
Q
Bipolar epidemiology
A
- Median onset 25years
- Male=female
- 1-2%
- Suicide rate more 20x normal population
23
Q
Differentials for mood disorders
A
- Normal fluctuations
- Adjustement disorder/bereavement, PTSD
- Dementia or other brain disorder
- Personality disorder
- Anxiety disorders
24
Q
Causes of mood disorders - biological
A
- Genetic
- Brain illness
- Physical illness
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Causes of mood disorder - psychological
* Childhood experiences
* View of yourself and the world
* Personality traits - particular people, very ordered and control
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Causes of mood disorders - social
* Work
* Housing
* Finance
* Relationships/support
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Types of treatments for mood disorders
* Biological
* Psychological
* Social
80% depressive disorders managed primary care
Bipolar managed secondary care - will be normal in between episodes - good as anyone
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Biological treatments for mood disorders
* Pharmacological
* Electroconvulsive therapy
* rTMS
* tDCS
* DBS
* Vagus nerve stimulation
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Monoamine hypothesis
* Neurotransmitter changes in depression in particular NA and serotonin
* At synaptic cleft
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Pharmacological examples
* Selective serotonin reuptake inhibitors - eg sertraline, fluoxetine - most common **first line**
* SNRI eg duloxetine
* Tricyclic antidepressants - amitryptiline prevent uptake, dangerous with overdose as affect lots, used for pain
* NASSAs - eg Mirtazapine - sedative and quick to act, works on autoreceptors (Noradrenaline and specific serotonergic antidepressants)
* Monoamine oxidase inhibitors - prevents breakdown of serotonin
* Melatonin receptor agonist - not used often, hepatotoxic
* Noradrenaline reuptake inhibitors
* SARI
* Mood stabilisers - lithium (worry re thyroids and kidney, check therapeutic index), valproate (not used for reporoductive age women and men under 55), carbamazapine, lamotrigine
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Monitoring with lithium
* Narrow TI - 0.4-1 mmol/L
* When testing, do sample 12 hrs after dose
* Do weekly initially and after each dose change weekly until stable level
* Once stable level, check every 3 months
* Can't be used with certain drugs
Need to do TFTs and U&E every 6 months
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ECT
* Elective current through brain - alter neurone activity triggers an epileptic seizure
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Indications for ECT
Psychotic depression
Catatonia
Severe depression refractory to medication
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rTMS
* Repetitive transcranial magnetic stimulation
* Involves electromagnetic coil against head which sends repetitive pulses of magnetic energy at fixed frequency
* Improves neurotransmission, neuroplasticity and serotonin/noradrenaline in dorsolateral pre-frontal cortex (limbic system)
35
tDCS
* Transcranial direct current stimulation uses small battery operated stimulator to deliver constant low strength current through 2 electrodes placed on head
* Neuroplasticity, neurotransmission and neurotransmitters
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Vagus nerve stimulation
* Pacemaker device implanted attached to stimulating wire along vagus nerve
* Travels up neck to brain where connects to areas to regulate mood
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Deep brain stimulation
* Electrodes directly onto brain
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Psychological treatment for mood disorders
* Psychoeducation - illness, relapses, medication
* CBT
* IPT
* Psychodynamic
* Mindfulness
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Social interventions for mood disorders
* Assess for gambling relating harms - signpost to self referral service, GamCare
* Mind charity UK
* Mental health cafes
* VitaMinds self referral
* LAMP - independent advocates in leicester
* Life Links leicester - MH support
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Depression prognosis
* First episode - continue AD for at least 6-12 month
* Multiple episodes - continuye them for much longer
* 80% further episode
* 10% severe, unremitting depression
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Bipolar prognosis
Poor prognosis suggested by:
* Severe episodes
* Early onset
* Cognitive deficits
-
* Treatment more effective earlier in illness
* 80% relapse after first episode within 5-7 years
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