Mood disorders, suicide and self-harm Flashcards
Knowledge of the epidemiology, aetiology and prognosis of mood disorders, suicide and self-harm
Mood disorders
Epidemiology: Peak incidence is in the teens/20s, equal in each gender
Aetiology: Genetics, early life experience, personality, acute/chronic stress, neurobiology
Prognosis
Suicide:
Epidemiology: Highest rates amongst unemployed, middle-aged males
Knowledge of the clinical presentation, including an understanding of the ICD-10 diagnostic criteria, of mood disorders
Knowledge of the physical conditions that present with psychiatric symptoms, including appropriate investigations for mood disorders
Physical conditions that may present with mood disturbances:
- Organic: Huntington’s, stroke, tumour, head injury
- Endocrine: Addison’s, Cushing disease, hypo/hyperthyroidism, parathyroid disorder,
- Metabolic: DM, hypercalcaemia, Vitamin B12, niacin deficiency, prescribed medications (steroids, dopaminergic medications, antidepressants)
- Medical: Renal disease, anaemia, temporal lobe epilepsy
- Autoimmune: SLE, MS
- Infection
- Substance misuse: Alcohol, recreational drugs
Investigations
Bloods: FBC, MCV, U&Es, calcium, TFTs, cortisol, LFTs, vitamin B12, folate
Urine drug screen
ECG
EEG
CT scan
Imaging
Knowledge of the common co-morbidity of mood disorders
- Substance misuse
- Chronic pain conditions
- Anxiety
- Personality disorder
Knowledge of the physical, psychiatric and social consequences of mood disorders
Physical
- Lack of self-care
- Self-harm or suicide
Psychiatric
- Relapses in mood
Social
- Loss of social engagement
- Difficulties maintaining relationships/employment/education
An awareness of the risk factors and principles of acute management for suicide, self-harm, neglect and harm to others
Knowledge of the indications, mechanism of action and side effects of antidepressants, mood stabilisers and ECT
SEE TABLES
Knowledge of the indications, theories and practical implementation of psychological interventions in mood disorders
Psychological interventions used in bipolar: Family intervention, structured condition specific psychological therapy
Psychological interventions used in depression: CBT
The intensity of therapy is dependent upon the severity of depression diagnosed.
Indications:
- All patients
- After acute mania has passed (unable to engage at this stage)
Pharmacological treatment of bipolar affective disorder
Lithium is first line for the long term treatment of bipolar affective disorder
If ineffective then valporate may be added
Knowledge of the indications and practical implementation of social interventions in mood disorders
Develop a structured targeted management plan for an individual patient with mood disorder or self-harm
Recognise psychopathologies of mood disorders in a clinical interview
Give a list of relevant differential diagnoses for a patient with mood symptoms
- Organic causes
- Endocrine, metabolic, neurological
- Substance misuse
- Withdrawal
- Mood disorder
- Bipolar disorder
- Depression
- Anxiety
- Psychosis
- Schizoaffective disorder
Explain the aetiology, bio-psycho-social management plan and prognosis for mood disorders to a patient, carer or colleague
Carry out a clinical risk assessment on a patient with a mood disorder or after an attempt of suicide or self-harm
