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3a psychiatry > Mood problems > Flashcards

Mood problems Flashcards

1
Q

What is bipolar

A

characterised by recurrent episodes of depression and mania (T1) or hypomania (T2)

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2
Q

Give 5 features of mania

A

completely impaired functioning +/- psychosis
* abnormally elevated mood, euphoric
* irritability
* grandiosity, excessive spending, ambitious plans
* decreased sleep, increased energy
* pressured speech and flight of ideas
* disinhibition/ impulsive
lasting at least 1 week

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3
Q

What is hypomania

A

milder symptoms of mania without having a significant impact on their function

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4
Q

What is required to make a diagnosis of bipolar disorder

A

BP 1: at least 1 manic (>=1w) episode or mixed episode
BP 2: at least 1 episode of major depression and one episode of hypomania (>=4d)

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5
Q

Patients with bipolar can sometimes experience auditory hallucinations. What type is most common

A

second person - talking to patient

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6
Q

What is cyclothymia

A
  • numerous periods of hypomanic and depressive symptoms
  • persistent instability of mood >2 years
  • doesn’t meet diagnostic threshold for major affective episode
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7
Q

Give 2 RFS for bipolar disorders

A
  • FHx
  • substance misuse
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8
Q

How is an acute manic episode managed pharmacologically

A
  • if patient not taking antipsychotics/ mood stabiliser: offer antipsychotic - haloperidol, olanzapine, quetiapine or risperidone
  • if tried 2 antipsychotics and they are ineffective or poorly tolerated, consider adding Lithium
  • If adding lithium is ineffective or not suitable, consider semisodium valproate
  • consider stopping antidepressant if on one
  • urgent referral to CMHT
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9
Q

How is an acute episode of depression managed in bipolar disorder

A
  • psychological intervention: CBT etc
    if not on any meds:
  • olanzapine + fluoxetine or
  • quetiapine monotherapy
  • lamotrigine monotherapy if above ineffective
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10
Q

What is the long term management for bipolar disorder

A
  • psychoeducation - triggers, coping strategies
  • psychotherapy - CBT, interpersonal therapy
  • peer/ carer support
  • maintenance: 1st - lithium, 2nd - valproate
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11
Q

What is unipolar depression

A

when the person only has episodes of depression, without hypomania or mania.

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12
Q

What are the core symptoms of depression

A
  • persistently low mood
  • anhedonia - loss of enjoyment
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13
Q

Give 4 physical symptoms of depression

A
  • Low energy (fatigue)
  • Abnormal sleep (particularly early morning waking)
  • Poor appetite or overeating (weight change)
  • Slow movements
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14
Q

Give 3 cognitive symptoms of depression

A
  • Poor concentration
  • Slow thoughts
  • Poor memory
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15
Q

Give 5 emotional/ behavioural symptoms of depression

A
  • Irritability
  • suicidality
  • Low self-esteem
  • Guilt
  • Hopelessness about the future
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16
Q

What questionnaire is used to assess the severity of depression

A

PHQ-9 Questionnaire

17
Q

Describe the PHQ-9 questionnaire

A
  • 9 questions about how often the patient is experiencing symptoms in the past two weeks
  • higher score = more severe the depression
18
Q

On the PHQ-9 questionnaire, what range would indicate less severe depression

A

< 16

19
Q

On the PHQ-9 questionnaire, what range would indicate more severe depression

A

≥ 16

20
Q

Give 5 differentials of depression

A
  • hypothyroidism
  • neuro: MS, Parkinson’s, dementia
  • bipolar disorder
  • grief reaction
  • anxiety disorders
21
Q

How is depression investigated

A
  • psych Hx, MSE, risk assessment
  • PHQ-9
  • Bloods: FBC, TFT, LFT, B12/folate
22
Q

How is less severe depression managed

A
  • 1st line: guided self help and active monitoring
  • individual or group CBT or behavioural activation
  • couples therapy
  • group exercise, group mindfulness and meditation
  • antidepressants (SSRIs) - not routinely prescribed first line. follow up 2-4w
23
Q

What can occur in severe depression

A

psychosis

24
Q

How is more severe depression managed

A
  • combination of individual CBT and an antidepressant (SSRIs or SNRIs)
  • couples therapy
  • guided self help and group therapy
  • antipsychotics (if experiencing psychosis)
  • treatment resistant: lithium
25
Q

What screening tool is used to detect postnatal depression

A

Edinburgh Postnatal Depression Scale

26
Q

What are baby blues

A
  • mood swings, low mood, anxiety, tearfulness
  • Typically seen 3-7 days following birth and resolves within 2w of delivery
27
Q

How are baby blues managed

A

reassurance and support

28
Q

What is postnatal depression

A
  • same sx as depression
  • may occur anytime during the first year of birth
  • symptoms should last at least 2w to be diagnosed
29
Q

How is postnatal depression managed

A
  • reassurance and support
  • CBT
  • SSRIs - sertraline or paroxetine
30
Q

What is puerperal psychosis

A

psychosis typically 2-3w after childbirth characterised by severe mood swings and disordered perceptions

31
Q

How is puerperal psychosis managed

A

Admission to hospital is usually required, ideally in a Mother & Baby Unit

3a psychiatry (10 decks)

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