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Part 3 – PM3B COPY T > (PM3B) Depression + Bipolar Disorder > Flashcards

(PM3B) Depression + Bipolar Disorder Flashcards

1
Q

In psychiatric terms, what is ‘affect’?

A

An objective description of a person’s emotional behaviour

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2
Q

In psychiatric terms, what is ‘mood’?

A

An individual’s prevailing subjective emotional state

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3
Q

What are some examples of affective disorders?

A

(1) Unipolar depression/ major depressive disorder
(2) Bipolar disorder
(3) Dysthymia (subthreshold depression)
(4) Cyclothymia

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4
Q

What is classification of affective disorders usually based on?

A

(1) Severity
(2) Presence/ absence of physical features (physical/ somatic)
(3) Presence/ absence of psychotic features
(4) Course (duration + recurrence)
(5) Presence/ absence of intervening manic phases

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5
Q

What is the system in the UK for classification of mood disorders?

A

(1) ICD-10

OR

(2) DSM-V

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6
Q

What is depression?

A

(1) Depressed mood
(2) Loss of pleasure in activities
(3) Definition relies on what a normal response to a situation should be (socially + culturally)

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7
Q

What percentage of the population have major depression?

A

~5%

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8
Q

What percentage of suicides are males?

A

~75%

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9
Q

What main groups of factors may give rise to depression?

A

(1) Brain regional changes
(2) Genes + environment
(3) Medical conditions + medications
(4) Biochemical

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10
Q

What effect can genes and environment have on causation of depression?

A

(1) Family history is common
(2) Genetic/ environmental factors
(3) Changes in temperament/ personality

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11
Q

What effect can biochemistry have on causation of depression?

A

(1) Reserpine (antihypertensive) reported to cause depression
(2) No reliable metabolic/ biochemical markers for depression

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12
Q

How can depression be diagnosed?

A

(1) ICD-10 – must exhibit ≥2 key symptoms
(2) DSM-V – must exhibit ≥1 key symptoms

Key symptoms are

  • Low mood
  • Loss of interest/ pleasure
  • Loss of energy (ICD-10 only)
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13
Q

What is the NICE guideline preference of depression diagnosis system?

A

DSM-V

Has more evidence

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14
Q

What scales are often used to formalise a potential diagnosis of depression?

A

(1) Hamilton Depression Scale Rating

(2) Beck Depression Inventory

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15
Q

What are two vitally important questions for a healthcare professional to ask a patient potentially suffering from depression?

A

(1) During the last month, have you often been bothered by feeling down, depressed, or hopeless?
(2) During the last month, have you often been bothered by having little interest/ pleasure in doing things?

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16
Q

What are some examples of important depression questionnaires?

A

(1) HADS
(2) BDI-II
(3) PHQ-9

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17
Q

What are the key/ core symptoms for DSM-V?

A

(1) Depressed mood (self-report or other’s observation

(2) Loss of interest or pleasure

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18
Q

What are they key/ core symptoms for ICD-10?

A

(1) Depressed mood
(2) Loss of interest
(3) Reduced energy

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19
Q

How many symptoms present does DSM-V require to diagnose depression?

A

5 out of 9 symptoms present

1 of 2 KEY symptoms must be present

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20
Q

How many symptoms present does ICD-10 require to diagnose depression?

A

4 out of 10 symptoms

2 of 3 KEY symptoms must be present

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21
Q

What are the 10 symptoms used to categorise depression in ICD-10?

A

(1) Depressed mood
(2) Loss of interest
(3) Reduced energy
(4) Loss of confidence/ self-esteem
(5) Inappropriate guilt/ self-reproach
(6) Recurrent thoughts of death/ suicide
(7) Diminished ability to think/ concentrate (indecisiveness)
(8) Change in psychomotor activity with agitation/ retardation
(9) Sleep disturbance
(10) Change in appetite + weight change

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22
Q

What are the 9 symptoms used to categorise depression in DSM-V?

A

(1) Depressed mood (self-report or other’s observation
(2) Loss of interest or pleasure
(3) Fatigue/ loss of energy
(4) Worthlessness/ inappropriate or excessive guilt
(5) Recurrent thoughts of death/ suicidal thoughts/ suicide attempts
(6) Diminished ability to think/ concentrate (indecisiveness)
(7) Psychomotor agitation/ retardation
(8) Insomnia/ hypersomnia
(9) Significant appetite/ weight loss

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23
Q

How is sub-threshold depression diagnosed using the DSM-V or ICD-10 scale?

A

(1) DSM-V: 2-5 symptoms (inc. 1 core)

(2) ICD-10: Cannot be diagnosed

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24
Q

How is mild depression diagnosed using the DSM-V or ICD-10 scale?

A

(1) DSM-V: >5 symptoms

(2) ICD-10: 4 symptoms

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25
Q

How is moderate depression diagnosed using the DSM-V or ICD-10 scale?

A

(1) DSM-V: Between mild + severe

(2) ICD-10: 5-6 symptoms

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26
Q

How is severe depression diagnosed using the DSM-V or ICD-10 scale?

A

(1) DSM-V: Several in excess of 5

(2) 7+ symptoms

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27
Q

What are the treatment aims for treatment of depression?

A

(1) Prevent suicide
(2) Identification of possible primary causes
(3) Provide symptomatic therapy
(4) Investigate adverse social, domestic, financial circumstances + provide support
(5) Initiate long-term therapy to prevent relapse/ recurrence

28
Q

What are the 3 principle divisions of treatment for depression?

A

(1) Pharmacological
(2) Psychological
(3) Psychosocial

29
Q

What is the stepped care model?

A

Helps with diagnosis + management of depression

Begins at Step 1 and increases with severity

(1) Assessment, support, monitoring, psychoeducation + referral for further assessment
(2) For patients diagnosed with persistent sub-threshold depressive symptoms – low intensity psychosocial + psychological interventions + medications + further assessment + interventions
(3) For persistent sub-threshold/ mild-moderate depression who have not responded to Step 2 interventions OR moderate-severe depression – medication + high-intensity psychological interventions + combined treatments + collaborative care
(4) For severe + complex depression + risk to save life (severe self-neglect) – medication + high-intensity psychological interventions + combined treatments + multi-professional and inpatient care + crisis service

30
Q

What is low-intensity psychosocial care?

A

Typically for persistent sub-threshold or mild to moderate depression

(1) Guided self-help
(2) Group physical activity programmes

31
Q

What is group CBT?

A

Alternative to low-intensity psychosocial

Used when low-intensity psychosocial interventions have been refused OR are not suitable

32
Q

What is high-intensity psychological care?

A

For persistent sub-threshold/ mild-moderate depression

(1) Where low-intensity psychosocial has failed

OR

(2) For use in moderate-severe depression (in combination with antidepressant)

33
Q

What are some examples of high-intensity psychological care?

A

(1) Individual cognitive behavioural therapy – CBT
(2) Interpersonal therapy
(3) Behavioural couples therapy

34
Q

Name 4 types of antidepressants.

A

(1) Monoamine oxidase inhibitors (MAOIs)

(2) Inhibitors of monoamine uptake
- Selective Serotonin
Reuptake Inhibitors (SSRIs)
- Tricyclics (TCAs)

(3) Modulators of serotonin (5HT) receptors and other NT receptors
(4) St John’s Wort

35
Q

What is the typical first line medication given for treatment of depression?

A

Selective serotonin reuptake inhibitors (SSRIs)

36
Q

What are SNRIs?

A

Serotonin and noradrenaline reuptake inhibitors

37
Q

What are NaSSas?

A

Noradrenergic and specific serotonergic antidepressant

38
Q

What are SARIs?

A

Serotonin antagonist and reuptake inhibitor

39
Q

What are SMSs?

A

Serotonin modulator and stimulator

e.g. vortioxetine – inhibits reuptake serotonin (SERT) + modulates many 5HT receptors

40
Q

What are NRIs?

A

Noradenaline reuptake inhibitor

e.g. reboxetine

41
Q

Give some examples of SSRIs.

A

(1) Sertraline
(2) Fluoxetine
(3) Paroxetine
(4) Citalopram
(5) Escitalopram

42
Q

Why are SSRIs the preferred first line medication for the treatment of depression?

A

(1) Fewer side effects
(2) No anticholinergic
(3) Lack of toxicity in overdose
(4) Less sedating than TCAs

43
Q

What is venlafaxine?

A

SNRI

Serotonin and noradrenaline reuptake inhibitor

44
Q

What is mirtazapine?

A

Fewer interactions

Fewer adverse events

45
Q

What is trazodone?

A

Only if sedation required

46
Q

What is the treatment course for sertraline to treat depression?

A

50-200 mg per day

47
Q

What is the treatment course for citalopram to treat depression?

A

20-40 mg per day

48
Q

What is the treatment course for escitalopram to treat depression?

A

10-20 mg per day

49
Q

What is the treatment course for fluoxetine to treat major depression?

A

20-60 mg per day

50
Q

What is the treatment course for paroxetine to treat major depression?

A

20-50 mg per day

51
Q

What is the treatment course for venlafaxine to treat major depression?

A

75-375 mg per day

52
Q

What is the treatment course for mirtazapine to treat major depression?

A

15-45 mg per day

53
Q

What are RIMAs?

A

Subclass of MAOI

Reversible inhibitor MAO-A

Safer + fewer side effects than other MAOIs

e.g. moclobemide

54
Q

What is electroconvulsive therapy?

A

Associated with neuronal death – specific mechanism unknown

For severe psychotic depression + bipolar disorder with psychotic symptoms

55
Q

What is the important information for a patient when initiating therapy for depression?

A

(1) Full antidepressant effect takes time (e.g. 2-4 weeks)
(2) Important to take as prescribed and continue after remission (e.g. 6 months+)
(3) Possible side-effects
(4) Potential interactions
(5) Antidepressants are not addictive
(6) Risk and nature of discontinuation symptoms with all antidepressants

56
Q

What is the follow-up following initiation of therapy for depression?

A

Typically see patient after 2 weeks of initiation

Every 2-4 weeks after for 3 months (may then extend)

57
Q

What is mania?

A

Severe + recurrent psychotic affective disorder

(1) Abnormally elevated mood, unwarranted optimism, exuberance, over-confidence, inflated self-esteem, hyperactivity, excessive libido and little sleep
(2) Increased drive and extrovert behaviour but often socially tactless
(3) Makes compliance problematic
(4) Attacks last ≥1 week

58
Q

What lasts longer, manic or depressive episodes?

A

Usually depressive

59
Q

What are the classifications of bipolar?

A

(1) Bipolar I disorder – more severe mania

2) Bipolar II disorder – less severe mania (hypomania

60
Q

What are the aims of treatment of bipolar disorder?

A

(1) Control manic and depressive attacks

(2) Minimise recurrence and stabilise mood

61
Q

How are manic attacks normally controlled?

A

Sedative anti-psychotics

62
Q

What is the long-term treatment for prophylaxis of bipolar disorder?

A

(1) Lithium
(2) Anticonvulsants – e.g. sodium valproate
(3) Other anticonvulsants – lamotrigine/ carbemazepine
(4) Atypical antipsychotics – olanzapine or quetiapine
(5) Benzodiazepines may be used short-term

Antidepressants are not normally used

63
Q

Why does lithium in the treatment of bipolar disorder require very careful monitoring?

A

Very narrow therapeutic window

64
Q

Why are antipsychotics given in the treatment of bipolar disorder and mania?

A

Can give control of mania + some help to prevent relapse

Mood stabiliser

65
Q

What are some examples of antipsychotics given in the treatment of bipolar disorder and mania?

A

(1) Olanzapine
(2) Quetiapine
(3) Haloperidol
(4) Risperidone

66
Q

What are some antiepileptics and anticonvulsants given in the treatment of bipolar disorder and mania?

A

(1) Valproate – possible effects at voltage-gated sodium channels + GABA signalling
(2) Carbamazepine – patients unresponsive to lithium
(3) Lamotrigine – prophylaxis of bipolar disorder + depression (NOT mania)

Part 3 – PM3B COPY T (33 decks)

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