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PM3B > (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-11

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

How can depression be diagnosed?

A

(1) ICD-11 – 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-11 only)

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12
Q

What is the NICE guideline preference of depression diagnosis system?

A

DSM-V

Has more evidence

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13
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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14
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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15
Q

What are some examples of important depression questionnaires?

A

(1) HADS

(2) BDI-II

(3) PHQ-9

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16
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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17
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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18
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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19
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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20
Q

How is sub-threshold depression diagnosed using the DSM-V or ICD-11 scale?

A

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

(2) ICD-11: Cannot be diagnosed

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21
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

22
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

23
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

24
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

25
Q

What are the 3 principle divisions of treatment for depression?

A

(1) Pharmacological

(2) Psychological

(3) Psychosocial

26
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

27
Q

What are some examples of high-intensity psychological care?

A

(1) Individual cognitive behavioural therapy – CBT

(2) Interpersonal therapy

(3) Behavioural couples therapy

28
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

29
Q

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

A

Selective serotonin reuptake inhibitors (SSRIs)

30
Q

What are SNRIs?

A

Serotonin and noradrenaline reuptake inhibitors
Potent inhibitors SERT
venlafaxine 75mg
duloxetine 60mg

31
Q

What are NaSSas?

A

Noradrenergic and specific serotonergic antidepressant
ANTAGONISTS of 5HT
mirtazapine 15-30mg, 2-4wks

32
Q

What are SARIs?

A

Serotonin antagonist and reuptake inhibitor
inhibits SERT
trazodone 150mg

33
Q

What are SMSs?

A

Serotonin modulator and stimulator

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

34
Q

What are NRIs?

A

Noradenaline reuptake inhibitor

e.g. reboxetine

35
Q

Give some examples of SSRIs.
S F P C E

A

(1) Sertraline
50-200mg, incr if req t

(2) Fluoxetine
20mg incr up to 60mg/day interval 3-4 weeks

(3) Paroxetine
20mg incr max up to 50mg

(4) Citalopram
20 if req max 40mg

(5) Escitalopram
10mg if req max 20mg

36
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

37
Q

What are RIMAs?

A

Subclass of MAOI

Reversible inhibitor MAO-A

Safer + fewer side effects than other MAOIs

e.g. moclobemide

38
Q

What is electroconvulsive therapy?

A

Associated with neuronal death – specific mechanism unknown

For severe psychotic depression + bipolar disorder with psychotic symptoms

39
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

40
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)

41
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

42
Q

What lasts longer, manic or depressive episodes?

A

Usually depressive

43
Q

What are the classifications of bipolar?

A

(1) Bipolar I disorder – more severe mania

(2) Bipolar II disorder – less severe mania (hypomania)

44
Q

What are the aims of treatment of bipolar disorder?

A

(1) Control manic and depressive attacks

(2) Minimise recurrence and stabilise mood

45
Q

How are manic attacks normally controlled?

A

Sedative anti-psychotics

46
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

47
Q

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

A

Very narrow therapeutic window

48
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

49
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

50
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)

PM3B (33 decks)

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