Depression and bipolar affective disorder

Question 1

core syx of depresssion 3

Answer 1

depressed mood for most of day, every day
-may be diurnal mood variation( worse in mornigs * improves as day proceeds)

anhedonia
-loos of interest or pleasure in daily life

fatigue- lack of energy goes beyond poor sleep and pervades life

Question 2

typical syx of depression outwith core syx 7

Answer 2

poor appetite w marked weight loss

disrupted sleep

psychomotor retardation

decreased libido

reduced ability to concentrate

feelings of worthlessness

recurrent thoughts of death

Question 3

how long do sy x have to be present for and what is needed for a diagnosis of depression

Answer 3

syx presnet for every or nerarly every day for over 2 weeks

represent a change from normal personality

must have at least 2 of 3 core syx
-plus 2 or more typical syx

Question 4

biological risk factors for depression 3

Answer 4

FHx

twin studies

also monoamine theory of depression
-decreased monoamines may cause depression

Question 5

psychological risk factors for depression 3

Answer 5

personality traits
-mood lability, automonic hyperarousal

low self esteem

childhood experiences

Question 6

social risk facotrs for depression 2

Answer 6

disruption due to life events

stress associtwed w poor social environment

Question 7

differentials for depression 4

Answer 7

psychaitric disorders- bipolar, schizo, anorexia, anxiety

substance misue

Question 8

criteria for severity of depression (mild,moderate, severity)

Answer 8

mild -2 typical syx
-2 core syx

moderate- 2 typical syx
-3+ core syx

severe- 3 typical syx
-4+ core syx

Question 9

what are the stages of the bereavment process 5

Answer 9

denial

anger

bargaining

depression

acceptance

Question 10

management of mild depresssion

Answer 10

suggest low intensity psycoloigcal interventions
-focus on sleep hygiene
-anxeity management
-problem solving techniques

examples:
-self help guided resources
-computerised CBT

only if syx persist beyond 8 weeks or previous history of depression then antidepressnat can be considered

Question 11

management of moderate depression

Answer 11

combo of antidepressant and high intensity psychological intervention

for a first episode of depression
-generic SSRI is recommeneded

Question 12

what does severe depression include 3

Answer 12

includes psychoitc depression, high risk of suicide and atypical depression

Question 13

management of severe depression

Answer 13

need a rapid sepcalist mental health assessment with consideration of inpatient admission or ECT

Question 14

mechanism of ECT

Answer 14

interrupts hyperconneceivity between various areas of the brain that maintain depression

Question 15

indications for ECT 3

Answer 15

prolonged or severe manic episode

severe depression

catatonia

Question 16

side effects of ECT

Answer 16

memeory loss- short term retrograde amnesia (usually resolves completely

confusion

headaches

clumsiness

Question 17

follow up for depresion

Answer 17

reviewed regularly, frequently at first then less often

Question 18

use of st john worts for depression

Answer 18

non prescribed herbal remedy or dpession

has superiority to placebo and equivalent antidepressants with fewer side effects

-use not encourage as upregulates livers CP450 so affects metabolism of drugs

Question 19

which antidepressants for depression

Answer 19

often trial and error

combinded use of CBT and anti-depressant for mild to moderate depression

discuss side-effects
-warn patient of initial worseing symptoms in first weeks to preserve before therapeutic effects are seen

then assess formally after 4 weeks

SSRIs are recommended first line

Question 20

first line medicl management of depression

Answer 20

generic SSRI
-low starting dose titrated up
-adise full effects may take up to 6 weeks
-continue for at least 6 months after recovery

Question 21

examples of SSRIs 3

Answer 21

fluoextine- only antidepressnat licensed for <18s

citalopram

sertraline

Question 22

side effects and monitoring in SSRI use

Answer 22

monitor FBC- for anaemia due to GI bleeding and avoid concurrent NSAIDs

U&Es for hyponatraemia

citaloprma- dose dependent prolongation of QTc intervals

Question 23

second line depression management

Answer 23

an alternative SSRI from first line

Question 24

third line for depression managent

Answer 24

no particular order

mirtazapine- can cause drowsiness at low doses
-may be helpful to aid sleep

venlafaxine
-can be helpful for anxious patients
-require baseline BP and ECG. monitoring for any cardiovascular side effects

Question 25

fourth line for depression

Answer 25

tricyclics - nortriptyline

MAOIs- moclobemide

SARI-trazodone

Question 26

signs of mania regarding cognititon 5

Answer 26

cognition
-grandiosity
-distractibiltiy/poor concentration
-flight of idea/racing thoughts
-confusion
-lack. of insight

Question 27

signs of mania regarding mood 3

Answer 27

irritability

euphoria

lability

Question 28

signs of mania regarding behaviours 5

Answer 28

rapid speech

hyperactivity

sleep

hypersexuality

extravagance

Question 29

psychotic syx of mania 2

Answer 29

delusison

hallucinations

Question 30

define hypomania

Answer 30

state with characterisitic syx of mania except for:

psychotic syx,
-impairemnt of daily functioning
-need for inpatient treatment

Question 31

define bipolar affective disorder

Answer 31

depression alternates with mania

Question 32

medical causes of mania 3

Answer 32

steroids

illiect substances
-amphetamines-
-cocaine

antidepressants

Question 33

physical causes of mania

Answer 33

infection

stroke

neoplasm

epilepsy

MS

metabolic distrubnaces

Question 34

what to ask when assessing a manic person

Answer 34

infections

drug use

personal or FHx of psych disorders

Question 35

invesitgations for a manic person 3

Answer 35

CT of the head

EEG

screen for drugs/toxins

Question 36

management of acute mania

Answer 36

for moderate/severe with psychotic syx, cycling speed, suicide risk:
-any 2nd gen antipsychotic
or
-semisodium valproate

may need mental health act

Question 37

prophylaxis for patients with bipolar affective disorder

Answer 37

mood stabiliser for longerterm control

give lithium carbonate
-if compliance good, U&Es, ECG and T4 normal

Question 38

psychosocial interveniton for bipolar affective disorder 3

Answer 38

psychoeducation

CBT

support groups

Question 39

pregnancy and bipolar affective disorder

Answer 39

lithium is teratogenic
but stopping mediaction in pregnancy can carry risks of manic relapse

EBSTEINS ANOMALY

if they continue lithium
-regulary perinatal reviews and close contact

if they stop
-immeditate lithium postpartum with breastfeeding advice

Question 40

medications if lithium does not work for bipolar affective diosrder

Answer 40

antivonvulsnats-sodium valporate- 2nd line

antipsychotics-olanzapine

combination treatments
-lithium plus carbamazepine

antidepressants with lithium