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Mental Health > 2 - Mood disorders > Flashcards

2 - Mood disorders Flashcards

(48 cards)

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1
Q

Define mood/affective disorder:

A

Any condition characterised by distorted, excessive, or inappropriate moods or emotions for a sustained amount of time

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2
Q

Name the 2 types of unipolar mood disorders:

A

1 - Depression

2 - Dysthymia

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3
Q

Name the 2 types of bipolar mood disorders:

A

1 - Cyclothymia

2 - Bipolar affective

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4
Q

Define cyclothymia:

A

Mild periods of elation and depression, broken up by periods of normal mood.

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5
Q

Define dysthymia:

A

Chronic low mood not fulfilling the criteria for depression

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6
Q

What is the monoamine hypothesis?

A

Deficiency of monoamines (dopamine, noradrenaline, serotonin) causes mood disorders including depression and bipolar disorder

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7
Q

What are the risk factors for depression?

A
  • Family history
  • Lack of social support
  • F:M 2:1
  • PMH of depression
  • Physical co-morbidities
  • Low socioeconomic status
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8
Q

Depressive illness could be secondary to which physical conditions?

A
  • Hypothyroidism
  • Cushing’s disease
  • Addison’s disease
  • Hyperparathyroidism
  • Anaemia
  • Malignancy
  • Parkinson’s disease
  • Huntington disease
  • Multiple Sclerosis
  • Stroke
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9
Q

What kind of substance abuse is commonly linked to causing depression?

A
  • Alcohol
  • Cocaine
  • Amphetamines
  • Cannabinoids
  • Sedatives/hypnotics
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10
Q

If a patient presented 2 months after the loss of his wife, complaining of low mood, lack of energy/appetite/sleep and excessive guilt, what is the diagnosis?

A

Normal bereavement

= Reactions < 6 months

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11
Q

What are the core symptoms of depression?

A
  • Anhedonia
  • Continuous low mood for > 2 weeks (usually AM)
  • Lack of energy
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12
Q

What are the additional symptoms of depression?

A
  • Decreased appetite
  • Trouble sleeping - severe = EMW
  • Negative thoughts
  • Trouble concentrating
  • Loss of libido
  • Psychomotor retardation
  • Suicidal ideation
  • Excessive guilt
  • Hallucinations
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13
Q

What type of hallucinations are most commonly seen in depressive illnesses?

A

Auditory:

2nd person derogatory

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14
Q

What is the classification for mild depression?

A

2 core symptoms + 2 other symptoms

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15
Q

What is the classification for moderate depression?

A

2 core symptoms + 3/4 other symptoms

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16
Q

What is the classification for severe depression?

A

3 core symptoms + ≥4 other symptoms

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17
Q

What are the biological treatments for depression?

A
  • 1st line = SSRI ie Sertraline
  • 2nd = SNRI ie Venlafaxine
    Other:s
  • MAOI ie Phenelzine
  • NARI ie Reboxetine
  • TCA ie Amitriotylline
  • NASSA ie Mirtazepine
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18
Q

In what type of depression would you consider prescribing a MAOI such as Phenelzine?

A

Treatment-resistant or atypical

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19
Q

What is the MoA of MAOIs?

A
  • Inactivate monoamine oxidase

- Reduced oxidation of dopamine/serotonin, noradrenaline, tyramine

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20
Q

Which foods would you advise a patient starting on a MAOI to avoid? Why?

Study These Flashcards
A

Tyramine-rich foods:

  • Marmite
  • Bovril
  • Aged/strong cheese
  • Cured/processed meat
  • Pickles/fermented food
  • Broad beans

= Risk of hypotensive reaction

21
Q

Which antidepressants would you avoid using if the patient had suicidal ideations? Why?

Study These Flashcards
A
  • MAOIs
  • TCAs

= Toxic in overdose

22
Q

What is the 1st line antidepressant for children/adolescents?

23
Q

What is the MoA of SSRIs?

Study These Flashcards
A
  • Inhibits neurotransmitter re-uptake pump on pre-synaptic membrane
  • Increases [neurotransmitter] available to bind to post-synaptic membrane
24
Q

If you are about to start a patient on aspirin + sertraline, what other type of drug must you add?

Study These Flashcards
A

PPI ie Lansoprazole

25
Why should an SSRI never be co-prescribed with heparin/warfarin?
- SSRI inhibits serotonin uptake in platelets - Inhibit platelet aggregation - 3/4x risk of bleeding
26
Which SSRIs should not be prescribed in long QT syndrome?
- Citalopram | - Escitalopram
27
The when should the effects of SSRIs on depression be clinically detectable?
4-6 weeks
28
Name some common side effects of SSRIs:
- Nausea - Dyspepsia - Diarrhoea - Constipation - Bloating
29
Name some rare side effects of SSRIs:
- Mania - Suicidal ideation - Tremor - EPSE
30
How would an overdose of SSRIs present?
Serotonin syndrome: - Extreme agitation - Hostility - Muscle rigidity - Migraine - Diarrhoea - Fever - Seizures - Unconsciousness
31
What medications can cause serotonin syndrome?
- SSRIs - TCAs - Lithium
32
Which antidepressants are safest in the elderly?
SSRIs
33
What is the MoA of Reboxetine (NARI)?
NARI | - Highly specific NA re-uptake inhibitor
34
What are some common ADRs of Reboxetine (NARI)?
- Nausea - Dry mouth - Constipation - Tachycardia - Palpitations +++ many more
35
What class of antidepressants are Venlafaxine and Duloxetine? What is the MoA?
SNRIs | - Prevent re-uptake of NA and 5-HT
36
Why are SNRIs (Venlafaxine) preferred over TCAs (Amitriptyline)?
SNRIs do not block cholinergic receptors unlike TCAs, so less anti-cholinergic side effects
37
What are some common side effects of SNRIs (Venlafaxine)?
- Nausea - Bloating - Diarrhoea - Constipation - Dyspepsia - Sleep disturbance - ^BP - Dry mouth - Hyponatraemia
38
What are the contraindications of SNRIs (Venlafaxine)?
- ^ risk of arrhythmias | - uncontrolled hypertension
39
What is the MoA of TCAs?
1) Inhibit NA re-uptake = ^[NA] 2) Reduce cholinergic neurotransmission 3) Suppress NA transmission at α-1 adrenoceptors
40
What are some common side effects of TCAs?
- Dry mouth - Urinary retention - Blurred vision - ^HR - Postural hypotension - Constipation - Impaired myocardial contractility - Sedation - Lowers seizure threshold - Impaired psychomotor performance
41
What are the contraindications for TCAs?
- Recent MI - Arrhythmias - Mania - Severe liver disease - Agranulocytosis
42
What are the indications for using an NASSA such as Mirtazepine?
Depressed patient who would benefit from weight gain and suffers insomnia
43
What are the main ADRs of Mirtazepine?
- ^^ appetite + weight gain | - Sedation
44
What are the psychological treatments recommended for the treatment of depression?
- CBT - IPT - Counselling - Self-help groups - Physical activity
45
What are the social treatments for depression?
Social support groups
46
Define Mixed Affective State:
Mix or rapid alternation within hrs between hypomania/mania/depression
47
What is the 2nd line drug treatment for depression?
SNRI: - Venlafaxine - Duloxetine
48
What are the indications for ECT for depression?
Treatment-Resistant depression + - Suicidal ideation OR - Not eating/drinking

Mental Health (4 decks)

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