2: Mood Disorders Flashcards
(132 cards)
1
Q
What is a mood disorder
A
Group of psychiatric conditions where primary disturbance is in mood
2
Q
What are the 4 categories of mood disorders
A
- Manic
- Hypomanic
- Major Depressive Disorder
- Mixed
3
Q
Define a manic episode
A
Period >1W (or less if hospitalised) of persistently raised, elevated, expansile and irritable mood.
4
Q
What is a hypomanic episode
A
Period >4d where individuals mood is elevated, expansile and irritable. But, not sufficient to cause pronounced impairment in social or occupational functioning.
5
Q
What is major depressive disorder
A
> 2W where individual has depressed mood or loss of pleasure in activities
6
Q
What is a mixed episode
A
Affective episode (2W) - characterised by rapid alternation in hypomanic, manic and depressive symptoms
7
Q
Define unipolar depressive disorder
A
Persistently and pervasive low mood for 2 weeks, that is significantly different to normal
8
Q
What is the time frame to diagnose unipolar depressive disorder
A
Symptoms persisting beyond 2W
9
Q
In which gender is unipolar depressive disorder more common
A
Females (2:1)
10
Q
What model outlines causes depression
A
Biopsychosocial model
11
Q
What biological factors contribute to depression
A
Genetics: 45% concordance in monozygotic twins
Endocrine: high cortisol, low thyroid
Neurotransmitter: low 5-HT
Neuroanatomy: decrease density in pre-frontal cortex
12
Q
What is theory describing serotonin deficiency in depression called
A
Monamine oxidase theory
13
Q
What psychological factors have been linked to depression
A
Personality - neuroticism increases risk of depression
14
Q
What are social factors that can cause depression
A
Adverse childhood events
Marital status
15
Q
What is a social risk factor for depression in men
A
Rates of depression are higher in separated males
16
Q
What is a mnemonic to remember ICD-10 criteria for depression
A
SIG E CAPS
17
Q
What are the 10 symptoms of depression
A
Sleep disturbance Interest loss Guilt or unworthiness Energy loss, Erection (libido) loss Cognitive decline Appetite loss Psychomotor agitation Suicidal ideation
18
Q
What is the ICD-10 criteria for depression
A
Individual must four (out of 10) or more of the following persisting for more than 2W:
- Anhedonia
- Loss of energy
- Low mood
- Appetite loss
- Insomnia and sleep disturbance
- Psychomotor retardation
- Libido
- Feelings guilt or unworthiness
- Reduced concentration
- Suicidal ideation
19
Q
What are the 3 core symptoms of depression
A
Anhedonia
Low mood
Anergia (Low energy)
20
Q
How is depression categorised
A
Into:
- Mild
- Moderate
- Severe
21
Q
What is required to define mild depression
A
4 Symptoms, 2 of which must be core symptoms
22
Q
What is required to diagnose moderate depression
A
6 symptoms, 2 of which must be core symptoms
23
Q
What is require to diagnose severe depression
A
7 symptoms, 3 of which must be core symptoms
24
Q
What are 3 delusions associated with depression
A
Nihlistic
Cotard
Delusiosn of guilt
25
What is a nihilistic delusion
That the world is going to end
26
What is a cotard delusion
The the person is already dead or rotting on the inside
27
What is delusion of guilt
Everything is their fault eg. the next door neighbour cat died and it was their fault
28
What are two other symptoms of depression
Low self-esteem
| Auditory hallucinations
29
What are 3 differential diagnosis for depression
- Adjustment disorder
- Bereavement
- Hypothyroidism
30
what is seasonal affective disorder
When individuals experience symptoms of major depressive disorder in winter
31
what is major depressive disorder with psychosis
Symptoms major depressive disorder with psychotic hallucinations and delusions
32
Explain delusions and hallucinations in MDD with psychosis
Delusions and hallucinations are usually congruent with mood
33
What is dysthymia also known as
Persistent major depressive disorder
34
What is dysthymia
Symptoms of major depressive disorder persisting beyond 2-years
35
What is first line for investigating depression
Ask two questions, how often in past month have you felt bothered by:
1. Feeling down or depressed?
2. Little pleasure in things used to enjoy?
36
What two questions should people be asked to screen for depression
1. Feeling down, depressed or hopeless
| 2. Little pleasure in something used to enjoy
37
If a person answer yes to either of the screening questions what is next line
PHQ-9 Questionnaire
| HAD
38
In the PHQ9 what defines mild depression
5-10
39
In the PHQ9 what defines moderate depression
10-15
40
In the PHQ9 what defines moderately severe depression
15-20
41
In the PHQ9 what defines severe depression
20-27
42
What is a positive score in HAD
More than 11
43
What should all patient's with depression receive during work-up
Risk assessment
44
What is offered for all cases of depression
Advice and Follow-up (in 2W)
45
What is offered for persistent sub-threshold depression symptoms or mild-moderate depression
Low intensity psychosocial intervention
46
What are the two low intensity psychosocial interventions
CCBT
| Group-Based CBT
47
What is step 3 for moderate-severe depression
High intensity psychosocial intervention or medication
48
what is step 4 for severe depression, severe self-neglect or risk to life
Crisis service
ECT
Inpatient care
49
How is mild-moderate depression managed
1. Advice and follow-up in two weeks
| 2. Low intensity psychosocial intervention
50
What advice is offered in mild-moderate depression
Sleep hygiene
51
What are two low-intensity psychosocial interventions
CCBT (Online-CBT)
| Group-CBT
52
If individual does not improve on low intensity psychosocial interventions, what is offered
High intensity psychosocial intervention or medication
53
what are three criteria for antidepressants
- Sub-threshold depressive symptoms persisting beyond 2-years
- Mild depression not managed by low intensity psychosocial methods
- Moderate - Severe depression
54
what is first line medication for depression
SSRIs
55
if an individual has chronic health problems, what SSRI should they be prescribed and why
Citalopram or Sertraline
| - Fluoxetine has highest drug interactions
56
what needs to be considered when giving SSRIs
Suicide risk
57
what happens if an SSRI is ineffective
Trial another SSRI after 3-4W
58
what is second-line medication for depression
TCA
59
what is third-line medication for depression
MAOI
60
what is fourth-line medication for depression
Venlafaxine
61
what is venlafaxine
SNRI
62
If switching one SSRI (citalopram, sertraline, escitalopram, paroxetine) to another SSRI what should be done
Stop one SSRI and start the next
63
If switching fluoxetine to another SSRI, what should be done
Stop Fluoxetine, wait 4-7d, then start the next SSRI
64
If switching SSRI (not fluoxetine) to TCA what is done
Gradually taper down SSRI and increase TCA
65
if switching SSRI (not fluoxetine) to Venlafaxine what is done
Gradually taper down SSRI and increase TCA
66
What is the risk of switching SSRIs
Serotonin Syndrome
67
What are the 4 causes of serotonin syndrome
- TCA
- SSRI
- Amphetamines
- Ectasy
68
What are three features of serotonin syndrome
- Autonomic Symptoms
- Altered mental status
- Neuromuscular excitation
69
What are the 3 symptoms of neuromuscular excitation
Myoclonus
Hypereflexia
Rigidity
70
What is an autonomic symptom of serotonin syndrome
Hyperthermia
71
How is serotonin syndrome managed
IV Fluids
| Benzodiazepines
72
How is seratonin syndrome managed if severe
Serotonin antagonists:
- Chlorpromazine
- Cyproheptadine
73
What is used to treat severe depression
ECT
Crisis Resolution and Home treatment team
74
When is ECT used
Severe life-threatening depression that needs urgent response
75
What is CRHT
Crisis resolution and home treatment team
76
If psychotic depression what may be used to treat
Anti-psychotics
77
How does ICD-10 define bipolar affective disorder
Disorder characterised by two or more disturbances in mood. This can be classified as elevation in mood and energy (mania and hypomania) or depressive mood.
78
How does DSM-V classify bipolar disorder
Into 5 distinct types
79
What is type I bipolar disorder
Manic and depressive disorder
80
What is type 2 bipolar disorder
Hypomanic and depressive disorder
81
What is bipolar type 3
Cylothermia
82
Define cyclothermia
persistent hypomanic symptoms that do not meet the diagnostic threshold and persistent depressive symptoms that do not meet the diagnostic threshold
83
What is the average age of onset for bipolar disorder
21y
84
Describe aetiology of bipolar
Very strong genetic component (40-70%) concordance amongst twins
85
What is the main risk factor for bipolar disorder
FH
86
What are 4 triggers for bipolar disorder
- Traumatic childhood experience
- Psychosocial stress
- Sleep disturbance
- Physical illness
87
Define mania
Period >1W where individuals experience persistently abnormally and persistently raised, expansive, irritable mood
88
Define hypomania
Period >4d where individuals experience elevated mood insufficient to cause impairment in their social or occupational functioning
89
What is a mnemonic to remember symptoms of manic episode
DIGFAST
90
What are the symptoms of a manic episode
```
Distractable
Irresponsible
Grandoisity
Flight of ideas
Activity increase
Sleep reduction
Talkativeness
```
91
Describe time-frame in the following
a. Mania
b. Hypomania
a. >1W
| b. >4d
92
Describe presentation of mania
Severe functional impairment, requires hospitalisation due to risk to self or others
93
What symptoms can be present in mania
Psychotic symptoms
94
Describe hypomania
Lesser version of mania
95
How long does hypomania last
4d
96
Describe psychotic symptoms in hypomania
No psychotic symptoms
97
What is a mnemonic to remember depressive symptoms
SIG E CAPS
98
What are symptoms of depressive episode
```
Sleep disturbance
Interest loss in activities
Guilt
Energy low, Erection (libido) loss
Cognitive decline
Appetite loss
Psychomotor agitation
Suicidal ideation
```
99
Explain investigation for bipolar depressive disorder
Any individual who presents to HCP should be asked - within the past 4-days have you experienced any symptoms of persistently raised mood?
100
What should happen to an individual if they have had episodes of hyper-excitability in the past 4-days
Specialist referral to psychiatric assessment unit
101
What does a specialist assessment involve
Risk assessment
| Psychiatric assessment
102
Describe conservative measures to manage mania or hypomania
1. Calming environment
2. Recommend individual does not make any large life choices until post-recovery
3. Refer to CMHT
103
What is first-line medical treatment for mania or hypomania
Antipsychotic
104
What antipsychotics are offered for mania in bipolar disorder
Olanzipine
Risperidone
Quetiapine
105
What is second-line for manic episode in bipolar disorder
Lithium
106
What is third-line for mania in bipolar disorder
Valproate
107
If someone is on an antidepressant and has a manic episode, what should be done
Stop antidepressant and start antipsychotic
108
if pharmacological measures are ineffective in manic episode of bipolar what is used
ECT
109
When is ECT used
To induce rapid remission in symptoms
110
What conservative measures are used to treat depressive episode in bipolar
High-intensity psychosocial intervention
111
Name three high-intensity psychosocial interventions
- Interpersonal therapy
- CBT
- Behavioural couples therapy
112
What medical treatment is first-line for depressive episode in bipolar disorder
Fluoxetine and Olanzapine
113
What is an alternative to fluoxetine and olanzapine in depressive episode of bipolar
Quetiapine
114
When is third (/second-line) for depressive episode in bipolar
Lamotrigine
115
What conservative measures are offered long-term for bipolar disorder
High-intensity individual and group psychological interventions to prevent relapses
116
What is first-line long-term management for bipolar
Lithium
117
What is second-line long-term management for bipolar
Valproate
Or:
Olanzapine
Or:
Quetiapine
118
What should individuals with bipolar be reviewed for annually
- BMI
- Weight
- Cardiovascular profile: HbA1c, Lipid Profile
- LFTs
119
If on lithium, what 3 things should be checked
TFT
Renal Function
Calcium
120
What two medications offered for bipolar are teratogenic during pregnancy
- Valproate
| - Lithium
121
What medications are safe alternatives in pregnancy
- Lamotrigine
| - Olanzapine
122
What drug for bipolar is contraindicated in breast feeding
Lithium
123
Explain risk of bipolar and what is done to address this
Increases risk of CVD (4-times) and diabetes (4-times0
: therefore monitor CVD risk factors annually in these patients
124
What is grief
Period of grief, low mood and adaptation following a bereavement
125
Define prolonged greif
Grief> 12m
126
Define delayed grief
Onset of grief 2W after initial loss
127
What are 4 risk factors for abnormal grief reaction
- Women
- Unexpected death
- Problematic relationship
- Poor social support
128
Who outlined stages of grief
Kuber and Ross
129
What is a mnemonic to remember Kuber-Ross stages of grief
DABDA
130
What are the Kuber Ross stages of grief
```
Denial
Anger
Bargaining
Depression
Acceptance
```
131
Explain how an individual may progress through stages
Individual may not progress through all stages, can progress through them in a non-linear fashion. If someone is stuck in a stage they may need assistance
132
What can happen in denial stage of grief
Individual may experience pseudo hallucinations (visual and auditory). They can focus on objects that reminds them of their loved one and even prepare meals for them
