3 - Mood disorders

Question 1

When is the usual onset of post-natal depression?

Answer 1

~ 1/2 months post-partum

Question 2

What are the risk factors for post-natal depression?

Answer 2

• PMH depression
• PMH PND
• FH depression
• Older age
• Single mother
• Unwanted pregnancy
• Poor social support

Question 3

What is the mean onset age for bipolar affective disorder?

Answer 3

~ 19 yrs

Question 4

Differentiate between Bipolar I and Bipolar II:

Answer 4

Bipolar I = Periods of SEVERE mood episodes from mania to depression
Bipolar II = Milder form, from mild hypomania to depression

Question 5

What are the risk factors for bipolar?

Answer 5

• FH
• Black > Ethnic minorities > White
• Anxiety disorders

Question 6

Are male or females more likely to develop bipolar?

Answer 6

Equal distribution

Question 7

Bipolar symptoms could be secondary to which physical conditions?

Answer 7

• Hyper/hypothyroidism
• Cushing’s disease
• Stroke

Question 8

Bipolar symptoms could be secondary to which drugs?

Answer 8

• Cocaine
• Amphetamines
• Corticosteroids
• or acute drug withdrawal

Question 9

Which personality disorders may present with bipolar-like symptoms?

Answer 9

• Histrionic

- EUPD

Question 10

What is the diagnostic criteria for Bipolar?

Answer 10

1 episode of mania/hypomania
+
further episode of mania/depression

Question 11

What are the symptoms of mania?

Answer 11

I DIG FASTER:

Irritability

Distractibility + disinhibited
Impaired insight + Increased libido
Grandiose delusions

Flight of ideas
Activity + Appetite increased
Sleep decreased
Talkative (pressure of speech)
Elevated mood/Energy increased
Reduced conc./Reckless

Question 12

What is the main difference between mania and hypomania?

Answer 12

Hypomania doesn’t include psychotic symptoms ie delusions

Question 13

What are the most common type of delusions present in Bipolar?

Answer 13

Grandiose

Question 14

What are the psychological treatments recommended for bipolar?

Answer 14

• Psychoeducation
• CBT
• Self-help groups

Question 15

What are the social treatments recommended for bipolar?

Answer 15

• Social support groups

- Calming activities

Question 16

Why shouldn’t antidepressants be used for bipolar?

Answer 16

Can induce mania

Question 17

What are the biological treatments for Bipolar?

Answer 17

• Mood stabilizers

- Antipsychotics

Question 18

What is the 1st line mood stabiliser for bipolar?

Answer 18

Lithium

Question 19

What is the MoA of lithium?

Answer 19

1) Decreases intracellular conc of Na+ and Ca2+
2) Decreases activity of Na+-dependent intracellular secondary messenger systems
3) Modulates dopamine and serotonin neurotransmitter pathways

Question 20

What are the ADRs of lithium?

Answer 20

LITHIUM:

Leucocytosis
Impaired renal function
Tremor/Teratogenic/Thirst
Hypothyroidism/Hair loss
Increased weight/fluid retention
Urine^^
Metallic taste

Question 21

How often should serum lithium levels be monitored?

Answer 21

Every 3 months

Question 22

What is the normal range for serum lithium?

Above what level does it become toxic?

Answer 22

Normal = 0.4-1.0mmol/L

Toxic > 1.5mmol/L

Question 23

What factors increase the toxicity of Lithium?

Answer 23

4 D’s:

Dehydration
Drugs (ACEi, NSAIDs)
Diuretics
Depletion of Na+

Question 24

What are the signs of lithium toxicity?

Answer 24

TOXIC:

Tremor
Oliguric renal failure
ataXia
Increased reflexes
Convulsions/Coma

Question 25

What are the contraindications for lithium?

Answer 25

- Untreated hypothyroidism - Addison's disease - Brugada syndrome

Question 26

What must be monitored for the 1st 6 months of sodium valproate?

Answer 26

LFTs - can cause liver dysfunction

Question 27

What are the ADRs of sodium valproate?

Answer 27

VALPROATE: ``` Very fat Aggression LFTs^ Platelets low Reversible hair loss Oedema Ataxia Tremor/Tiredness/Teratogenic Emesis + GI disturbances ```

Question 28

What are the contraindications of sodium valproate?

Answer 28

- Pregnancy - Hepatic dysfunction - Porphyria

Question 29

Name the mood stabilisers:

Answer 29

- Lithium - Sodium valproate - Carbamazepine - Lamotrigine - Gabapentin

Question 30

What are the indications for carbamazepine?

Answer 30

- Mania - Alcohol withdrawal - Prophylaxis of bipolar unresponsive to lithium - Tonic-clonic seizures

Question 31

Which mood stabiliser is a potent CYP450 inducer?

Answer 31

Carbamazepine

Question 32

What is the MoA of carbamazepine?

Answer 32

1) Blocks VGSC = inhibits repetitive neuronal firing 2) Decreases glutamate release 3) Decreases dopamine and NA turnover

Question 33

What are the ADRs of carbamazepine?

Answer 33

- GI disturbances - Dermatitis - Dizzyness - Hyponatraemia - Blood disorders

Question 34

What are the contraindications of carbamazepine?

Answer 34

- AV conduction abnormalities - Acute porphyria - Pregnancy

Question 35

Name the mood stabiliser which is 1st line for epilepsy, but can be used for bipolar:

Answer 35

Lamotrigine

Question 36

Name some ADRs of lamotrigine:

Answer 36

- GI disturbances - Rash - Headache - Tremor

Question 37

What is the 1st line antipsychotic for bipolar?

Answer 37

Quetiapine

Question 38

What are some common side effects of Quetiapine?

Answer 38

- Asthenia - Dysarthria - Dyspnoea - ^ plasma-cholesterol/triglyceride levels - ^ appetite - Irritability - Peripheral oedema - Sleep disorders - antihistamine = sedation

Question 39

Which hormone MUST be monitored while on Quetiapine? - at start - at 6 months - yearly

Answer 39

Prolactin