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Psychiatry > Mood disorders > Flashcards

Mood disorders Flashcards

0
Q

Depression lifetime risk and male:female

A

About 17 %, 1:2

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1
Q

Mood disorder course is generally…

A

Relapsing and remitting

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2
Q

Bipolar affective disorder lifetime risk and male:female

A

About 3%, 1:1

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3
Q

BPAD and depression genetic link

A

Depressed relatives => increased risk depression

Bipolar relatives => increased risk bipolar AND depression

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4
Q

Childhood experiences associated with later depression

A

Early childhood abuse
Relentless criticism
Parental loss
Perceived lack of affectio

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5
Q

Vulnerability factors for depression in adults

A 
Unemployment
Lack of confiding relationship
Lower socioeconomic status
Social isolation
Women - at home with 3+ children

These decrease resilience to adverse situations.

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6
Q

Life events related to depression

A

Death of spouse, divorce, separation, jail, death or relative

Risk of depression increases 6 fold in 6 months following events

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7
Q

Life events precipitating mania

A

Can be negative or positive

Triggers get less important over time

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8
Q

Manic episodes can be triggered by…

A

Puerperium
Sleep deprivation
Flying across time zones

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9
Q

Physical illnesses which directly cause depression …

A 
Cushiness syndrome
Hypothyroidism
Stroke
Parkinson's disease
Multiple Sclerosis
Hyperparathyroidism
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10
Q

Pharmacological causes of depression

A

Beta-blockers
Anti hypertensives
Stimulants (eg cocaine)

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11
Q

Physical causes of mania

A

Cushing’s syndrome
Head injury
Multiple sclerosis
Steroids, antidepressants, stumulant

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12
Q

Learned helplessness model of depression

A

Seligman’s studies
Dogs given unavoidable electric shocks gave up trying to escape
Even when conditions were changed
Depressed people ‘learn’ they can’t change their situation

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13
Q

Psychoanalytical theories of depression

A

Early experience and relationships determine risk

Mental states as ‘internal drama’

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14
Q

Monoamine theory of depression - deficiency in…

A

Noradrenaline
Serotonin (5-HT)
Dopamine

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15
Q

Noradrenaline affects

A

Mood and energy

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16
Q

Serotonin affects

A

Sleep, appetite, energy, mood

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17
Q

Dopamine affects

A

Psychomotor activity

18
Q

Findings in depression (monoamines)

A

Decreased plasma tryptophan (5-HT precursor)
Decreased CSF 5-HIAA (5-HT metabolite) in suicide victims
Decreased CSF dopamine metabolite

Suggesting monoamines deficiency in depression

19
Q

Reserpine…

A

Depletes monoamines

Can cause depression

20
Q

Mania and monoamines

A

May be related to dopamine overactivity
Amphetamine, cocaine increase DA, can induce mania
Antipsychotics - DAr antagonists - can treat mani

21
Q

Cortisol and mental health

A

May mediate between stressful life events and biological changes in depression
? Via damaging hippocampal neurons?
Failure of cortisol suppression in depression, mania, schizophrenia, old age

22
Q

Diagnosis of depression

A

Two core symptoms

Two weeks

23
Q

Core symptoms of depression

A

Low mood
Anergia
Anhedonia

24
Q

Cognitive symptoms of depression

A

Worthless, useless, guilty, hopeless, pessimistic, poor concentration, memory impairment can resemble dementia

25
Q

Biological symptoms depression

A 
Initial insomnia
Early morning waking
Decreased appetite for food and sex
Diurnal - worse in morning
Psychomotor retardation
Physical symptoms = aches, pains
26
Q

Psychotic symptoms

A

Very severe depression
Auditory hallucinations - degoratory voices
Rare visual hallucinations eg evil spirits
Nihilistic delusions
Persecutory delusions ‘deserve’ persecution/punishment

27
Q

Depression grading

A

Mild, moderate, severe, severe with psychotic symptoms

28
Q

Seasonal Affective Disorder

A

Low mood in winter
Often reversed biological symptoms
Overeating, oversleeping

29
Q

Atypical depression

A

Reversed biological symptoms

May retain mood reactivity

30
Q

Agitated depression

A

Depression with psychomotor agitation, not retardation

Restlessness, pacing

31
Q

Depressive stupor

A

Psychomotor retardation so profound that become, mute. No eating, drinking, moving

32
Q

DD - Physical causes (depression)

A

Hypothyroidism, head injury, cancer, ‘quiet’ delirium

33
Q

DD - Adjustment disorder

A

Mild affective symptoms following life event

Not enough to diagnose depression

34
Q

DD - bereavement

A

Normal response to loss

Abnormal if v.intense, prolonged (>6 months) or delayed

35
Q

Substance misuse and depression

A

Alcohol / drugs may be a form of self medication or cause depression

36
Q

Dementia - differential

A

Dementia can begin with affective changes

Or - depression can effect memory = pseudo-dementia

37
Q

Investigations - depression

A

Collateral history
Physical examination
Blood tests - TFT, FBC, HbA1c (diabetes and anaemia cause fatigue)
CT / MRI NOT routine, use if suspected head injury
Rating scales for monitoring

38
Q

Psychological treatment in depression

A

First step to treat mild depression
Ideally involved in moderate and severe also
CBT, psychodynamic therapy, interpersonal therapy

39
Q

Cognitive Behavioural Therapy

A

Help patient notice negative automatic thoughts (NATs)
Which result in poor mood/behaviour
Thought, mood, behaviour are mutually reinforcing
Target thoughts and behaviour, so knock on effect on mood

40
Q

CBT in depression

A

Worthlessness belief effects behaviour and mood eg withdrawal
Challenge NATs, expose to positive activities
Made aware of common thinking errors
Build more realistic belief set

41
Q

Psychodynamic psychotherapy

A

Patient transfers beliefs etc onto relationship with therapist
Eg ‘I will be rejected’
Put words to these feelings so pt can recognise and challenge hidden beliefs

42
Q

Electro convulsive therapy in depression

A

Acts fast - severe / psychotic depression
Anaesthetised, generalised tonic-clinic seizure
Can be some memory loss

43
Q

Depression prognosis

A

About 50% will have another episode
Episodes last 8-9 months
Treatment can decrease this to 2-3 months
Psychotic depression poorer prognosis, ECT helps
Up to 15% with major depression take their own lives

Psychiatry (18 decks)

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