Abnormal mood Flashcards
(128 cards)
1
Q
what is adjustment disorder
A
getting over a significant life event (may present similar to depression but not depression)
2
Q
how long does adjustment disorder last
A
<1 month from event
3
Q
50% of mental health disorders start before the age of
A
14
4
Q
50% of mood disorders start before the age of
A
30
5
Q
risk factors for depression
A
significant life events - loss of primary caregiver <11yo
chronic illness - eg cancer, diabetes, stroke
6
Q
typical age of onset of depression
A
10-20yo
7
Q
what age does late onset depression occur in
what is it associated with
A
> 60yo
loneliness
8
Q
are men or women more likely to get depression
A
women
9
Q
which pathways are decreased in depression (2)
A
serotonin pathway
noradrenaline pathway
10
Q
what is the neurotransmitter in the serotonin pathway that is decreased in depression
A
5-hydroxytrytamine (5-HT)
11
Q
what part of the brain does the serotonin pathway innervate (and hence is less stimulated in depression)
A
amygdala
12
Q
what chemical normally recycles serotonin and noradrenaline (and is hence a target for treatment of depression)
A
monoamine oxidase (MAO)
13
Q
how do monoamine oxidase inhibitors (MAOi) work
A
decrease how much serotonin ad noradrenaline are recycled = increase conc of them = decrease depressive symptoms
14
Q
what 2 (main) endocrine changes happen in depression
A
increased cortisol
large adrenal glands
15
Q
what happens to hippocampal volume in depression
A
decreases
16
Q
presentation of depression (things you must ask!)
A
sleep disturbance = tiredness suicidal ideation loss of appetite = weight loss amotivation - housebound? anhedonia - loss of enjoyment in things previously enjoyable lack of concentration irritable psychomotor retardation - slowing of thoughts/movements
ask about delusions for ?psychosis
ask about manic symptoms for ?bipolar
17
Q
what is initial insomnia
A
when you cant get to sleep for hours
18
Q
what is middle/interrupting insomnia
A
when you wake in the middle of the night and cant get back to sleep
19
Q
what is late insomnia
A
when you wake up several hours earlier than normal and cant get back to sleep
20
Q
when is depression typically worse (what time of day)
A
worse in morning, better as day goes on
diurnal variation
21
Q
what is loss of pleasure/joy in things previously enjoyable called
associated with depression
A
anhedonia
22
Q
what is psychomotor retardation
associated with depression
A
slowing of thoughts/movements
23
Q
what is it called when someone has depressive delusions (of worhlessness etc), 2nd person hallucinations (people telling them theyre useless), nilhistic delusions (walking corpse)
A
psychotic depression
24
Q
what is a nilhilistic delusion
what syndrome is this characteristic of
A
the idea that their body is dying
that they are a walking corpse
coharts syndrome - in the elderly, rare
25
social history questions to ask in ?depression
```
finances
people at home (esp if suicidal)
sexual function
upbringing
recent traumatic event/change
```
26
describe the mental state examination (MSE) findings likely in someone with depression
appearance - disheveled, furrowed brow, reduced facial expression
behavior - difficult rapport, reduced eye contact
speech - slow, low, quiet, monotonous, unresponsive to Qs
emotion - low, depressed, flat, tearful, 'empty'
perception - probs none
thoughts - normal form, slow/absent, negative content, pessimism, guilt, suicide
insight - usually yes, sometimes blame other things
cognition - slow, poor memory
27
walking corpse
| elderly person
coharts syndrome
28
how long does depressive symptoms need to be present for diagnosis
what are the other 2 core symptoms included in diagnosis
>2 weeks
loss of interest/pleasure
decreased energy
29
what must you rule out before you give antidepressants in ?depression
bipolar
30
mild depression criteria
2/3 core symptoms
| 2/7 additional symptoms
31
moderate depression criteria
2/3 core symptoms
| 4/7 additional symptoms
32
severe depression criteria
3/3 core symptoms
| 5/7 additional symptoms (suicidal ideation = severe)
33
treatment of mild depression
```
NOT anti depressants
exercise!!
hobbies, socializing
improve sleep
time off work
online CBT
```
34
treatment of moderate depression
SSRI (antidepressant) and CBT
35
after how long could you consider anti depressants for mild depression
>8 weeks
36
treatment of severe depression
psych referral
ECT
?detention
37
how long should you continue an antidepressant for once its started working (if first episode)
6-12 months after started working
38
how long should you continue an antidepressant for once its started working (if second episode)
12-24 months after started working
39
how long should you continue an antidepressant for once its started working (if third episode)
indefinitely - patient decides but recommend to continue low dose
be aware of side effects
patient probs will want to be on it
40
if after 6 weeks antidepressant isnt working, what do you do
increase dose
41
if increased dose of antidepressant isn't working what do you do
change drug
42
first line antidepressant for depression
SSRIs
43
second line antidepressant for depression
diff SSRI
44
first line SSRI choice for depression
citalopram
45
indication for fluoxetine for depression (as first line)
<18yo
46
SSRIs used for depression (4)
citalopram
sertraline
paroxetine
fluoxetine
47
indication for sertraline for depression (first line)
cardiac problems
48
what do you do if citalopram is ineffective
try diff SSRI - fluoxetine, paroxetine, sertraline
49
what do you need to monitor if you give citalopram
ECG for QT prolongation
50
if someone on antidepressants starts feeling better and just stops medication then starts getting headaches, sweaty, needle like sensation in head and anxiety, what has happened
discontinuation syndrome (bc stopped taking drug)
51
SNRI example
venlafaxine
52
when are SNRIs used in depression
fourth line
after
SSRI
diff SSRI
SSRI + mirtazapine
53
indication for mirtazapine in depression
insomnia
poor appetite
bc SEs are weight gain and sedation
54
what is bad about SNRIs (venlafaxine)
SEs are worse than SSRIs
55
alternative antidepressant options after SSRI/diff SSRI/mirtazepine/SNRI
tricyclics (TCAs)
monoamine oxidase inhibitors (MAOi)
lithium carbonate - last line
56
alternative to antidepressants in severe depression
ECT (electroconvulsive therapy)
57
indications for ECT (electroconvulsive therapy) in severe depression
suicide risk
not eating
patients choice - past good experience from it
58
how many treatments are involved in ECT therapy for severe depression
over what time
9 treatments
2 per week
lasts 4.5 weeks
59
alternative to antidepressants in someone that doesn't want to take drugs (eg side effects), or childhood abuse
mild/moderate depression
CBT
| psychoeducation
60
which herbal remedy do people take for depression but you should discourage (hence ask if theyre taking it)
st johns wort (hypericum perforatum)
61
side effects of CBT
headache
tooth damage (given block)
memory/cognitive problems
62
does bipolar or depression have a higher suicide risk
why
bipolar
bc the change between mania and depression (the highs and lows) is so drastic
63
psychotic symptoms after birth
puerperal psychosis
note diff from post natal depression
64
how many people get post natal depression
how many people et postnatal blues
10%
75%
= important to differentiate
65
how long does post natal depression usually last
1-4 weeks after birth
66
how long does baby blues usually last `
3-10days after birth
67
differences in treatment of baby blues and post natal depression
baby blues - reassurance
| post natal depression - counselling (mild), antidepressants and CBT (moderate), mother baby unit admission (severe)
68
what medication can trigger bipolar disorder
SSRIs
69
what causes bipolar disorder
multifactorial - genetic and environmental
70
bipolar I
mania and depression
71
bipolar II
hypomania and depression
72
cyclothymia
mild bipolar
| cycling of mood lots of times per day
73
mixed affective disorder
major depressive episodes and mania/hypomania at same time/during same day
74
do people with bipolar usually have insight
nah
75
hypomania vs mania
| which is abnormal for the individual but DOESNT interfere with their normal function
hypomania
76
MSE findings for mania
appearance - bright colours
behavior - inappropriate, reckless, loss of normal inhibitions
speech - pressured, uninterruptable, puns ,rhyming
emotion - elated, irritable
perception - probs no hallucinations, maybe delusions
thoughts - increased flow, tangential, flight of ideas (NOT knights move), grandiosity
insight - probs nah
cognition - ? depends robs don't know
77
differences between mania and hypomania (5)
mania has; (hypomania doesn't)
```
psychosis
flight of ideas
grandiosity
interferes with their normal function
requires hospitalisation
```
78
what must you ALWAYS ask in bipolar
suicidal ideation
79
what is speech like in MSE of mania
uninterruptable
use of puns (words with same sounds)
use of rhymes
80
if you ?mania as part of bipolar, what endocrine condition do you need to rule out
hypo/hyperthyroidism
81
what drugs do you need to stop ASAP if diagnosis of bipolar
why
antidepressants
can cause a manic episode - dangerous!
82
what is the only exception to not giving antidepressants in bipolar
bipolar depression
give fluoxetine (SSRI) with antipsychotic SHORT TERM, alongside antipsychotic (not alone
83
first line class of antipsychotics for bipolar
atypical second generation antipsychotics
84
second line class of antipsychotics for bipolar
typical first generation antipsychotics
85
example of first line antipsychotic for bipolar (atypical second generation antipsychotics )
olanzepine
quetiapine
risperidone
86
example of second line antipsychotic for bipolar (typical first generation antipsychotics )
haloperidol
87
side effects of atypical second generation antipsychotics (eg olanzepine) (3)
weight gain
sedation
prolonged QT syndrome
88
side effects of typical first generation antipsychotics (eg haloperidol)
extra pyramidal side effects (EPSE)
89
how do you treat extra pyramidal side effects (EPSE) if the occur when taking haloperidol
procyclidine
90
last line antipsychotic for bipolar (after olanzepine and haloperidol)
clozapine
91
if antipyschotics (olanzepine, haloperidol then clozapine) are ineffective then what would you add on
who needs to do this
lithium carbonate
psychiatrist, not GP
92
what must you do if you start someone on lithium
check lithium levels regularly
93
what is the gold standard long term treatment for bipolar
lithium
94
side effects of lithium
hypothyroidism (need to check TFTs)
dry mouth, salty taste
diabetes - polydipsia, polyuria
tremor
95
alternative to lithium if antipsychotics alone are ineffective in bipolar
sodium valproate
96
non drug treatments of bipolar
ECT - ?hospitalization
| CBT
97
how long do antidepressants take to work
weeks-months - warn patients!
98
how long should you trial an antidepressant for before changing it
6 months
99
are antidepressants addictive
no
this is sometimes why people aren't keen, just reassure them
100
how do SSRIs work
selective serotonin reuptake inhibitors = increases conc of serotonin at synaptic cleft = decreases depressive symptoms
101
SSRI examples (4)
fluoxetine
citalopram
sertraline
paroxetine
102
which SSRI is first line (for anything)
citalopram
103
side effect of citalopram
long QT syndrome
104
what do you use in patients with cardiac problems instead of citalopram (as causes long QT)
sertraline
105
side effects of SSRIs
nausea
headache
worsened anxiety
sexual dysfunction
106
what happens if you just stop taking a SSRI all of a sudden
discontinuation syndrome = need to warn patient not to!
107
which age group shouldn't get SSRIs
why
<25s
increases risk of suicide
108
how do SNRIs work
selective noradrenaline reuptake inhibitors = increases conc of noradrenaline at synaptic cleft = decreases depressive symptoms
109
SNRI examples (2)
duloxetine, venlafaxine
110
why aren't SNRIs used much
side effects worse than SSRIs eg insomnia (need to take it in the morning)
111
how do tricyclics (TCAs) work
prevent reuptake of serotonin and noradrenaline = increase conc and presynaptic terminal = decreases depressive symptoms
112
are TCAs used much
why
no
side effects not great - dry mouth, falls, cognitive impairment, postural hypotension
but good as an antidepressant if willing to tolerate SEs
113
tricyclic examples (3)
imipramine
amitriptyline
clomipramine
114
which group of people are contraindicated tricyclics (if you give must be low dose)
why
elderly
increased risk of falls and cognitive impairment
115
if someone has ?dementia and is on amitriptyline (tricyclic) what should you do
take them off amitriptyline to see if it resolves
116
which antidepressants are monoamine reuptake inhibitors
SSRIs
SNRIs
tricyclics
117
which antidepressants aren't monoamine reuptake inhibitors
monoamine oxidase inhibitors (MAOi)
118
example of monoamine oxidase inhibitors (MAOi)
phenelzine
| moclobemide
119
how do monoamine oxidase inhibitors work (MAOi)
monoamine oxidase usually breaks down serotonin and noradrenaline
so MAOi = stops break down happening = increases conc of serotonin and noradrenaline = decreases depressive symptoms
120
side effects of monoamine oxidase inhibitors (MAOi) (3)
hypertensive crisis
postural hypotension
insomnia
121
what do you need to avoid if you are taking a monoamine oxidase inhibitor
what foods contain this (5)
what can it cause if you don't avoid these foods
tyrosine
avoid; red wine, cheese, yeast products, gravy, caffiene
= HYPERTENSIVE CRISIS
122
when are MOAi used in depression
last line, in SSRI/SNRI/tricyclic resistant depression
123
why isn't MOAi (monoamine oxidase inhibitors) used earlier on in treatment pathway for depression if they are better than the other antidepressants
hard compliance! need to avoid red wine, cheese, yeast etc
needs to carry a MAOi card
restrictions with medication also
124
which antidepressant drug isn't a monoamine oxidase inhibitor, SSRI, SNRI or tricyclic (hence is an atypical antidepressant)
mirtazapine
125
how does mirtazapine work
blocks alpha2, 5-HT2, 5-HT3
126
side effects of mirtazapine
weight gain
| sedation (may be good)
127
when would you use mirtazapine in depression
alongside SSRI/SNRI
128
amitriptyline mechanism
inhibits monoamine reuptake in presynaptic membrane
