Affective Disorders Flashcards

Question

light therapy

Answer 1

C25K and parkrun = increases activity while connecting people with others though shared, achievable challenges

Answer 2

individual/groups goal orientated, here and now 8 - 24 weeks behavioural activation first step * next step is to activate behaviours AND thoughts Negative automatic thoughts (NATs): generalisation and minimisation * discussion and behavioural experiments to challege distorted beliefs relapse prevention

Answer 3

over a year or 16-20 weeks transference (past experiecne cause them to behave unconsciously in certain ways) draw from unconscious and articulate and evaluate them

Answer 4

IPT * unresolved loss, role transitions, relationship conflicts, and social skills deficits MBCT * mindful awareness aka notice what happening externally and within mind and body at any particular moment * mindful meditation practce and reduces risk of relaspe in recurrent depressive disorder

Answer 5

psychoeducation support groups exercise, diet, sleep hygiene problem solving for social stressors CMHTs (e.g. home treatment/crisis teams, care coordinators)

Answer 6

50% have second depressive episode recurrence risk increases with each episode average episode lasts 8-9 months, 2-3 months with tx depression w/ psychotic sx worse prognosis but responds better to ECT 15% die by suicide (severe and w/ psychotic sx highest risk)

Answer 7

Hypomania (F30.0) = mood elevated to a degree that is out of character for individual (collateral hx) and sustained for **at least 4 days in a row** (_NOT severe enough for_ disruption of work result in social rejection, _no psychotic features, no require admission_ – mania more severe) * Not as extreme as mania (hypomania -\> moderate mania -\> severe mania) * Has been _at least one other affective episode in the past_ At least 3 of the following present: * Increased activity, restlessness * Increased talkativeness (pressured speech) * Difficulty concentrating, distractibility * Decreased need for sleep (don’t feel tired when wake up from sleep) * Increased sexual energy (may have promiscuity) * Mild spending sprees (often thing they don’t need with money they don’t have) * Increased sociability

Answer 8

Mania = **impaired functioning** (social, occupation), or needs hospitalisation + presence of **psychotic symptoms** ## Footnote **more than a week**

Answer 9

**At least 2 episodes**, _one must be hypomania/mania/mixed_ (other can be depressive) with **complete recovery between 2 episodes** Mania lasts **1w-4m**, depression longer (6 months) **Distributed evenly** between genders First episode \<30 years, peak at 15-19 years Length of time to diagnosis \>10 years as misdiagnosed depression/mania seen as ‘good days’ 50% attempt suicide (half tend to complete) remission = no mood disturbance for last several months

Answer 10

mania core sx: elated/irritable energetic new activities, contacts

Answer 11

**organic** = delirium, intoxication (e.g. amphetamines, cocaine), dementia, frontal lobe damage, cerebral infection (e.g. HIV), myoxedema amdness (hyperactivity in extreme hypothyroidism) **schizoaffective disorder** = psychotic and affective sx evolve simultaneously **emotionally unstable personality disorder** = labile mood and impulsivity can mimic mania, but will be persistent traits, not episodic sx **perinatal disorders** **ADHD** = more persistent and develops earlier

Answer 12

bedside * collateral hx * physical examination bloods * FBC, TFTs, CRP/ESR for infection/autoimmune/thyroid pproblems * HIV tests * urinary drug screen * lumbar puncture radiology * CT/MRI head for intracerebral causes if indicated (e.g. abrupt symptoms, change in consciousness, focal neurological signs)

Answer 13

**Acute mania with agitation** = IM therapy w/ neuroleptic or BDZP (e.g. Lorazepam, aripriprazole). May need urgent admission to a secure unit. **Acute mania without agitation** = anti-psychotic (e.g. olanzapine but alternatives include haloperidol, risperidone and quetiapine) **Acute depression** = SSRIs (e.g. citalopram) Acutely patients may lack insight and will refuse admission to hospital. May need to contact mental health services for them to apply for a section 2. Chronic: * **1st line: Lithium monotherapy** (0.6-1.2 mmol/L) initially, then add other drugs like anti-psychotics (lithium takes 2 weeks to work) * **SSRIs like citalopram in depressive episodes** but caution as can cause mania (add mood stabilisers as cover) * **2nd line: sodium valproate (if lithium fails),** has teratogenic effects particularly in women of childbearing age. _DO NOT start sodium valproate in primary care to treat BPAD_ and not until anti-psychotics have been tried.

Answer 14

stop exacerbating meds (e.g. antidepressants, steroids, dopamine agonists) limit access to drugs and alcohol where possible monitor food and fluid intake to prevent dehydration consider a short course of benzodiazepines/hypnotics start/optiminising mood stabilising medication * SGA or * mood stabiliser or * mood stabiliser plus SGA for severe sx/poor response rarely, considering ECT (e.g. life-threatening overactivity and exhaustion despite medication)

Answer 15

lithium takes 2 weeks to work

Answer 16

electrolyte changes due to low-salt diets, dehydration, diarrhoea, and vomiting drugs interfering with lithium excretion (e.g. NSAIDs, thiazide diuretics, ACE inhibitors) overdose

Answer 17

_stop lithium_ and _transfer for medical care_ (rehydration, dialysis) **Mild-moderate:** resuscitation with 0.9% IV normal saline **Severe:** haemodialysis for severe lithium toxicity (\>2 mmol/L) if neuro symptoms or renal failure are present

Answer 18

coarse tremor (fine tremor in therapeutic levels), hyperreflexia, acute confusion, polyuria, seizure, coma

Answer 19

slowly and cautiously if symptom-free for a sustained period

Answer 20

identify relapse indicators (early warning indicators) = insomnia, increased energy relapse prevention strategies: * daily routine * sleep hygiene * healthy lifestyle * limiting excessive stimulation/stress * addressing substance misuse * medication changes

Answer 21

reduces relapse frequency and duration and number of inpatient admissions informs wellness recovery action plan (WRAP) = to identify triggers and relapse indicators, agreeing a mx plan for future episodes

Answer 22

family therapy IPSRT = IPT + stbailsiing sleeping, waking, eating and exercise times support biological rhythms which regulat mood BiPolar UK support group share WRAP to OH staff as stress levels, travel and unsocial hours may affect recovery

Answer 23

don't say 'i know how you feel' avoid platitudes don't give quick fixes don't say ot's OK don't fear the tear slow down have hope 'there are lots of effective tx to help you get better' 'it's really common to feelhopeless when you're depressed; as you recover that will change'

Answer 24

mood * how have you been feeling recently? * more anxious/snappy? * which bit of the day feels the worse/do you dread the most? anergia * how are your energy levels at the moment? * how's it affecting you? (screen work/studies/childcare etc.) anhedonia * can you enjoy things like you used to?

Answer 25

worthlessness * how do you see yourself as a person? * can you think of anything you are proud of? * how would you compare yourself to other people? guilt * **why** do you think you've had a hard time recently? * do you **blame yourself f**or these problems? * do you worry that you've **let people down**? helplessness * **what do you think would help?** * what about your family, friends, or the doctors, do you think they would help? hopelessness * how do you see the **future?** * is it ever so bad **you feel life isn't worth living?**

Answer 26

sleep * how's your sleep been lately? * which part of the night is the problem? * how does that affect your energy levels? appetite * what's your appetite been like recently? * has your weight changes? how much roughly? * clothes baggy or tight? * can you be bothered or find the energy to cook for yourself? libido * when people feel low, they can lose their sex drive. has that been a pproblem for you?

Answer 27

hallucinations * have you seen or heard anything recently that seemed strange or frightening? * do people talk to you? delusions * are you worried that people have turned against you? * do you worry you've done anything unforgiveable? * is your body working properly? is any part failing, dying or rotting? risk * have you felt so bad, you wanted to harm yourself in some way? * are you eating and drinking enough? * are you looking after yourself? washing, dressing, cleaning? * have you had any thoughts of suicide?

Answer 28

Closed question, echo, summary, redirection, comment on behaviour avoid mirroring point out inappropriate behvaiour, saying why -\> warn you have to end interview if behaviour continues -\> leave * that's not OK, I'm here to talk to you, if you do it again, we'll stop the the interview, you're making me feel uncomfortable, we can talk another time, thank you

Answer 29

Mood, energy, interest cognitive * self worth = how do you seee youself as a person? * optimism/hope = you seem such a positive person. Where do you see yourself in a month/year? * concentration/thoughts = how's your concentration? you have so many ideas, where do they come from? Biological * sleep = how's your sleep been lately? * libido = have you noticed any changes in your sex drive? Psychotic * do you pick on things other people can't see or hear? * talents/powers, mission/special purpose, people jealous of you? Risk/impulsivity * done anything you wouldn't usualluy do * any trouble recently * have you had moments of wanting to harm or kill yourself?

Answer 30

look at notes gain team member's views contact GP for background, including psych history and how he's been coping prior to admission check causes of delirium: ix results stool chart (constipation?), drug chart (recent changes, anticholinergic medications)

Answer 31

pros and cons of moving to nursing home bereavement = empathy, normalisation, recruitment of family/friends/faith leaders. Call them if they don't know pt is in hospital * bereavements support from social support and counselling delirum = ix fully and tx underlying medical cause(s) * dementia only diagnosed after delirium is treated and with a clear history of decline * contact liason psychiatry (mental health team in the hospital) to further assess dementia and advise on ongoing mx depression mild/moderate * appropriate blood test * depression rating scale * psych therapy * consider cardiac saftery before starting antidepressants * OH assessment on functional ability -\> inform RA and POC * follow-up by GP or an older adult CMHT depending on response to treatment depression severe * specialist review and mx by liason psychiatry. They may recommend admission to a psychiatric ward

Answer 32

Do not routinely consider medication unless: * past hx of moderate or severe depression * sx's have been present for a long time (\>2 years) * symptoms persist despite other interventions * NOTE: **do NOT** recommend St. John's wort but warn patients about uncertainty in dosing and drug interactions

Answer 33

Stopping Antidepressants: should be done over a period of 4 weeks

Answer 34

Explanation = persistently low mood that impacts on day to day functioning * very common (each year, 1 in 4 people suffer a mental health problem) address social needs explain the role of psychological therapy (CBT - talking therapy based on the principle that thoughts, mood and behaviour are intertwined) explain the role of medication (takes a number of weeks to work, follow-up in 1 or 2 weeks, warn about side-effects) advise about the crisis resolution and home treatment team support = mind.co.uk, samaritans

Answer 35

Mood stabiliser * even out extreme highs of mania and profound lows of dpression * more effective against mania * lithium, sodium valproate, carbamazepine Lithium * 0.6 - 1.0 mmol/L * toxic 1.2 + * check levels 1 week after starting/changing dose and monitor weekly until steady therapeutic level achieved * monitored every 3 months from then on * U+Es and LFTs monitored every 6 months (can cause renal impairment and hypothyroidism)

Answer 36

Mood stabilisers are **teratogenic** Risk of harm should be weighed against harm of manic relapse * Lithium - Ebstein's anomaly * Valproate + carbamazepine - spina bifida **Women of childbearing age** should be given contraceptive advice and prescribed a **_folate supplement**_ _**if using valproate_** **Closely monitor the foetus** if medications are used in pregnancy

Answer 37

antipsychotics * olanzapine * usually atypical (e.g. olanzapine, risperidone, quetiapine) as fewer side effects * typical (chlorpromazine, haloperidol) anticonvulsants * lamotrigine is 2nd line for prophylaxis in BPAD type II

Answer 38

**Stop all medications that may induce symptoms** (e.g.anti-depressants, drugs of abuse, steroids and dopamine agonists) **Monitor food and fluid intake** to prevent dehydration If treatment free: * Give an _antipsychotic_ and a _short course of benzodiazipines_ (diazepam, lorazepam) If already on treatment * Optimise the medication * Check compliance * Adjust doses * Consider adding another agent (e.g. antipsychotic as well as mood stabiliser) * Short-term benzodiazepines may help ECT may be used if patients are unresponsive to medication

Answer 39

**mood stabilisers** are the main stay other drugs may be added when sx arise or when facing stress that could precipitate relapse (e.g. antipsychotics or benzodiazepines) _depression in BPAD_ * diffcult as antidepressents can cause a switch to mania * SO, antidepressants given with **mood stabiliser or antipsychotic** * **1st line** = fluoxetine + olanzepine/quatiapine * **2nd line** = lamotrigine * monitor closely for signs of mania and immediately stop antidperessants if signs are present * medications can be cautiously withdrawn if patient is symptom-free for a sustained period

Answer 40

consider admission and section if at risk explain diagnosis = condition where patients have a tendency to experience the extremes of emotion for variable lengths of time explain importance of controlling it = both extremes can lead to making certain decisions and taking risks that you would otherwise regret explain that there are medications available (helps balance the chemicals in the brain) advise about crisis resolution team and Samaritans

Answer 41

self neglect risk of suicide/self-harm risk to others poor social support psychotic symptoms lack of insight tx resistant depression

Answer 42

RFs: female, young age Co-morbidities: higher rates of anxiety, somatisation disorder, alcohol/drug misuse Clinical features: * low mood but no anhedonia * extreme fatigue * reversed diurnal variation in mood * **hypersomnia:** excessive sleeping (10+ hours a day, at least 3 days a week, for at least three months) * **hyrerphagia:** excessive eating w/ weight gain (\>3kgs in 3 months) * interpersonal rejection sensitivity * **leaden paralysis:** feelings of heaviness in limbs (1hr/day, 3days/week, at least months)

Answer 43

Chronic low grade depressive 5% UK, more in females Clinical features: * Depressed mood (\>2 years) * reduced energy and fatigue * appetite increased/reduced * insomnia/hypersomnia * low self esteem * poor concentration * difficulty making decisions * thoughts of hopelessness less severe than depression, more chronic course, low remission ate, on average may last 5 years

Answer 44

low mood with change in season (sunlight hits pineal gland → decreases melatonin synthesis → increased 5HT synthesis) increased appetite including ‘carbohydrate craving’ mx: * simple measures = light therapy (specialised SAD lights) * pharmacological = antidepressants (SSRIs), propanolol

Answer 45

functional impairment 4 days vs 7 days

Answer 46

secondary to a physical cause * organic brain damage (especially right hemisphere), more common in elderly * medication: L-Dopa and corticosteroids * illicit drugs: stimulant or other street drugs induced mania, if mood state significantly outlasts the drugged state then a diagnosis of BPD can be made * Hyperthyroidism: hypomanic, agitated depressed

Answer 47

2% (1.5% if general population)

Answer 48

**Common side effects:** headache, GI (nausea, diarrhoea/constipation), sleep distrubance/vivid dreams, sexual dysfunction, hyponatraemia, GI bleeding **Serotonin syndrome:** common but potentially lethal in 0.1% patients treated; psychological sx, neurological sx including myoclonus and autonomic sx. **Discontinuation syndrome:** especially with SSRIs with short half life e.g. paroxetine. Experience ‘flu-like’ sx, ‘electric shocks’, trouble sleeping, GI effects, anxiety. **Suicidality:** potential association (small evidence in adolescence) but every patient should be warned, given safe netting advice and be reviewed regularly. **Duration:** once well its recommended at the same dose for _6 months_ and for _2 years_ for those at greater risk of relapse e.g. multiple recent episodes or significant history

Answer 49

SAD Depression 2o to hypothyroidism Atypical depression Dysthymia BPAD Type 1

Answer 50

BPAD = FHx Depression = gender + ethnicity

Answer 51

BPAD Type 2 hypomania episode

Affective Disorders Flashcards

(92 cards)