Affective Disorders Flashcards

Question

Psychological factors which may increase the risk of depression?

Answer 1

Traumatic life events/childhood experiences: adverse experiences including loss of a loved one, lack of parental care and childhood sexual abuse Environmental factors (e.g. support) Low self-esteem and negative automated thoughts (e.g. helplessness, hopelessness, worthlessness) Lack of education

Answer 2

Poor social support Poor economic status or support Marital status: separated or divorced

Answer 3

Thyroid function Full blood count B12 Metabolic panel Neuro imaging

Answer 4

Severe depressive episodes that are life threatening or require rapid response

Answer 5

Risk to self: self-harm, suicide or neglect (commonest in depression) Risk to others: when depression presents with psychotic features, such as command hallucinations, they may be at risk of harming others Risk from others: patients with depressive symptoms may be more vulnerable to abuse, criminal acts or neglect

Answer 6

Past history of moderate or severe depression Presence of mild depression that has been present for at least 2 years Presence of mild depressive symptoms after other interventions Patient preference

Answer 7

Risk assessment Review their response to high-intensity psychosocial intervention compliance and symptoms Review their response to antidepressant therapy, compliance, side effects and adjust doses if appropriate Measurement scales to assess response to treatment and quality of life Relapse prevention plan Assess social support and previous issues flagged up during the consultation

Answer 8

Suicide: the risk of suicide in patients with depression is four times higher than in patients without depression Substance misuse and alcohol use problems: patients are at increased risk of becoming dependent on substances Persistent symptoms: 10-20% of patients will have persistent symptoms over 2 years Recurrence of depressive episodes: most patients have a recurrence in later life Reduced quality of life: patients may struggle with employment and relationships Antidepressant side effects: may include sexual dysfunction, risk of self-harm, weight gain, hyponatraemia and agitation

Answer 9

Mood/affective disorder characterised by episodes o depression and mania or hypomania

Answer 10

Bimodal distribution peaking around age of onset at 15-24 years and 45-54yeata Roughly equal distribution of prevalence between men and women

Answer 11

Invokes genetic environmental and neurobiological components Heritable within families but genetics not only determine factor

Answer 12

First-degree relatives of a person affected with bipolar disorder are at increased risk of developing bipolar and unipolar mood disorders and schizoaffective disorder The genetic risk associated with bipolar disorder is a type of polygenic inheritance (the sum effect of many low-penetrance mutations). Some polymorphisms in genes that code for monoamine transporters and brain-derived neurotrophic factor (BDNF) are associated Evidence suggests there is an overlap in the genetic risk between bipolar disorder and schizophrenia.3 Genetic contributions may also be associated with copy number variants and gene-gene interactions

Answer 13

Negative life events can precipitate depressive or manic episodes potentially mediated in circadian rhythms disruptions in genetically predisposed individuals

Answer 14

There is some evidence that increased dopamine activity in the brain may be important in the aetiology of mania, particularly since many drugs that increase dopaminergic signalling in the central nervous system can be associated with symptoms characteristic of mania such as elevated mood, reduced need for sleep and reduction in social inhibitions The presentation of psychosis in bipolar disorder suggests there may be region-specific increases in dopaminergic neurotransmission, though not necessarily a global increase in dopamine signalling. Similar to unipolar depression, there are disturbances of the hypothalamic-pituitary-adrenal axis resulting in increased cortisol secretion. Administration of exogenous corticosteroids can also result in symptoms of mania

Answer 15

Genetic factors: combined effect of many single nucleotide polymorphisms (SNPs) Prenatal exposure to Toxoplasma gondii (the parasite that causes toxoplasmosis) Premature birth <32 weeks gestation Childhood maltreatment Postpartum period Cannabis use

Answer 16

A disorder of persistent instability of mood involving numerous periods of depression and mild elation, none of which are sufficiently severe or prolonged to justify a diagnosis of bipolar affective disorder or recurrent depressive disorder Early onset Chronic course Common in relatives of BPD

Answer 17

In bipolar I, the person has experienced at least one episode of mania In bipolar II, the person has experienced at least one episode of hypomania, but never an episode of mania. They must have also experienced at least one episode of major depression.

Answer 18

Elevated mood out of keeping with the patient’s circumstances Elation accompanied by increased energy resulting in overactivity, pressure of speech, and a decreased need for sleep Inability to maintain attention, often with marked distractibility Self-esteem which is often inflated with grandiosity and increased confidence Loss of normal social inhibitions

Answer 19

For a diagnosis, the manic episode should last for at least seven days and have a significant negative functional effect on work and social activities. Mood changes should be accompanied by an increase in energy and several of the other symptoms mentioned in the ICD-10

Answer 20

Elevated mood Increased activity level Grandiose ideas of self importance

Answer 21

Mania can also occur alongside psychotic symptoms such as delusions and hallucinations, which are often auditory.8 Psychotic symptoms are mood-congruent in bipolar disorder, so therefore grandiose in nature. Flight of ideas and thought disorder may also be present.

Answer 22

Hypomania is less severe than mania and is characterised by an elevation of mood to a lesser extent than that seen in mania. Although hypomania does involve some extent of functional impairment, this is lesser than that seen in mania and is not severe enough to cause the more marked impairment in occupational or social activities

Answer 23

Persistent, mild elevation of mood Increased energy and activity, usually with marked feelings of wellbeing Increased sociability, talkativeness, over-familiarly, increased sexual energy and a decreased need for sleep (but not to the extent that there is a significant negative effect on functioning regarding work or social activities) Irritability may be present Absence of psychotic features (delusions or hallucinations) For a diagnosis, more than one of these features should be present for at least several days.

Answer 24

Schizophrenia (both can have delusions and hallucinations) Organic brain disorder (frontal lobe pathologies) Drug use (psychotropic drugs, steroids can cause elation) Recurrent depression BPD (affective instability can present similarly to rapid cycling bipolar disorder) Cyclothymia (chronic mood disturbance with both depressive and hypomania periods)

Answer 25

Delusions and hallucinations can occur in both bipolar disorder and schizophrenia. In bipolar disorder, these are mood congruent and so tend to be grandiose In schizophrenia, they tend to be more bizarre and difficult to understand. Where features of schizophrenia and bipolar disorder are present in a roughly equal proportion, the diagnosis of schizoaffective disorder should be considered

Answer 26

BPD is characterised by affective instability which can present similarly to rapid cycling bipolar disorder. However, mood changes tend to occur more quickly in BPD/EUPD. Other features of mania such as grandiose ideas and a marked increase in energy are generally not seen in EUPD

Answer 27

Mixture of both manic, hypomania and depressive features Changing between states multiple times a day

Answer 28

Mania: symptoms should have lasted for at least seven days Hypomania: symptoms should have lasted for at least four days Depression (characterised by low mood, loss of interest or pleasure, and low energy) with a history of manic or hypomanic episodes

Answer 29

In an acute episode of mania, people with a new diagnosis of bipolar disorder should be managed in secondary care with a trial of oral antipsychotics:11 Haloperidol Olanzapine Quetiapine Risperidone If the patient is on antidepressant medication, this should be tapered off and discontinued. Benzodiazepines may be used as an adjunct to manage symptoms of increased activity and allow for better sleep

Answer 30

The recommended pharmacological options for managing depressive episodes in the context of bipolar disorder are: Fluoxetine + olanzapine Quetiapine alone Olanzapine alone Lamotrigine alone As well as these pharmacological options, psychological interventions such as cognitive behaviour therapy (CBT) may also be useful.11

Answer 31

Mood stabilisation with lithium If not effective can use sodium valproate (if pt not woman of child bearing age (unless pregnancy prevention plan)) Structures psychotherapies such as CBT or family focused therapies

Answer 32

Significant reduction in risk of relapse with a manic episode Significant reduction in death by sucked Around half of patients will show a good response to lithium, although those with rapid-cycling bipolar disorder, mixed affective states or mood-incongruent features of psychosis may be less likely to respond well

Answer 33

Increased risk of death by suicide Increased risk of death by general medical conditions such as cardiovascular disease Side effects of antipsychotic drugs: these can include metabolic effects, weight gain and extrapyramidal symptoms Socioeconomic effects: major mental illness is associated with a negative drift down the socioeconomic ladder

Answer 34

Common to both: mood - predominantly elevated, irritable speech and thought - pressured, flight of ideas, poor attention Features such as the length of symptoms, severity and presence of psychotic symptoms (e.g. delusions of grandeur, auditory hallucinations) helps differentiates mania from hypomania behaviour - insomnia, loss of inhibitions, increased appetites

Answer 35

C haracterised by rapid speech with frequent changes in topic based on associations, distractions or word play

Answer 36

2-3 times increased risk of diabetes, cardiovascular disease and COPD

Answer 37

if symptoms suggest hypomania then NICE recommend routine referral to the community mental health team (CMHT) if there are features of mania or severe depression then an urgent referral to the CMHT should be made

Answer 38

The DSM states that a major depressive episode must have at least four of the following symptoms, They should be new or suddenly worse, and must last for at least two weeks: Changes in appetite or weight, sleep, or psychomotor activity Decreased energy Feelings of worthlessness or guilt Trouble thinking, concentrating, or making decisions Thoughts of death or suicidal plans or attempts

Answer 39

Denial: this may include a feeling of numbness and also pseudohallucinations of the deceased, both auditory and visual. Occasionally people may focus on physical objects that remind them of their loved one or even prepare meals for them Anger: this is commonly directed against other family members and medical professionals Bargaining Depression Acceptance It should be noted that many patients will not go through all 5 stages.

Answer 40

Abnormal, or atypical, grief reactions are more likely to occur in women and if the death is sudden and unexpected. Other risk factors include a problematic relationship before death or if the patient has not much social support.

Answer 41

delayed grief: sometimes said to occur when more than 2 weeks passes before grieving begins prolonged grief: difficult to define. Normal grief reactions may take up to and beyond 12 months

Answer 42

Seasonal affective disorder (SAD) describes depression which occurs predominately around the winter months.

Answer 43

SAD should be treated the same way as depression, therefore as per the NICE guidelines for mild depression, you would begin with psychological therapies and follow up with the patient in 2 weeks to ensure that there has been no deterioration. Following this an SSRI can be given if needed. In seasonal affective disorder, you should not give the patient sleeping tablets as this can make the symptoms worse. Finally, the evidence for light therapy is limited and as such it is not routinely recommended.

Answer 44

In the DSM-V, insomnia is defined as difficulty initiating or maintaining sleep, or early-morning awakening that leads to dissatisfaction with sleep quantity or quality. This is despite adequate time and opportunity for sleep and results in impaired daytime functioning.

Answer 45

Patients typically present with decreased daytime functioning, decreased periods of sleep (delayed sleep onset or awakening in the night) or increased accidents due to poor concentration. Often the partner's rest will also suffer.

Answer 46

Associated with: Female gender Increased age Lower educational attainment Unemployment Economic inactivity Widowed, divorced, or separated status Other risk factors: Alcohol and substance abuse Stimulant usage Medications such as corticosteroids Poor sleep hygiene Chronic pain Chronic illness: patients with illnesses such as diabetes, CAD, hypertension, heart failure, BPH and COPD have a higher prevalence of insomnia than the general population. Psychiatric illness: anxiety and depression are highly correlated with insomnia. People with manic episodes or PTSD will also complain of extended periods of sleeplessness.

Answer 47

Daytime napping Enlarged tonsils or tongue Micrognathia (small jaw) and retrognathia Lateral narrowing of oropharynx

Answer 48

Diagnosis is primarily made through patient interview, looking for the presence of risk factors . Sleep diaries and actigraphy may aid diagnosis. Actigraphy is a non-invasive method for monitoring motor activity. Polysomnography is not routinely indicated. It may be considered in patients with suspected obstructive sleep apnoea or periodic limb movement disorder, or when insomnia is poorly responsive to conventional treatment.

Answer 49

Identify any potential causes e.g. mental/ physical health issues or poor sleep hygiene. Advise the person not to drive while sleepy Advise good sleep hygiene: no screens before bed, limited caffeine intake, fixed bed times etc. ONLY consider use of hypnotics if daytime impairment is severe.

Answer 50

The hypnotics recommended for treating insomnia are short-acting benzodiazepines or non-benzodiazepines (zopiclone, zolpidem and zaleplon). Diazepam is not recommended but can be useful if the insomnia is linked to daytime anxiety. Use the lowest effective dose for the shortest period possible. If there has been no response to the first hypnotic, do not prescribe another. You should make the patient aware that repeat prescriptions are not usually given. It is important to review after 2 weeks and consider referral for cognitive behavioural therapy (CBT). Other sedative drugs (such as antidepressants, antihistamines, choral hydrate, clomethiazole and barbiturates) are not recommended for managing insomnia.

Answer 51

Patients are unable to speak or move but remain fully conscious. A severe form of depressive retardation

Answer 52

Recurrent mood disorders

Answer 53

Reduced ability to experience pleasure - i.e. enjoyment of things they would have previously enjoyed

Answer 54

Poor sleep pattern - daytime napping, sleeping in late Trouble falling asleep Trouble staying asleep Early morning wakening

Answer 55

2 core symptoms + 2 additional symptoms Able to function

Answer 56

2 core symptoms +3/4 others Still functional but struggling to function

Answer 57

3 core + at least 4 other symptoms

Answer 58

Hallucinations Delusions: Hypochondriacal/ Guilt/ Nihilistic/ Persecutory

Answer 59

Worries about the baby’s health or ability to cope with the baby

Answer 60

Mildly elevated, expansive or irritable mood Increased energy/activity Increased self esteem Sociability, talkativeness, over familiarity Increased sex five Reduced need for sleep Difficulty focusing on and completing tasks

Answer 61

Elevated/expansive/irritable mood for at least 1 week Increased energy/activity Grandiosity/increased self esteem Pressure of speech Flight of ideas/racing thoughts Distractible Reduced need for sleep Increased libido Social inhibitions lost Psychotic symptoms (grandiose delusions or hallucinations)

Answer 62

Reduced need for sleep

Answer 63

Chronic low mood not fulfilling the criteria of depression

Answer 64

Genetic Physical illnesses Childhood experiences Personality traits Work, housing finance, relationships, support

Answer 65

International Classification of Diseases 10th edition (ICD-10) criteria: differences from DSM-IV ICD-10 does not discriminate between bipolar disorder types I and II ICD-10 requires two discrete mood episodes, at least one of which must be manic, for a bipolar disorder diagnosis. In DSM-IV, one episode of mania (or mixed mood), or one episode of hypomania plus a major depressive episode, suffice for a BD diagnosis

Answer 66

Severe depression can mimic dementia but gives a pattern of global memory loss rather than short-term memory loss - this is called pseudodementia

Answer 67

disorders in which the fundamental disturbance is a change in affect or mood to depression (with or without associated anxiety) or to elation. The mood change is usually accompanied by a change in the overall level of activity; most of the other symptoms are either secondary to, or easily understood in the context of, the change in mood and activity. Most of these disorders tend to be recurrent and the onset of individual episodes can often be related to stressful events or situations.

Affective Disorders Flashcards

(91 cards)