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Affective Disorders Flashcards

(46 cards)

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1
Q

Depression screening

A

PHQ-9

0-4 - non to minimal
5-9 - mild
10-14 - moderate
15-19 - moderately severe
20-27 - severe

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2
Q

Depression core management

A

Assessment and Monitoring

Psychoeducation and Self -Help - mild

Medication - moderate or severe

Psychological therapy - moderate or severe

Combined treatment - medicine and therapy for severe

Long term management

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3
Q

Mild to moderate depression management

A

Low-Intensity Psychosocial Intervention 6-8 sessions
Computerised CBT
Structured group physical activity programme

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4
Q

Moderate to severe depression management

A

Medication
- SSRI (sert)

Drug interaction - fluox, fluvoxamine, paroxetine
Discontinuation symptoms - paroxetine
Death from overdose - venlafaxine
Overdose - TCA
BP monitoring needed - venlafaxine
Postural hypotension and arrhythmia

Review after 2 weeks
18-25 or high risk review after 1 week

High-intensity psychological intervention - individual CBT, interpersonal therapy

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5
Q

Complex and severe depression management

A

Crisis resolution and home treatment teams to manage crises

Develop a crisis plan that identifies potential triggers and strategies to manage triggers

Consider inpatient treatment if significant risk of suicide, self-harm or neglect

Consider ECT for acute treatment of severe depression when:
- It is life-threatening and rapid response is required
- Other treatments have failed
- When there is evidence it has worked for the patient in the past

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6
Q

Switching antidepressants

A

Fluoxetine to other - 4-7 day washout period before staring another SSRI

Fluoxetine or Paroxetine to TCA - lower starting dose of TCA recommended to reduce serotonin syndrome

To new serotonergic antidepressant or MAOI - caution due to serotonin syndrome

From non-reversible MAOI - 2 week washout period

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7
Q

Mania and BPAD core management

A

Medication - mood stabiliser and antipsychotics for acute episodes. avoid antidepressant without mood stabiliser sue to risk of mania

Psychological intervention - psychoeducation, CBT, family focused intervention

Physical health monitoring - weight, BP

Crisis planning

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8
Q

Mood stabilisers (Mania/BPAD)

A

Stabilise the extreme highs of mania and profound lows of depression

More effective against mania

Three main drugs:
o Lithium
o Sodium valproate
o Carbamazepine

Mechanism of action is uncertain (possibly to do with sodium channels or GABA)

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9
Q

Lithium

A

Therapeutic range: 0.6-1.0 mmol/L
- 0.6-0.8 is suitable for patients who are lithium-naïve
- 0.8-1.0 is suitable for patients with chronic/long-term lithium use or who have had a relapse in symptoms

Becomes toxic from 1.5mmol/L, with severe toxicity above 2mmol/L

Measure BMI, check FBC. U&Es and TFTs before starting

Plasma lithium levels should be checked 1 week after starting or changing dose and monitored weekly until a steady therapeutic level is achieved (aiming for 0.6-0.8 mmol/L)

Blood sample should be taken 12 hour after taking dose of lithium

It should be monitored every 3 months from then on

U&Es and TFTs should be monitored every 6 months (can cause renal impairment and hypothyroidism)

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10
Q

Lithium toxicity

A

Symptoms:
- Coarse tremors
- Polyuria
- Seizures

Triggers:
- salt balance and electrolyte changes
- drugs interfering with lithium
- accidental or deliberate overdose

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11
Q

Lithium toxicity management

A

Check lithium level

Stop lithium dose
- Warning: stopping lithium abruptly could precipitate symptoms of mania/depression

Transfer for medical care (rehydration, osmotic diuresis)

If overdose is severe, the patient may need gastric lavage or dialysis

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12
Q

Sodium valproate (Mania/BPAD)

A

Treats acute mania

Prophylaxis in BPAD

Given as sodium valproate because of reduced side effects

Check BMI, FBC and LFTs before starting

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13
Q

Carbamazepine (Mania/BPAD)

A

Can cause toxicity at high doses

Induces liver enzymes

Close monitoring of carbamazepine levels is essential

Check for drug interactions before prescribing

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14
Q

Mood stabiliser during pregnancy

A

Mood stabilisers are teratogenic

Risk of harm to fetus should be weighed against harm of manic relapse

Lithium - Ebstein’s anomaly

Valproate and carbamazepine - spina bifida
- Women of childbearing age should have a pregnancy prevention programme
in place
- Do not start valproate for the first time in people younger than 55 years

Closely monitor the foetus if mood stabilisers are used in pregnancy

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15
Q

Antiosychotics (Mania/BPAD)

A

Olanzapine

Usually atypical (e.g. olanzapine, risperidone, quetiapine) because of fewer side-effects

Before starting, check BMI, pulse, BP, fasting blood glucose or HbA1c, lipid
profile

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16
Q

Anticonvulsants (Mania/BPAD)

A

Lamotrigine is 2nd line for prophylaxis in BPAD type II

Check FBC, U&Es and LFTs before starting

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17
Q

Acute treatment of Mania or hypomania

A

Stop all medications that may induce symptoms (e.g. anti-depressants, recreational drugs, steroids and dopamine agonists)

If not currently on treatment
- Give an antipsychotic and a short course of benzodiazepines

If already on treatment
- Optimise the medication
- Consider adding another medication (e.g. antipsychotic added to mood stabiliser)
- Short-term benzodiazepines may help

ECT may be used if patients are unresponsive to medication

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18
Q

Mania and BPAD long term management

A

Mood stabilisers

Depression in BPAD
- Difficult because antidepressants can cause a switch to mania
- To reduce this risk, antidepressants should only be given with a mood
stabiliser or antipsychotic
- 1st line: fluoxetine + olanzapine/quetiapine
- 2nd line: lamotrigine
- Monitor closely for signs of mania and immediately stop antidepressants if signs are present

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19
Q

Psychological treatment

Study These Flashcards
A

CBT

Psychodynamic psychotherapy

20
Q

Opioid overdose

21
Q

Decrease intestinal absorption of antidepressants

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A

Activated charcoal

22
Q

Paracetamol overdose

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A

N-acetylcysteine

23
Q

Follow up intervention following SH or suicide attempt

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A

Within 1 week of SH or discharge

24
Q

Psychosis/Schizophrenia screening

Study These Flashcards
A

Brief Psychiatric Rating Scale

<31: Minimal symptoms
31–40: Mildly symptomatic
41–53: Moderately symptomatic
54+: Marked to severe symptoms, often indicating the need for more intensive
treatment.

25
Psychosis/Schizophrenia prevention and early intervention
Early Intervention in Psychosis (EIP) Service - Psychosis is toxic: the longer a patient is psychotic, the more it will affect their cognitive abilities, insight and social situation - As a result, a gradual onset of symptoms is associated with a worse prognosis as diagnosis and treatment is delayed - The sooner effective treatment can be started the better the prognosis - The service aims to engage patients with very early symptoms, from adulthood till ~35 years - Patients are offered antipsychotics and psychosocial interventions with the aim of keeping the duration of untreated psychosis (DUP) under 3 months - The service can be used in children >14 years old - CAMHS can manage psychosis in children up to 17 years old
26
Schizophrenia medication management
Antipsychotics - Dopamine antagonists (block D2 receptors) - Newer atypical antipsychotics block 5-HT2 receptors - Extrapyramidal side-effects (EPSEs) can occur at higher concentrations of ALL antipsychotics (but less common with atypicals) - Avoid using more than one antipsychotic at one time where possible - Pay attention to cardiovascular risk due to high rates in schizophrenic patients
27
Typical antipsychotics
Chlorpromazine Haloperidol Flupentixol decanoate Often used for depot injections. Effective and cheap but worse side effect profile.
28
Atypical antipsychotics
Olanzapine Risperidone (available as depot) Quetiapine Aripiprazole Clozapine Amisulpride
29
Consider starting an atypical antipsychotic when:
Choosing 1st line treatment in newly diagnosed schizophrenia There are unacceptable side-effects from typical antipsychotics Relapse occurs on a typical antipsychotic
30
Extrapyramidal side effects (antipsychotic)
Dystonia Akathisia Parkinsonism Tardive dyskinesia
31
Hyperprolactinaemia (antipsychotics)
Galactorrhoea Amenorrhoea Gynaecomastia Hypogonadism
32
Other side effects (antipsychotics)
Sexual dysfunction Risk of osteoporosis Weight gain Risk of diabetes Seizures
33
Schizophrenia psychological management
CBT has not been shown alone to improve outcomes, but combined with other therapies can be helpful in treating schizophrenia Family therapy can reduce relapse rates Concordance therapy
34
Schizophrenia social management
Psychoeducation vital to reduce relapse
35
Schizophrenia treatment resistance
Fail to respond to two or more antipsychotics, at least on atypical, each for 6 weeks Clozapine Weekly FBC for neutropenia If lack of response, augmentation with another antipsychotic
36
Paranoid personality disorder
Different to schizophrenia in the lack of hallucinations
37
Schizoaffective disorder
Schizophrenia with mood disturbances
38
Schizoid personality disorder
Shows very little, if any, interest and ability to form relationships with other people. It's very hard for the person to express a full range of emotions.
39
Schizotypal personality disorder
Dress, speak, or act in ways outside of societal norms and do not fully understand how relationships are formed or the impact of their actions on others.
40
Borderline personality disorder
Emotional instability – the psychological term for this is affective dysregulation Disturbed patterns of thinking or perception – cognitive distortions or perceptual distortions Impulsive behaviour Intense but unstable relationships with others
41
Histrionic personality disorder
Feel underappreciated or depressed when they’re not the center of attention. Have rapidly shifting and shallow emotions. Be dramatic and extremely emotionally expressive, even to the point of embarrassing friends and family in public. Be persistently charming and flirtatious. Be overly concerned with their physical appearance. Use their physical appearance to draw attention to themselves by wearing bright-colored clothing or revealing clothing. Act inappropriately sexual with most of the people they meet, even when they’re not sexually attracted to them. Be gullible and easily influenced by others, especially by the people they admire. Think that their relationships with others are closer than they usually are. Have difficulty maintaining relationships, often seeming fake or shallow in their interactions with others. Need instant gratification and become bored or frustrated very easily. Constantly seek reassurance or approval.
42
Avoidant personality disorder
Avoids working with others because of fear of criticism, disapproval, or rejection. Doesn't want to get involved with people unless they are sure of being liked. Holds back from close relationships because they fear being shamed or mocked.
43
Persistent prolonged bereavement disorder
Grief symptoms persist and significantly impact daily life for an extended period, often beyond 6 months for children and adolescents, or 12 months for adults.
44
Acute stress disorder
Within first month - PTSD persists after the first month
45
Othello syndrome
Delusional belief that one's partner is unfaithful, despite a lack of evidence.
46
Conversion disorder
Psychiatric illness where physical symptoms affecting voluntary motor or sensory function cannot be explained by a neurological or general medical condition

Psychiatry (11 decks)

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