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4th year psych > Affective disorders > Flashcards

Affective disorders Flashcards

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1
Q

Aetiology depression (molecular)

A

Decreased availability of monoamine neurotransmitters plus hypercortisolaemia in severe –> Decrease in BDNF (brain derived neurotrophic factor) which promotes neurogenesis.

Dysfunctional limbic system and related areas

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2
Q

What are the monoamine neurotransmitters?

A

Noradrenaline and serotonin

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3
Q

Risk factors for depression

A

Genetics/gene - environment interaction

PMH treatment with interferons (cytokines)

Physical illness

Medications e.g. steroids, isotretinoin

Female

LT alcohol or drugs

History of abuse, childhood stress, parental loss

Poor resilience/catastrophising

Recent adverse life events (housing, financial, employment, relationships etc)

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4
Q

three cardinal signs of depression

A

Low mood

Anhedonia

Anergia (low energy)

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5
Q

Diagnostic criteria for depression (ICD-10)

A

2 or more of the three main symptoms for 2w or more

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6
Q

What are the three affective disorders?

A

Bipolar

Mania

Depression

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7
Q

ICD-10 criteria for mild/mod/severe depression?

A

Mild: 2 core and 2 other

Moderate: 2 core and 3 other

Severe: 3 core and 4 other

But also depends on freq and number of sx, degree of distress and interference with ADLs

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8
Q

What other sx do you get in depression?

A

Decreased: concentration, self esteem, sleep, appetite

guilt, wortheless

Hopeless

Self-harm

Psychomotor retardation or agitation

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9
Q

How might an older person’s profile of sx differ in depression?

A

More biological sx than mood

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10
Q

What three things do depressed people have depressed thoughts about? What is this known as?

A

Self

World

Future

Beck’s cognitive triad

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11
Q

What diurnal variation might you get in depression?

A

Mood worse in am

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12
Q

Depressive retardation may be similar to

A

Flat affect chronic schizophrenia

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13
Q

Differentials for depression

A

Normal sadness

Schizophrenia (for psychotic depression)

Alcohol/drug withdrawal

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14
Q

Management of depression

A

Mostly primary care

Treat co-morbs and substance misuse in all

Self help, exercise, computer CBT

CBT/interpersonal therapy

Mod/severe: psych therapy and antidepressant

Could augment the antidepressant

Severe: ECT

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15
Q

What would indicate psych referral in depression?

A

Severe, unresponsive, bipolar, recurrent, high suicide risk

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16
Q

How long does depression normally last?

A

3-8m

20% >2y

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17
Q

What percent of depression recurs? What about if it was severe?

A

50% (80% severe)

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18
Q

Do recurrent episodes of depression tend to be similar?

A

no get worse so prophylaxis is good

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19
Q

Lifetime suicide risk in severe depression

A

15%

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20
Q

Severe depression is associated with _____ disease

A

Cardiac

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21
Q

what is hypomania?

A

Less severe mania, no psychosis

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22
Q

ICD-10 criteria for bipolar diagnosis?

A

At least 2 episodes, including at least one hypomanic/manic

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23
Q

Onset of bipolar age?

24
Q

How genetic is bipolar?

Study These Flashcards
A

at least 60% inherited

25
What is the neurophysiological basis for bipolar?
Abnormal hypothalamic pituitary adrenal axis MRI- smaller prefrontal lobes, enlarged amygdala and globus pallidus. Hypothyroid involved in 25% rapid cycling
26
What, earlier in life, can lead to abnormal hypothalamic pituitary adrenal axis dysfunction (in bipolar)
prolonged psychosocial stressors in childhood
27
Two things that might induce mania in bipolar?
Post-partum Sleep deprivation
28
How does mania present?
Elated mood Irritable Psychomotor agitation Decreased need for sleep High self esteem Disinhibited Pressured speech, flight of ideas Mood-congruent delusions and hallucinations, usually auditory
29
What is rapid cycling bipolar defined as?
at least 4 episodes per year
30
Do people with bipolar have insight?
Often no
31
Median duration of manic episode in bipolar?
4m
32
Median duration of depressive episode in bipolar?
6m
33
Differentials in a manic episode?
Substance abuse e.g. cocaine Due to endocrine/epilepsy/medication Schizophrenia/schizoaffective disorder Personality disorder ADHD (although high mood is rare)
34
Most effective LT treatment for bipolar?
Lithium
35
How would you start someone on lithium for biploar including monitoring
125mg-1g PO BD Check U&Es, ECG, TFTs Adjust dose until plasma level 0.6-1 mmol/L First check on day 4-7. 12h after they've taken it. Check weekly until they are stable for 4w, then monthly for 6m then 3 monthly Check TFT and U&E at 6m Warn signs toxicity
36
progressively increasing lithium levels could indicate what
nephrotoxicity
37
SEs lithium
Hypothyroid nephrogenic diabetes insipidus toxicity
38
What are the signs of lithium toxicity
Worsening vision D&V Hypokalaemia Ataxia Tremor Dysarthria Coma
39
Can you stop lithium cold turkey?
No taper over 2-4w or else it will induce mania in 50%
40
Second line treatment for bipolar?
Anticonvulsants: semisodium valproate (±lithium) or olanzapine or quetiapine
41
Can you prescribe an antidepressant in bipolar?
Must also have a mood stabiliser. Stop the AD at onset of acute manic episode
42
How would you treat episodes of mod/severe depression in bipolar?
Quetiapine, olanzapine, lamotrigine | Olanzapine and fluoxetine combination
43
Prognosis for a single manic episode?
90% have manic/depressive recurrence. Frequency and severity tend to increase for 4/5 episodes then plateau.
44
Bipolar increases risk of what
Premature mortality, only partially explained by suicide rate of 10%
45
What is cyclothymia?
Chronic mood fluctuation over 2y of depression and hypomania but not severe enough to be diagnosed) 30% will develop full bipolar
46
What is mood like in mania
Irritable Euphoric Labile
47
What is cognition like in mania?
Grandiose, flight of ideas, low concentration, confused, lack insight
48
What is behaviour like in mania?
Rapid speech hyperactive reduced sleep hypersexuality extravagance
49
Psychotic symptoms in mania?
Delusions and hallucinations
50
Causes of mania
Bipolar Physical- infection, hyperthyroid, SLE, TTP, stroke, hyponatraemia, ECT Drugs- amphetamines, cocaine, antidepressants, catopril, steroids, procyclidine, L-dopa, baclofen
51
Which antidepressant especially increases risk of mania?
Venlafaxine
52
Management of first presentation of mania?
Ask about infection, drug use, FHx psch CT head, EEG, drug screen
53
Treatment for mod/severe mania
Olanzapine 10mg PO or semisodium valproate
54
SEs olanzapine
Weight gain and glucose desensitivity.
55
Symptoms of mania in primary care management?
Urgent referral to CMHT

4th year psych (15 decks)

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