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Psychiatry > Affective Disorders > Flashcards

Affective Disorders Flashcards

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1
Q

9 types of depression?

A 
Depressive disorder
Bipolar affect disorder
Dysthymia disorder
Cyclothymia disorder
Recurrent depressive disorder
atypical depression
Adjustment disorder
Mixed anxiety and depression
Post natal depression
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2
Q

3 cardinal features of depressive disorder?

A

Loss of energy
Anhedonia
Low mood

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3
Q

Additional features of depressive disorders?

A 
Loss of concentration
Inability to sleep 
Loss of appetite
Thoughts of guilt and self blame
Thoughts of hopelessness
Suicidal or life worth not living
Reduced self esteem
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4
Q

4 somatic symptoms of depression?

A

Weight loss
Early morning wakening
Anhedonia
Loss of libido

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5
Q

Different in classification between mild, moderate and severe depression?

A 
Mild = 2 core, 2 additional
Moderate = 2 core, 3/4 additional
Severe = psychosis, 3 core, 4 additional
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6
Q

What psychotic symptoms may a severely depressed person present with?

A

Hallucinations - derogatory
Delusions - mood congruent
Cotards Syndrome - think they dont exist or rotting inside

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7
Q

Investigations performed on someone with depressive disorder?

A

FBC, U&E, LFTS, B12, folate, bone profile, TFTs
history, MSE, drug and alcohol history
ECG, Brain CT/MRI

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8
Q

Psychological intervention for mild depression?

A

CBT for 9-12 weeks

group physical intervention for 10-12 weeks

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9
Q

Biopsychosocial intervention for mid/moderate depression?

A

Either bio or psycho
Bio - SSRI for 9 months for remission, 2 years for relapse
Psycho - high intensity CBT, behavioural activation

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10
Q

Biopsychosocial intervention for moderate-severe depression?

A

Bio and psycho
Bio - SSRI, antipsychotic, ECT
Psycho - high intensity intervention, psychodynamic psychotherapy

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11
Q

Treatment options for refractory depression?

A 
Change SSRI to different type or class
Add lithium
Add T3
Add antipsychotic 2nd gen
Combine mirtazapine and a SSRI/SNRI
ECT
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12
Q

5 examples of SSRI?

A 
Paroxetine
Sertraline
Escitalopram
Fluoxetine
Citalopram
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13
Q

Side effects of SSRIs?

A 
Weight loss
Agitation
Poor sleep
Loss of libido
Nausea and vomiting
Bleeding
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14
Q

2 examples of SNRIs?

A

Duloxetine

Venlafaxine

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15
Q

What 2 things can venlafaxine increase?

A

QTc and BP

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16
Q

3 examples of TCAs?

A

Amitriptyline
Clomipramine
Iofepramine

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17
Q

Side effects of TCAs, why?

A 
dry mouth
Constipation
Sedation
Blurred vision
Heart block - arrythmias
Due to being potent SNRI, anticholinergic and antagonist at a1 adrenergic receptor
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18
Q

3 modes of action of TCAs?

A

SNRI
Anticholinergic
alpha 1 adrenergic receptor antagonist

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19
Q

2 examples of MAOI?

A

Phenelzine

Moclobemide

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20
Q

Mode of action of MAOI?

A

Inhibit monoamine oxidase to reduce amine neurotransmitter breakdown

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21
Q

Potential side effects of MAOIs?

A 
Rise in BP with certain tyramine foods (mature cheese, pickle, broad beans, oxo, marmite)
Postural hypotension
Sedation
Headache
serotonin syndrome
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22
Q

Mirtazapine is what drug class? SE?

A 
NaSSA 
Weight gain
Low WBC
Sedation
Dizziness
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23
Q

Describe features of serotonin syndrome?

Study These Flashcards
A 
Headache
Agitation 
Hallucinations
Shivering 
Sweating
Nausea and vomiting
Hyperthermia
Myoclonus
Hyperreflexia
Tremor
24
Q

Drug that treats serotonin syndrome?

Study These Flashcards
A

Cyproheptadine

25
4 symptoms of discontinuation syndrome?
Flu like symptoms GI upset vivid dreams Electric shocks
26
3 main indications for ECT? other ways?
Suicidal high risk Depressive stupor Life threatening because of refusal of food or fluids Treatment resistant depression psychotic depression Psychomotor retardation
27
Mean time suffering depressive episode?
4-6 months
28
Describe recurrent depressive disorder?
recurrent depression, no mania | mean 6 months episodes
29
Atypical depression?
``` Low mood but responds to happy events hyperinsomnia weight gain Interpersonal rejection sensitivity occupational and social impairment Responds with older MAOI ```
30
Describe dysthymia?
Chronic depression Antidepressants and psychological intervention Difficult to treat Not quite depression
31
Cyclothymia?
Cycling between mild elation and mild depression Not quite BPAD Mood stabilisers
32
Mixed anxiety and depressive disorder?
Together both anxiety and depression are symptoms but when uniquely analysed, neither of them meet criteria
33
How long does hypomania have to be present for to be diagnosed?
4 consecutive days?
34
Symptoms of hypomania?
Increased sex drive Mild spending sprees or reckless behaviour Increased energy Decreased need for sleep Increased talkativeness (pressure of speech)
35
Define hypomania
Elevated or irritable mood out of character for the individual and sustained for 4 consecutive days with interference to activities of daily living
36
Define mania?
Elevated, irritable or expansive behaviour that is out of character for the individual lasting for at least 7 days and with severe interference to activities of daily living
37
Symptoms of mania?
``` Increased sex drive and inappropriate behaviour Increased talkativeness (pressure of speech) Flight of ideas - distractible Grandiosity Decreased need for sleep Distractibility Appetite increased Increased energy Reduced concentration Reckless behaviour and spending ```
38
What can antidepressants do in BPD?
precipitate manic episode
39
Long term treatment of BPD with what 3 drugs?
Lithium, antipsychotics, valproate
40
3 indications for long term medication of BPD?
It they are suffering frequent episodes with severe functional impairment If they have a manic episode with severe consequences 2 or more acute episodes
41
6 differential diagnosis of BPD?
``` Schizophrenia Schizoaffective disorder Anxiety Cyclothymia Organic disorder in the frontal lobe Anorexia nervosa ```
42
3 subcategories of BPD and their severity?
BPD 2 BPD 1 rapid cycling BPD
43
Drug classes used to treat a manic episode?
Anti-psychotics Mood stabilisers Benzodiazepines ECT
44
Antipsychotics used to treat BPD?
Haloperidol Chlorpromazine Aripiprazole Olanzapine Risperidone Quetiapine
45
SE of antipsychotics?
``` Increase prolactin Metabolic syndrome Hypotension Sedation Anticholinergic effects ```
46
Monitoring requirements of antipsychotics? Baseline and follow up?
``` Weight/ glucose/ HbA1c/ BMI/ waist circumference FBP/ lipids/ cholesterol TFT/ LFT/ U&E ECG and BP History or FH of HD Smoking Baseline check then check at 12-16 weeks Repeat yearly ```
47
What monitoring is required for Lithium and how often?
Height and weight LFT U&E and TFT (6 monthly) ECG
48
How often do serum levels of Lithium need to be taken?
Weekly till stabilised at 0.6-0.8 mmol/l | then every 3 months
49
Side effects of lithium?
``` GI fine tremor Renal impairment Hyperparathyroidism Hypercalcaemia Hypothyroidism Oedema Weight gain Polydipsia/polyuria ```
50
What drugs interact with Lithium?
``` NSAIDs Antipsychotics ACE inhibitors Diuretics CCBs - neurotoxicity Pregnancy - ebsteins anomaly ```
51
What do toxic levels of lithium present with?
``` Ataxia Nystagmus Tremor Dysarthria Renal impairment Seizures ```
52
3 examples of AEDs and side effects associated?
Lamotrigine, Carbomazepine, Sodium Valproate ``` Teratogenic GI upset Weight gain Thrombocytopenia Hair loss Tremor Ataxia Aggression Vasculitis Hepatic dysfunction Confusion Stupor Pancytopenia Leucopenia Pancreatitis ```
53
Mean age of onset of BPAD?
19
54
CALMER pneumonic for BPAD?
``` CBT Antipsychotics Lorazepam Mood stabilizers ECT Risk assessment ```
55
2 drugs used in rapid tranquilisation?
Lorazepam | Haloperidol
56
how does mood stabilizer choice change depending on if the person is experiencing a manic depressive or manic episode?
``` Mania = lithium Depressive = Lamotrigine ```
57
Combination of what 2 drugs is used for rapid cycling?
Lithium and sodium valproate

Psychiatry (17 decks)

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