elearning on affective disorders

Question 1

burden of disease with depression?

Answer 1

2nd highest in world by 2020

highest in 15-34 yrs

Question 2

lifetime prevalence depression?

Answer 2

20%

Question 3

gender depression

Answer 3

2:1 females until >55

Question 4

age of onset depression

Answer 4

late 20s

Question 5

one distinctly female symptom of depression?

Answer 5

amenorrhoea

Question 6

organic causes of low mood

Answer 6

1. endocrine: adrenal, thyroid, hypoPituitarism
2. infections - mono, syph, AIDS, encephalitis
3. neuro - stroke, parkinsons, MS, tumour
4. carcinoma - paraneoplastic syndrome
5. meds: statins, interferon, isoretinoin
6. .nutritional deficiencies
   MI, cerebral ischaemia

Question 7

importance of substance abuse?

Answer 7

must abstain from substance for 2 wks before can diagnose

cannot MSE in acute intoxication

Question 8

ddx for mild depression?

Answer 8

normal

reactive eg bereavement/job loss

anxiety

BPAD

personality disorder

dysthymia

OCD

eating disorder

Question 9

ddx when severe depression w/o psychotic sx

Answer 9

1. prodromal psychotic illness
2. dementia - normal sleep, no diurnal variation, gradual onset, focal neuro signs eg apraxia, agnosia, dysphasia
3. severe/chronic OCD

if psychosis also think schizophrenia

Question 10

what’s disulfiram?

Answer 10

used in aversive tx of alcohol abuse

Question 11

combination therapy of antidepressants?

Answer 11

no not usually except maybe SSRI+ mirtazapine in refractory

Question 12

response rate to antidepressants?

Answer 12

short term response rate 60%

eventual response unlikely if nothing at 4 wks

Question 13

if not responding to meds in depression?

Answer 13

1. try another class
2. discuss compliance
3. review comorbid substance use
4. augment - lithium, combination tx

Question 14

relapse rates antidepressant

Answer 14

continued tx for 6 months = 20-25% rate relapse, 50% on placebo

Question 15

if symptoms reduce can reduce dose of antidepressant?

Answer 15

no, relapse rate will increase

Question 16

what is ecstasy

Answer 16

extreme state of subjective transcendence of the outside world

Question 17

what is elation

Answer 17

abnormal mood state without an infectious quality

Question 18

what is euphoria

Answer 18

normal mood state with an infectious quality

Question 19

biological symptom BPAD has in common with mania?

Answer 19

early morning waking often 1st sign

Question 20

psychotic symptoms of BPAD

Answer 20

mood congruent - magical powers, deification, hallucinations

Question 21

BPAD completed suicide risk

Answer 21

15-20%

Question 22

what are the types of mood stabilisers?

Answer 22

1. Lithium
2. Anticonvulsants eg lamotrigine, valproate, carbamazepine
3. antipsychotics - some have a mood stabilising effect eg olanzapine, quetiapine, risperidone

Question 23

what medical condition can blunt the response to antidepressants and mood stabilisers?

Answer 23

hypothyroidism

Question 24

can you use antidepressants in BPAD?

Answer 24

1. yes in depressive episodes

2. low dose, watch for manic switch

Question 25

what is a spotter?

Answer 25

friend, family member or partner of patient who is given psychoeducation to recognise early warning signs of mood disturbance

Question 26

CBT in BPAD

Answer 26

limited evidence of its effect

Question 27

additional indications for the use of antidepressants

Answer 27

anxiety disorders - agoraphobia, GAD, social phobia | OCD

Question 28

adequate therapeutic trial?

Answer 28

4-6 weeks

Question 29

steps when drug not working

Answer 29

1. ensure diagnosis correct 2. check compliance and tolerability 3. consider increasing dose

Question 30

risk factors for hyponatraemia when on antidepressants?

Answer 30

1. previous hyponatraemia 2. old age 3. diuretics 4. DM 5. HTN 6. renal failure 7. COPD

Question 31

when do side effects of SSRIs appear and disappear?

Answer 31

1. early, before therapeutic effect | 2. dissipate after 1st week slightly

Question 32

sexual side effects of antidepressants?

Answer 32

1. reduced libido 2. delayed orgasm 3. ED

Question 33

List 6 SSRIs

Answer 33

``` fluox parox fluvoxamine sertaline citalopram escitalopram ```

Question 34

list 4 TCAs

Answer 34

amitriptaline clomipramine lofepramine dothiepin

Question 35

list 2 SNRIs

Answer 35

venlafaxine | duloxetine

Question 36

list 3 MAOIS

Answer 36

phenelzine tranylcypromine moclobamide

Question 37

are antidepressants addictive?

Answer 37

no

Question 38

elderly people and antidepressant dosing once symptoms improve

Answer 38

leave on them for longer as would for recurrent episodes, 2yrs

Question 39

stopping an antidepressant?

Answer 39

gradually | inform of discontinuation symptoms

Question 40

which MAOI doesn't require dietary restrictions?

Answer 40

reversible inhibitors of MAO-A eg moclobamide UNLESS high dose

Question 41

steps in prescribing antidepressants

Answer 41

1. thoroughly assess 2. confirm diagnosis 3. discuss drug, s/e, discontinuation with patient 4. consider severity of illness, past response to tx, potential lethality in OD

Question 42

increase dose or switch class?

Answer 42

``` increase dose if tolerable switch class if not ```

Question 43

first step in mania presentation?

Answer 43

stop antidepressant

Question 44

treatment of mania/hypomania?

Answer 44

drugs: lithium/ antipsychotics/ sodium valproate short acting benzos

Question 45

before prescribing lithium tell patients:

Answer 45

1. side effects and toicity 2. salt free diet is contraindicated 3. maintain adequate hydration 4. don't double up on doses 5. contraception

Question 46

indications for lithium

Answer 46

1. prophylaxis against manic and depressive relapse in BPAD 2. tx acute mania and hypomania 3. tx resistant unipolar depression

Question 47

tests to do before starting lithium?

Answer 47

renal cardiac thyroid calcium - risk hyperparathyroidism

Question 48

what is the plasma level of lithium aimed for?

Answer 48

0.6-1

Question 49

tremor and lithium?

Answer 49

normal s/e - not toxic | see with mild thirst and polyuria

Question 50

what skin conditions can be exacerbated by lithium

Answer 50

acne | psoriasis

Question 51

what is the long term complication of lithium?

Answer 51

nephrotoxicity reduced GFR in 20% - usually benign - small number can develop interstitial nephritis also, nephrogenic DI - cause of the thirst and polyuria

Question 52

endocrine complication of lithium?

Answer 52

hypothyroidism - doesn't mean should stop tx, just replace thyroxine can also cause hyperthyroidism - less common

Question 53

lithium and NSAIDs

Answer 53

can increase serum lithium levels by up to 40% lithium toxicity DO NOT CO-PRESCRIBE AND INFORM PATIENTS

Question 54

signs of lithium toxicity

Answer 54

1. coarse tremor 2. ataxia 3. slurred speech 4. drowsiness 5. disorientation 6. seizures

Question 55

lithium side effects at therapeutic plasma level

Answer 55

``` GI - NVD fine tremor dry mouth polyuria/dipsia vertigo weight gain hypo/er thyroidism worsened acne/psoriasis ```

Question 56

lithium 1.2-2mmol side effects

Answer 56

1. coarse tremor 2. ataxia 3. dysarthria 4. nystagmus 5. renal impairment 6. anorexia 7. muscle weakness

Question 57

lithium >2 mmol/L side effects

Answer 57

1. hyperreflexia and hyperextension of limbs 2. convulsions 3. syncope 4. oliguria 5. CVS failure 6. seizure 7. coma 8. death

Question 58

intermittent use of lithium in BPAD?

Answer 58

can worsen the course high incidence of manic relapse after discontinuing Don't start lithium unless intend to continue long term can reduce risk of relapse by gradually reducing amt

Question 59

suicide and lithium?

Answer 59

long term lithium tx reduces the risk of suicide to that of general population

Question 60

carbamazepine + pregnancy

Answer 60

nope | spina bifida