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Psychiatry > Mood Disorders > Flashcards

Mood Disorders Flashcards

1
Q

How long do the symptoms of depression need to last for a diagnosis of major depressive episode?

A

2 weeks

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2
Q

What are the clinical criteria for a major depressive episode?

A

5 or more of: SI(G) E CAPS
- Depressed mood
- Sleep - Insomnia or hypersomnia
- Interest in activites decreased (anhedonia)
- (Guilt or worthlessness) not a major criteria
- Energy loss
- Concentration difficulties
- Appetite change or weight change
- Psychomotor agitation or retardation
- Suicidal ideation or recurrent thoughts of death
Needs to cause distress or impair functioning

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3
Q

Lifetime risk of unipolar depression

A

10-20%

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4
Q

Unipolar depression F:M ratio?

A

2:1

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5
Q

What is kindling?

A

The first major depressive episode is preceded by a causative event (e.g. large loss), but subsequent episodes do not need such a strong trigger

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6
Q

How often do life events precipitate depression?

A

70% of cases

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7
Q

Vulnerability factors to developing a major depressive episode (7)

A 
Family history
Social class low
Life events
Personality
Childhood experience
Post partum
Social network - lack of interpersonal relationships
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8
Q

Biological treatment of a major depressive episode (overview)

A
  1. SSRIs - fluoxetine, paroxetine, citalopram, sertraline
  2. Tricyclics - amitriptyline, nortriptyline, imipramine
  3. SNRIs - venlafaxine
  4. Mirtazepine
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9
Q

Adverse effects of SSRIs (6)

A 
Nausea and other GI symptoms
Headache
Insomnia
Anxiety/agitation (in first few days)
Sexual dysfunction
Prolonged QT interval
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10
Q

Fluoxetine dose

A

20-60mg daily (start at 20 and increase slowly)

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11
Q

Citalopram dose

A

20-40mg daily

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12
Q

Sertraline

A

50-200mg daily (start at 50 and increase slowly)

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13
Q

Adverse effects of tricyclics (5)

A 
Anticholinergic effects (dry mouth, blurred vision, palpitations)
Postural hypotension
Arrhythmias
Sedation
Weight gain
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14
Q

Dose of amitriptyline

A

75-150mg daily (can reduce to 50mg for maintenance if required)

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15
Q

Dose of nortriptyline

A

75-100mg daily

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16
Q

When can you use venlafaxine?

A

After trialling 2 other antidepressants

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17
Q

Psychological therapy options in depression (4)

A

Supportive therapy/counselling
Interpersonal therapy
CBT and DBT
Psychodynamic therapy

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18
Q

Social therapy options for depression

A

Minimise adverse life events and promote secure and confiding relationships

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19
Q

MOA of ECT

A

Increase in neurotransmitter concentration after seizure with reduction in beta-adrenergic receptors, increase in BBB permeability, and increase in grey matter in the hippocampal area after the seizure

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20
Q

Three major indications for ECT

A

Major depression
Bipolar disorder
Acute or catatonic schizophrenia

21
Q

Contraindications for ECT

A 
Relative contraindications:
		○ Recent MI
		○ Berry aneurysm
		○ Brain mass
		○ Increased ICP
22
Q

Adverse effects of ECT

A 
Death (0.01%)
Sore muscles
Headache
Short term confusion / delirium
Memory impairment
23
Q

Characteristics of atypical depression (5)

A 
Mood reactivity
Overeating
Oversleeping
Leaden paralysis
Poor response to medication
24
Q

What is dysthymia?

A

Chronic low grade depression which rarely fulfills the criteria for recurrent depression. Can be complicated by major depressive episodes.

25
Q

What is Seasonal Affective Disorder (SAD)

A

Onset of atypical depressive symptoms in autumn or winter, with possible mild hypomania during summer.

26
Q

What is the difference between bipolar I and bipolar II disorder?

A

Bipolar I is characterised by at least one manic episode and one major depressive episode. Bipolar II is at least one hypomanic episode and one major depressive episode.

27
Q

Criterion A of a manic episode

A

Distinct period of persistently elevated, expansive or irritable mood and abnormally and persistently increased goal-directed activity

28
Q

How long do symptoms last for mania and hypomania?

A

7 days for mania, 4 days for hypomania

29
Q

Criterion B of a manic episode (symptoms)

A

3 or more of:

  • Grandiosity
  • Decreased need for sleep
  • Pressure of speech
  • Flight of ideas / racing thoughts
  • Distractibility
  • Increased goal-directed activity
  • Involvement in risky behaviours
30
Q

Criterion C for bipolar I disorder

A

Symptoms cause marked impairment in functioning or there are psychotic features.

31
Q

Definition of hypomania (criterion C for bipolar II disorder)

A

Symptoms last for 4 days and do not cause marked impairment in functioning and there are NO psychotic features

32
Q

Prevalence of bipolar affective disorder

A

1%

33
Q

Mean age of onset of bipolar disorder

A

21 years

34
Q

Aetiology of bipolar disorder

A

Very strong genetic link, so need to ask about family history

35
Q

Suicide risk in bipolar I disorder

A

15x that of the normal population

36
Q

Cyclothymic disorder

A

For at least 2 years there have been numerous periods of hypomanic symptoms that don’t meet criteria for a hypomanic episode and numerous periods of depressive symptoms that do not meet the criteria for a major depressive episode

37
Q

Biological treatments for bipolar disorder (overview)

A

Lithium
Sodium Valproate
Lamotrigine (better for depressive symptoms)
Atypical antipsychotics - quetiapine / olanzapine
Risperidone can be used for mania but not as a mood stabiliser

38
Q

When do you start lithium?

A

As soon as the person has signs of mania

39
Q

What is the response rate to lithium?

A

75%

40
Q

What serum level of lithium do you aim for?

A

0.8mmol/L

41
Q

When do you measure lithium levels?

A

5 days after starting treatment, and after any changes in dose

42
Q

Side effects of lithium (5)

A

Fine tremor (coarse tremor sign of toxicity)
Metallic taste in mouth
Weight gain
Loose stools (diarrhoea is a sign of toxicity)
Thyroid dysfunction long term

43
Q

When should sodium valproate be used?

A

Rapid cycling bipolar disorder
Resistance/intolerance to lithium
Prominent manic rather than depressive symptoms

44
Q

When should sodium valproate NOT be used?

A

In women of reproductive age (very teratogenic)

45
Q

Side effects of valproate

A

Weight gain
Nausea
Hair loss

46
Q

A risk to consider when giving lamotrigine

A

Steven-Johnson syndrome

47
Q

Psychological treatment that can be effective for bipolar disorder

A

CBT
Interpersonal therapy
Social rhythms therapy (emphasis on daily routines)

48
Q

Poor prognostic factors for bipolar disorder (6)

A 
Poor tx adherence
Mixed state
Rapid cycling
Chronic depression
Severe mania
Family hx of non-response to tx
49
Q

Lithium monitoring

A

Lithium levels after 5 days, then 3 monthly (more if high risk patient)
Renal function and electrolytes every 3 months
TFTs checked at 3 months, then 6 monthly
Serum Ca and Mg every 2 years

Psychiatry (7 decks)

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