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Toni's Psych > Mood Disorders > Flashcards

Mood Disorders Flashcards

1
Q

What cognitive symptoms might be seen in a depressive episode?

A

Reduced concentration and attention
Poor self esteem
Guilt
Hopelessness

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2
Q

What somatic/biological symptoms might be seen in a depressive episode?

A 
Anhedonia
Reduced emotional reactivity
Early am waking/initial insomnia
Diurnal variation
Psychomotor retardation/agitation
Loss of appetite/weight loss
Loss of libido
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3
Q

What factors might increase the risk of depression in women?

A

Brown and Harris

3 or more children

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4
Q

When might you consider in patient admission to assess patients with depression?

A

If evidence of:
Distressing hallucinations/delusions, psychotic phenomena
Active suicidal ideation/ planning, esp if prev attempts
Severe self neglect due to lack of motivation (dehydration/starvation)

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5
Q

What medication is used 1st line in the treatment of depression?

A 
SSRIs:
Sertraline
Paroxetine
Citalopram
Fluoxetine
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6
Q

How long are SSRIs usually prescribed for in depressive episodes

A

4 - 6 wks
From remission:
Full dose 6 months
(If recurrent depression 2 years)

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7
Q

What factors are considered when prescribing medication for depression?

A

Side effects
Prev good response
Safety in OD
Concomitant physical illness

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8
Q

What are the criteria for a depressive episode?

A

Min 2 wk duration

2/3: anhedonia, anergia, low mood

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9
Q

What are the causes of treatment failure?

A

Inadequate dose
Insufficient duration of treatment
Poor compliance

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10
Q

What are the options if a patient has not responded to a pharmacological treatment?

A 
Increase dose
Change to another antidepressant of same class
Change to another antidepressant of a different class
Consider augmentation with lithium or another antidepressant 
Consider other types of treatment e.g. Psychotherapy or ECT
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11
Q

What is CBT?

A

Identifies distorted/illogical thoughts and assumptions
Attempts to replace them with more ‘reality-based’ thinking and behaviours
Involves behaviour experiments, target setting and activity scheduling
Req betw 6-20 sessions

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12
Q

What is the role of CBT in depression?

A

Can be as effective as antidepressants in treating mod episodes
When used after medication can reduce rate of relapse

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13
Q

What are the indications for ECT in depression?

A

Poor response to adequate trials of antidepressants
Intolerance of antidepressants due to SEs
Severe suicidal ideation
Psychotic features or severe psychomotor retardation
Severe self neglect
Previous good response

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14
Q

Course and prognosis of depression

A

Self limiting
Without treatment 1st episode: 6 months -1yr
60% relapse
Risk of future relapse increases with each episode

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15
Q

Risk of suicide in depression

A

Rates of suicide 20 x greater in those with depression compared to general population

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16
Q

Why might you consider inpatient admission for assessment of a patient presenting with mania?

A

Reckless behaviour endangering themselves / others
Significant psychotic sx
Impaired judgement e.g. sex / money
Excessive psychomotor agitation, risk of self injury, dehydration, exhaustion
Thoughts of harming self/ others

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17
Q

What is the mainstay of treatment for BPAD?

A

Mood stabilisers
Lithium valproate
Valproic acid + carbamazepine

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18
Q

What pharmacological treatment is used to treat acute mania?

A 
Treatment free:
Atypical antipsychotic / mood stabiliser
With short course benzodiazepines
On treatment:
Optimise, consider adding another agent
Short course benzos
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19
Q

When is maintenance treatment for BPAD indicated?

A

Those who have had >1 episode

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20
Q

What is the prognosis in BPAD?

A

Poor
90% who have a single manic episode have future ones
Avg = 4 episodes in 10 yrs
10-15% have 4 or more in 1 yr = rapid cycling
10-15% complete suicide

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21
Q

What is the Monoamine hypothesis?

A

Depression and mania due to imbalances in
Noradrenaline
Serotonin
Dopamine
Likely oversimplification of reality however explains in part why antidepressants work

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22
Q

Are depression and BPAD heritable?

A

A combination of genes probably increase the risk of mood disorders which run in families
Adoption studies show higher risk in children of depressed parents even when raised in ‘depression free’ adoptive families

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23
Q

What childhood experiences might put someone at risk of depression?

A

Early childhood abuse
Relentless criticism
Parental loss
Perceived lack of affection

24
Q

What factors might out adults at risk of depression?

A 
Vulnerability factors can reduce resilience to adverse situations:
Unemployment
Lack of confiding relationship
Lower socio-economic status
Social isolation
25
Life events increase risk of depression sixfold in the 6 months following them. Rank according to degree of stress.
1. Death of spouse 2. Divorce 3. Marital separation 4. Jail term 5. Death of close relative
26
What can trigger manic episodes?
The puerperium Sleep deprivation Flying across time zones
27
What are organic causes of depression?
Cushing's, hypothyroidism, hyperparathyroidism Stroke, Parkinson's, MS Medications: beta blockers, antihypertensives
28
What are organic causes of mania?
Cushing's Head injury, MS Drugs: steroids, antidepressants, stimulants
29
What is Beck's model of depression?
Negative thinking -> depressed mood -> negative thoughts: Self = worthless, guilty Future = hopeless World = helpless
30
What is the learned helplessness model of depression?
Seligman 1976 Dogs repeatedly given unavoidable electric shocks Gave up escape attempts even once freed People learn that they cannot change their situation and give up trying
31
What is the monoamine hypothesis?
Depression is the result of a deficiency in the following: Noradrenaline: mood + energy Serotonin: sleep, appetite, memory and mood Dopamine: affects psychomotor activity
32
What biochemical findings in depression support the monoamine hypothesis?
Decr: plasma tryptophan (5HT precursor) Decr: CSF level 5-HIAA (5HT metabolite) in suicide victims Decr: CSF level homovanillic acid (dopamine metabolite)
33
What can the monoamine hypothesis not explain?
4-6 wk delay in action of antidepressants | Despite rapid chemical effects
34
How does the monoamine hypothesis explain mania
Dopamine over activity As drugs which increase dopamine levels can induce manic symptoms: bromocriptine, amphetamine, cocaine Antipsychotics (dopamine receptor antagonists) treat mania
35
What symptoms might you expect to see with seasonal affective disorder?
Predictable low mood in winter Reversed biological symptoms: overeating, oversleeping Treatment = light box
36
What symptoms might you see in atypical depression?
Reverse biological symptoms: overeating + over sleeping | May retain mood reactivity
37
What symptoms might you see in agitated depression?
Psychomotor agitation instead of retardation: Restlessness Pacing Hand-wringing
38
What symptoms might you see in depressive stupor?
Profound psychomotor retardation: Mute Stop eating + drinking Stop moving
39
What is the differential diagnosis in suspected cases of depression?
Bio: hypothyroidism, head injury, neoplastic, delirium Adjustment disorder: mild affective sx following life event Bereavement / normal sadness BPAD/schizoaffective/schizophrenia: prev manic/psychotic features Substance misuse: Postnatal depression Dementia
40
When is grief abnormal?
Extremely intense: severity of depression, sx disabling Prolonged: > 6 months without relief ? >12 now Delayed: no sign of emotional response for >2 wks Look for evidence of the person moving forward, get worried if grief becomes stuck
41
How would you investigate a person with apparent depression?
Collateral history Physical examination FBC: anaemia, TFT:hypothyroidism, G/HBA1c: DM= fatigue Rating scale to monitor severity/ treatment response If suspected cerebral pathology: CT/MRI head
42
What rating scales are used in depression?
BDI: Beck Depression Inventory HADs: Hospital Anxiety and Depression Scale Used to determine severity or monitor treatment response
43
What are the aims of CBT in depression?
To challenge negative beliefs (NATs negative automatic thoughts) Through: discussion + behavioural experiments Build alternative realistic beliefs Increase daily exposure to positive stimulating activities Activity scheduling
44
What is ECT?
Fast life saving treatment Electrodes used to produce generalised tonic-clinic seizure Whilst patient is under GA Risk = a degree of memory loss
45
What are the criteria for diagnosing a manic episode?
Symptoms for at least 1 wk Preventing work and ordinary social activities If not entirely disrupting ability to function = hypomania
46
What are the core symptoms of mania?
``` Elevated mood (can be labile) Boundless energy, overactive Increased enjoyment and interest ```
47
What are the cognitive symptoms in mania?
Inflated self-esteem and confidence Hopeful, optimistic Poor concentration, distractible, sometimes forgetful
48
What are the biological symptoms in mania?
``` Dramatically reduced sleep Increased appetite High libido Reckless, inappropriate, disinhibited behaviour Drugs, alcohol, gambling, sex ```
49
What is Type 1 BPAD
Manic episodes, interspersed with depressive episodes
50
What is Type 2 BPAD?
Mainly recurrent depressive episodes | Less prominent hypomania episodes
51
What is rapid cycling BPAD?
Four or more affective episodes/ year More common in women May respond better to sodium valproate
52
What is the differential diagnosis in cases of suspected mania?
Organic cause Schizophrenia Cyclothymia Postnatal disorders
53
How would you investigate a person with apparent mania?
``` Collateral history Physical examination FBC, TFT, CRP: rule out infection/thyroid problem Urine drug screen If indicated CT/MRI ```
54
What are CIs to ECT use?
Complete CI: Raised ICP | Relative CI: heart disease, poor anaesthetic risk
55
What are side effects of ECT?
Short term: Headache, nausea, memory loss, cardiac arrhythmia Long term: Impaired memory
56
When might ECT be used in BPAD?
In cases of prolonged or severe mania
57
How do you differentiate mania from hypomania?
In mania there will be evidence of psychotic sx Hypomania: Elevated mood, irritable, pressured speech, flight of ideas, inattention, insomnia, loss of inhibitions, incr appetite

Toni's Psych (14 decks)

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