Mood disorders Flashcards Preview

Psych > Mood disorders > Flashcards

Flashcards in Mood disorders Deck (55):
1

what are the 3 main symptoms depressive illness, and for how long should the patient be experiencing them

low mood, anhedonia, reduced energy. at least 2 of these for at least 2 weeks

2

features depression

decreased concentration, low self esteem, ideas of guilt and self worth, hopelessness, thoughts self harm, decr sleep or appetite

3

what is common in depression with regards to pattern of the depression

diurnal variation- worse on waking. early morning waking

4

what are the features of psychotic depression

delusions- nihilistic, hallucinations- 2nd person

5

what differentiates psychosis in schizophrenia and depression

the thought content in depression is mood congruent

6

differentials for depression

normal sadness to bereavement, schizophrenia if psychotic, alcohol/drug withdrawal

7

aetiology of depression

genetics, parental loss, early childhood, abuse, alcohol/drug use, severe physical illness, life event, deprivation, lack of relationship

8

neurochemical changes in depression

decreased monoamines- noradrenaline and serotonin.

9

what hormone is high in depression

cortisol

10

what system isn't functioning well in depression

limbic system and prefrontal cortex

11

what guides the severity of the depression

no of symptoms, severity of symptoms, degree of associated distress, interference with daily life

12

management mild depression

self help groups, physical activity sessions, computerised CBT

13

management moderate depression

add antidepressant and individual CBT

14

management severe depression

ECT

15

how long to continue antidepressants for

6 months- reduced relapse

16

what can you give for resistant depression

combine (augment) antidepressant with lithium, atypical antipsychotic or another anti depressant

17

which antidepressant is the only one licensed for use in the UK for adolescents

fluoxetine

18

what emergency can you get from antidepressants

serotonin syndrome

19

what is serotonin syndrome

increased serotonin- agitation,confusion, tremor, tachycardia, hypertension

20

how do SSRIs work

selective serotonin reuptake inhibitor. inhibit the reuptake of serotonin

21

examples of SSRIs

citalopram, fluoxetine, setraline

22

when should you give SSRIs

once a day- in the morning

23

side effects SSRIs

N&V, headache, diarrhoea, dry mouth, insomnia. linked to suicidality

24

what is the syndrome you get when stopping SSRIs

discontinuity syndrome- shivery, dizzy, anxiety, headache, nausea, 'electric shocks'

25

how long should you give antidepressants for

6 months after improvement of symptoms

26

what is SNRI

serotonin- noradrenaline reuptake inhibitor

27

example of SNRI

venlafaxine

28

how does venlafaxine work

block serotonin and NA reuptake. less sedation and anti muscarinic side effects. hypertension so don't give to those prone to arrhythmia or hypertension

29

what is NSSA and example

noradrenergic and specific serotonin antidepressant. mirtazapine

30

how do MAOIs work

inhibit monoxidase A and B so increasing levels NA, dopamine, serotonin

31

TCAs examples

nortryptiline, amytryptilline, imipramine, clomipramine, doxepin

32

how do TCAs work

potentiate action of monoamines inhibiting their uptake into nerve terminals. block reuptake of both serotonin and NA

33

side effects TCAs

dry mouth, constipation tremor, QT prolongation, arrhythmias, convulsants, weight gain, sedation, mania

34

what is Becks cognitive triad

thought content often contains pessimistic thoughts- the self, the world, the future

35

how long should you treat the episode at full dose

4-6 weeks. takes about 2 weeks to start working so don't change it too soon

36

what muscle relaxant is used in ECT

suxamethonium- to relax muscles and so intensity of movement during seizure is reduced

37

contraindications to ECT

absolute-incr ICP, prev MI (as HR and BP incr), aneurysm. relative- any medical problem

38

indications for ECT

depression- severe life threateining resistant; catatonia; mania; schizophrenia ?

39

how many ECTs is the usual course

12 but 7-9 usually needed to achieve remission

40

side effects ECT

mortality low, muscle aches, confusion, short term memory loss.

41

what drugs can be used to reduce relapse after ECT

nortryptilline and lithium

42

lifetime risk depression

10-20%, rates almost doubled in women

43

what can the episodes be in bipolar

depressive, manic, hypomanic, mixed

44

what is the difference between manic and hypomanic

hypomanic is less severe and no psychotic symptoms

45

what is the ICD10 definition diagnosing bipolar

at least 2 episodes including one manic/hypomanic

46

what is the difference between bipolar type 1 and type 2

type 1- manic, type 2-hypomanic

47

what is cyclothymic disorder

mod fluctuations lasting at least 2 years, with depressive and hypomanic episodes but not enough to meet diagnostic

48

features manic/hypomanic episode

elated or irritable. incr psychomotor activity, incr optimism, rapid thinking and speech, decr social inhibition, incr self esteem, mania only- mood congruent delusions

49

ddx mania

substance abuse, endocrine, schizophrenia, schioaffective, personality disorders

50

prevalence bipolar 1 an 2

1% 1, 1.5-2% 2

51

when is peak age of onset in bipolar

20s

52

aetiology

predisposing- genetics. precipitating- stress, life events, sleep deprivation, illict drugs, childbirth, hyperthyroidism, steroids, epilepsy

53

management

anti manic drugs- lithium, valproate, carbamazepine, lamotrigine. atypical antipsychotics- olanzapine etc

54

psychological treatment bipolar

focus on depressive symptoms, problem solving, promoting social functioning, education

55

prognosis

90% recurrence after single episode, worse prognosis if rapid cycling, better if type 2