Mood disorders Flashcards
(32 cards)
epidemiology
depression: F>M (2x);
10-20% gen pop lifetime prevalence; 5% (1/4 major depression; 10% of cases referred (2o care), 0.1% Ax
bipolar: lifetime risk 1%; M=F; average age 21y
more stats in notes
depression - aetiology
biological: genetics (40%; more with more severe); illness, substances, hormones (postnatal), brain changes
- brain: frontal lobe, limbic, neuroplasticity, NT (low NA/5HT/DA)
psych: negative thoughts, PDT, learned helplessness
social: stressors, isolation, breavement/loss, childhood (e.g. abuse), social adversity
depression - prognosis
50-60% recover, 10-25% chronic (>2y)
recurrence: 85% lifetime risk; 25%
depression - Dx criteria
add least 2 core symptoms
more than 2 weeks
depression - features
‘DEPRESSION’;
Core: persistent low mood; anhedonia (interest/enjoyment), anergia
cognitive: concentration, memory, motivation; self-esteem, confidence, worthless; guilt, hopeless, helpless; DSH/SI
biological: sleep (EMW, insomnia/hypersomnia, repeated waking), appetite and weight (?carbs); somatisation; diurnal (AM worse); psychomotor; libido; blunted affect
mania - Dx criteria
elevated/irritable mood >1/52 and 3+ of:
- decreased sleep
- grandiosity/self esteem
- pressured speech
- flight of ideas
- distractible
- psychomotor agitation/goal-directed activity
- risky/disinhibited behaviour
mania - features
> 1/52 or Ax needed
elevated/irritable mood; labile;
increased energy, decreased sleep
disinhibition, libido, grandiosity, risky behaviour
distractible, flight of ideas, rapid thinking
impaired function
DSH/SI stats
depression 5-15% suicide; BAD 10%; schiz 4-10%
alcohol 15%
SI: leading CoD 15-44 (esp. M); hanging (M), poison (F)
peaks in spring, economic depression, prominent media coverage
DSH: F>M (2x); divorced>single>widow>married
2/3
DSH/SI - RF
fixed: male, young/old, LGBTQ, prisoner, unemployment, occupations, socioeco class, immigrant/refugee, poor support/isolation
clinical: psych/physical illness (90% of psych; 25% already known); substances; PMH (DSH 50%; 100x), FHx; stressors
DSH/SI - immediate Mx
history: before during after (intent, discovery, final acts); current MSE/plans, protective factors
Risk + MSE; ?IP/MHA
reduce access, support, modify RFs (illness, social function, crisis planning)
acute mania Mx
environment: ?Ax; less stimulating, control/structure, delay decisions
check current meds and dose/compliance: ?increase dose, ?combo (APD/MS)
bio: stop ADD, start APD (olanz best); mood stabiliser (L/V); ?BZD
psychsocial: education
BPS Mx
history/collateral, ?MHA/MCA, levels, ?tranq
location and team: CRHT, EIP, IP, CMHT
investigations
BPS approach
follow-up
risk assessment
coping mechs: alcohol and drugs;deterioration
SI/DSH/neglect; dependents
reputation, disinhibtion/impulse control, grandiosity, exhaustion
risk from others: aggravation
elderly: comorbidity, access, bereavement, support, suicide
*DSH >65yo = Ax (intention)
adjustment reaction
reaction to stressors
onset
bereavement?
phases of grief
grief counselling: facilitate progression
psychotic depression
delusions: mood congruent; nihilistic, worthless, guilt, ill health, poverty, imminent disaster, may be persecutory
hallucinations: olfactory (rotting), auditory (2nd person; defamatory/accusatory)
depression severity
number of symptoms and functional impact: subthreshold 20: severe; ADD + PT
Low mood DDx
organic: delirium, dementia, SOL, substances, hypothyroid, anaemia, metabolic, hyperCa, infection, meds, pain
psych: depression, dysthymia, BAD, cyclothymia, anxiety, psychosis, PD, adjustment, ED, schizoaffective
Hypomania features
> 4 days
mildly elevated/irritable; distractible, ?labile
increased energy, increased libido, decreased sleep
risk taking, sociable, over-familiartity
psychosis in mania
10% have FRS
delusions: mood congruent; self-esteem/ideation; grandiose; irritability and suspicious (can be persecutory)
hallucinations: less common, mood congruent 2nd person auditory
patterns of mood
recurrent depression: repeated dips; otherwise normal variation
dysthymia: >2y persistent low mood, not depression
double depression: dysthymia + depression
BAD: >2 episodes, at least one manic
cyclothymia: >2y of increased variation but subthreshold
rapid cycling: >4 episodes per year
barriers to presentation
masking physical illness; physical priority
communication/time/rapport
clinician awareness
substance abuse, comorbid MH
subtle mania Sx, not seen as an issue to patients, lack of insight
NT functions
low NA: energy, motivation, attention, memory
low 5HT: mood, sleep, food cravings
low DA: anhedonia, cravings, compulsive behaviour
cortisol: stress; excess = toxic to hippocampus
Bipolar - aetiology
biological: genetic (70%), FDR 7x, substances
psychological: PDT, negative thoughts
social: stressors, interpersonal conflict
