Mood disorders Flashcards
(29 cards)
What is bipolar disorder?
Episodes of mania and depression and periods in between in which the patient is normal. Patients may experiences one type more than the other
What are the symptoms of mania?
- elated/expansive/irritable mood and 3 other symptoms of the following: - increased sex drive and loss of inhibition - increased energy - reduced sleep - Grandiosity/increased self esteem - distractible - pressure of speech - flight of ideas - social inhibitions lost - psychotic symptoms (hallucinations and delusions)
What are the symptoms of hypomania
3 or more characteristic symptoms of mania for 4 days however not severe enough to interfere with social/occupational functioning
What is a mixed episode
rapid alternation of manic and depressive symptoms
a period (at least 1 week) in which the criteria are met for a manic/hypomanic episode and at least 3 symptoms of depression for most of the days during the manic episode
OR
a period of major depression with at least 3 symptoms of manic/hypomannia present
What is rapid cycling bipolar disorder
experience of at least 4 episodes of depression, mania. hypomania or mixed within a year
How is bipolar classified
Bipolar I = 1+ manic episodes or mixed episodes without any depressive episodes
Bipolar II = 1+ depressive episode with at least 1 hypomanic episode
What are the complications of bipolar disorder
SUICIDE and SELF HARM
- financial issues from overspending during mania
- STIs and unplanned pregnancies
- Damage to reputation, income, occupation and relationships
- self neglect, exhaustion, dehydration
- exploitation by others
- alcohol and substance misuse
- harm to others
What are the differentials for bipolar
in some cases some of these diagnoses may coexist
- unipolar depression
- cyclothymia - chronic disturbance of mood, periods of hypomania and depression
- schizophrenia
- substance misuse
- organic brain disease
- metabolic disease -> thyroid, cushings
- personality disorder - mood changes are usually rapid and do not go in cycles
What is the pharmacological management for bipolar disorder
Mood Stabilizers
- Lithium Carbonate - therapeutic range is 0.4-1 mmol/L
- Sodium valproate - not given to women of child bearing age
- Lamotrigine - use mainly for bipolar depression
Antipsychotics - haloperiodol - olanzapine - quetiapine if 2 antipsychotics do not work add Lithium or sodium valproate
Avoid antidepressants as this can lead to an episode of mania
What is the social management for bipolar
make patients aware of support groups and websites they can use for advice
help with getting back to work
entitlement to benefits
PIP
housing options
Driving - must not drive during acute mania - must inform DVLA
Carers care plan
Avoiding alcohol and substance misuse
Avoiding caffeine
smoking cessation
adequate amount of sleep and avoiding shift work
What are the psychological management strategies for Bipolar
identify personal, social, occupational and environmental triggers
encourage compliance
Psychological interventions specifically for bipolar disorder
CBT to treat depression
Self monitoring of symptoms
Which physical health checks are needed for patients with Bipolar Disorder?
Weight/BMI
Bp and Pulse
Metabolic - fasting blood glucose, HbA1c, lipid profile
LFTs
U+Es, TFTs, Calcium levels if on long term lithium
What are the core symptoms of depression
Persistent low mood
lack of energy
lack of interest/pleasure
What are the other symptoms of depression
Early morning wakening Diurnal variation Weight loss Decreased appetite Decreased libido low self esteem worthlessness hopelessness feelings of guilt psychomotor retardation poor concentration
What are the symptoms of psychotic depression
hallucinations - mainly auditory
delusions - mood congruent, guilt, nihilistic, persecutory, hypochondriasis
Which investigations should be done if depression is suspected?
Used to exclude organic causes Bloods: FBC - to rule out anaemia TFTs - rule out hypothyroidism LFTs U+Es Glucose Calcium - hypercalcaemia inflammatory markers
HIV/syphilis test, drug screening - if evident from the history
What are the differentials for depression
Bipolar disorder - ask about any periods where their mood was very high
Schizophrenia - may coexist
dementia - may occasionally present as dementia
Seasonal affective disorder
Bereavement
Organic cause e.g. hypothyroidism
How is depression classified
Mild = 2 core + 2 other symptoms (still able to function)
Moderate = 2 core + 3 others
Severe = 3 core + 4 others
Also severe with psychotic symptoms
What is atypical depression
Oversleeping Overeating Variably depressed mood Extreme fatigue and heaviness in limbs Pronounced anxiety
Which diseases are associated with depression?
Eating disorders Dysthymia Substance misuse other psychiatric disorders may coexist PTSD Parkinsons Cerebrovascular disease endocrine disorders Cancer esp Pancreatic autoimmune conditions
What should be assessed when a patient presents with symptoms of depression
Full history
MSE
Risk assessment both to self and others and driving
Ask about organic causes for e.g. weight gain and hair loss for hypothyroidism
Establish onset, speed of onset and duration
Ask about social situation - job, relationship difficulties, housing, finance
Collateral hx from family/carer - idea of premorbid personality
Ask about premorbid personality
Past psychiatric hx
assess for psychotic symptoms
What is the pharmacological management for depression
Moderate to severe depression antidepressants are used
1st line - SSRIs
e.g. sertraline, citalopram, fluoxetine (children and young people), paroxetine
try two SSRIs before SNRIs/TCAs
SNRIs = duloxetine and venlafaxcine
TCAs = amitryptaline and clomipramine
What monitoring is needed when a patient first starts an SSRI
If not suicidal initial follow up after 2 weeks and 2-4 weeks monitoring
make patient aware of any side effects and that suicidal ideation may increase in first few weeks
If at risk of suicide see after 1 week, if very high risk only prescribe limited amount to reduce risk of OD.
Which treatment is used in severe treatment resistant depression
ECT
