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mood disorders Flashcards

1
Q

Core symptoms of depression (present for 2weeks, most days)

A 
Low mood
Anhedonia
Reduced energy (anergia)
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2
Q

Additional symptoms of depression (2 weeks)

A 
Reduced concentration
Reduced self-esteem
Ideas of guilt and unworthiness
Pessimism about the future
Ideas/Acts of self-harm/suicide

Disturbed sleep
Disturbed appetite

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3
Q

Somatic symptoms of depression (overlaps with DSM5)

A

Markedly reduced appetite
Weight loss (>5% of normal body weight in 1 month)
Early morning wakening (at least 2 hours before usual time)
Diurnal variation in mood (depression worse in the morning, improving through the day)
Psychomotor retardation/agitation
Loss of libido
Marked anhedonia
Lack of emotional reactivity

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4
Q

What is depression with psychosis?

A

In severe cases of depression!

Delusions:
Content congruent with low mood
Worthlessness, guilt, ill health, poverty, imminent disaster

Nihilistic delusions - belief that the self, part of the self, part of the body, other persons, or the whole world has ceased to exist
Persecutory delusions can also occur

Hallucinations:
2nd person auditory - eg. accusatory
Olfaction - eg. filth, rotting flesh

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5
Q

What are important risks for suicide in depression

A

Self-harm

Hopelessness

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6
Q

What is the suicide rate in depression?

A

5-15% completed suicide

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7
Q

What is ICD 10

A

Used to classify depression into mild, moderate and severe

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8
Q

What is a mild depressive episode according to ICD 10

A

At least 2 or 3 core symptoms
With additional symptoms overall at least 4 symptoms

With or without somatic syndrome

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9
Q

What is a moderate depressive episode according to ICD 10

A

At least 2 or 3 core symptoms
With additional symptoms overall at east 6 symptoms

With or without somatic syndrome

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10
Q

What is a severe depressive episode according to ICD 10

A

ALL 3 CORE symptoms

Plus additional symptoms giving at least 8 overall

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11
Q

What is a severe depressive episode with psychotic symptoms according to ICD 10

A

ALL3 CORE symptoms
Plus additional symptoms giving at least 8 overall

PLUS
delusions, hallucinations or depressive stupor (speechless and motionless for an extended period)

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12
Q

Psychiatric differentials for mood symptoms

A

Schizophrenia
Anxiety disorder
Eating disorder
Dementia

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13
Q

Organic differentials for mood symptoms

A 
Multiple sclerosis
Parkinsons
CVA
Head injury
Cerebral tumours

Cushing’s/Addison’s disease

Iatrogenic - L-Dopa, opiates

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14
Q

When are patients managed in hospital rather than Community (GP)

A

Severe depression
First line treatment unsuccessfull
Levels or risk escalating

Community mental health team or Crisis team may be indicated

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15
Q

Epidemiology of depression

A

M:F = 1:2
Lifetime prevalence of depressive symptoms is 10-20%
Point prevalence of major depressive illnessis 5%

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16
Q

What is the aetiology of depression

A

Biological: substance misuse, genetics, serious illness, hormonal changes

Psychological: negative thoughts, learned helplessness

Social: life events, social isolation, bereavement, loss, childhood abuse, social adversity

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17
Q

Prognosis of depression

A

50-60% will recover within a year

Chronic depression (more than 2 years) occurs in 10-25%

5-15% will die by suicide

RELAPSE is a PROBLEM:
75% will have one relapse in the next 10 years

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18
Q

Investigations for physical causes of mood disorders

A

CRP or ESR for infection

Vit B12 and folate for deficiencies

Urine drug screen

EEG - if epileptic focus or intracranial pahology suspected

Brain CT and MRI
EEG

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19
Q

List the social interventions in mood disorders

A

Support with regard to education, training, employment

Carer support

Community psychiatry nurse (CPN) and outpatient appointments to monitor symptoms, mood, mental state (for severe depression)

Support with regards to housing and benefits

Work around social inclusion

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20
Q

List the psychological treatments of depression

A

CBT
Interpersonal therapy
Psychoeducation (empower to know about disease)
Self-help materials

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21
Q

List the biological treatments of depression

A

1st line SSRIs

In treatment resistant depression, augmentation with:
2nd generation antipsychotics
Lithium
Triiodothyronine

Electroconvulsive Therapy (ECT)

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22
Q

STEP 1 of management of depression (suspected presentation)

A 
Assess
Active monitoring
Psychoeducation
Computerized CBT
Sleep hygiene
Guided self-help
23
Q

STEP 2 of management of depression (mild-moderate)

A

PRIMARY CARE

Low-intensity psychological interventions (such as self-help)
Medication -SSRIs such as citalopram, sertraline, fluoxetine, paroxetine

24
Q

STEP 3 of management of depression (moderate-severe) or treatment resistant

A

PRIMARY CARE
Medication
High-intensity psych interventions (individual CBT and IPT)
Consider referring ot secondary care

25
STEP 4of management of depression (severe complex depression, life-threatening, severe self-neglect)
SECONDARY care ``` Medication - here, other agents might be considered, including drugs like: venlafaxine (SNRI) mirtazapine (NASSA) imipramine (TCA) phenelzine (MAOI) ``` adjunctive medications: such as antipsychotics or lithium High-intensity psychological interventions ECT Crisis Resolution and Home Treatment (CRHT) Multidisciplinary (MDT) approach Inpatient care
26
How long should pharmacotherapy be continued for after recovery from a single episode of depression
6 months to reduce risk of relapse
27
How long should pharmacotherapy be continued for after recovery from recurrent depression
2 years
28
Epidemiological risk factors for suicide
Male of any age (although younger females more likely to self-harm) Being lesbian, gay, bisexual, or transgender (particularly younger people) Prisoners (especially remand) Being unmarried (single, widowed, divorced) Unemployment Working in certain occupations (farmer, vet, nurse, doctor) Low socioeconomic status Living alone, social isolation
29
Clinical risk factors for suicide
Clinical factors: Psychiatric illness or personality disorder (see Fig. 6.2) Previous self-harm Alcohol dependence Physical illness (especially debilitating, chronically painful, or terminal conditions) Family history of depression, alcohol dependence or suicide Recent adverse life-events (especially bereavement)
30
Management of self-harm
Initial assessment of physical health, mental state, safeguarding, social circumstances and risk of repetition/suicide Comprehensive psychosocial assessment Monitor accordingly Self-harmers are 66x more likely to die by suicide
31
Factors predicting repetition of self-harm
No. of previous episodes Personality disorder History of violence Alcohol misuse/dependence Being unmarried
32
Which factors indicate suicidal intent?
``` Precautions to avoid intervention Planning Leaving a note Use of violent methods Perceived lethality by patient (did you think that it would kill you?) ```
33
Investigations for mood disorders
Social: collateral info from GP, community mental health team, family Consider home visit to assess self-care Psychological: Beck Depression Inventory (BDI) Hospital Anxiety and Depression Scale (HADS)
34
Action of antidepressants
most inhibit serotonin reuptake or noradrenaline reuptake or both
35
Side effects of SSRIs
(fluoxetine, citalopram, sertraline, paroxetine) ``` Nausea Insomnia Apathy/fatigue Diarrhoea Dizziness Sweating ``` Akathisia Sexual dysfunction Paroxetine causes cardiac defects in first trimester
36
Indications and side effects of TCAs
Amitryptiline, Imipramine, Clomipramine ``` Toxic in overdose! Anti-muscarinic side effects: Dry mouth Blurred vision Constipation Retention ``` ``` Sedation Weight gain Dizziness Hypotension Delirium ``` Indicated in pregnancy! (not teratogenic)
37
Side effects of SNRIs
2nd or 3rd line treatment Venlafaxine Duloxetine Similar SEs as SSRI with more discontinuation symptoms (headache, distress, depression)
38
Side effects of MAOI and indications
Phenelzine, Trancypromine Used in treatment resistant depression and atypical depression Risk of CHEESE Reaction (tyromine containing foods) Anti-muscarinic side effects
39
Indications for ECT
Treatment resistant depression Life-threatening severe depression Treatment resistant mania Catatonia
40
Contraindications to ECT
Cochlear implant (ABSOLUTE) ``` Raised ICP History of stroke, MI, aortic aneurysm Uncontrolled arrhythmias DVT Decompensated cardiac failure ```
41
Side effects of ECT
Headache Confusion Impaired cognitive function Temporary retro and anterograde amnesia Some events in previous years can be lost
42
Indications of antidepressants
``` Depressive illness Anxiety disorders Neuropathic pain Insomnia Bulimia nervosa Impulsivity Migranies IBS Chronic fatigue syndrome ```
43
What is Mirtazapine?
Noradrenaline and specific serotonergic antidepressant (Nassa)
44
When is Mirtazapine used. Side effects?
May be superior to SSRIs in depression Reduce anxiety Combine with other antidepressants if treatment resistant Sedation and/or weight gain on relatively low doses
45
Interactions with St John's Wort
Inducer, leading to loss of therapeutic effect: Oral contraceptive Digoxin Warfarin HIV protease inhibitor Anticonvulsants (phenytoin, carbamazepine)
46
Which antidepressants have the greatest withdrawal effects
paroxetine (SSRI) venlafaxine (SNRI) Tapering the dose down over 4 weeks can help reduce the symptoms
47
Which antidepressants do not cause weight gain?
SSRIs | SNRIs
48
Which antidepressants cause weight gain?
TCAs | Most caused by NaSSA
49
Which antidepressant does NOT cause sedation?
SSRIs
50
Epidemiology of self-harm
Male to female ratio - 1:2 Divorced > Single > Widowed > Married Two-thirds of people who harm themselves are under 35 years of age Overdoses and cutting are the most common methods
51
Factors of self-harm
Predisposing Precipitating Perpetuating
52
Indications for ECT
Treatment-resistant depression Life-threatening severe depression Treatment-resistant mania Catatonia A patient will typical receive between 4 and 12 sessions in a course of ECT. The sessions usually occur twice per week.
53
Mechanism of ECT
Modulation of neurotransmitter functioning Changes in regional blood/activity Modulation of neuronal connectivity Alterations of neuronal structures, including hippocampal neurogenesis
54
How is ECT monitored?
With an EEG | Can see when the seizure has finished

Psychiatry (15 decks)

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