Mood disorders

Question 1

What is the difference between mania and hypomania

Answer 1

KEY DISTINCTION IS PSYCHOTIC SYMPTOMS
mania - psychotic symptoms, or impaired function, >7ds
hypomania - not too much impaired function, >4ds

Question 2

What are the two types of bipolar affective disorder?

Answer 2

type 1 - depression and mania

type 2 - depression and hypomania

Question 3

If person presents to GP with hypomania?

Answer 3

routine referral to community mental health services

Question 4

If person presents to GP with mania?

Answer 4

urgent referral to community mental health services

Question 5

Management of mania acutely?

Answer 5

antipsychotic e.g. HOQR (haloperidol, olanzapine, quetiapine, risperidone)

maybe rapid tranqs

Question 6

Management of mania long term?

Answer 6

mood stabiliser: LITHIUM is first line

valproate, lamotrigine

Question 7

“Use of medication by the parenteral route (usually intramuscular or, exceptionally, intravenous) if oral medication is not possible or appropriate and urgent sedation with medication is needed.” What is this?

Answer 7

rapid tranqs

Question 8

Defined in accordance with the Mental Health Act 1983 Code of Practice: ‘the supervised confinement of a patient in a room, which may be locked. Its sole aim is to contain severely disturbed behaviour that is likely to cause harm to others’. What is this?

Answer 8

seclusion

Question 9

What medications are used for rapid tranquilisation of adults?

Answer 9

IM lorazepam
OR
IM haloperidol plus IM promethazine

Question 10

Man presenting with mania. On sertraline.

Answer 10

Mania? STOP THE ANTI-DEPRESSANT

anti-depressants can induce mania

Question 11

What is lithium’s therapeutic window?

Answer 11

0.4-1.0 mmol/L

Question 12

After starting a patient on lithium, how often should lithium blood levels be checked?

Answer 12

after starting, lithium levels should be performed weekly and after each dose change until concentrations are stable

thyroid and renal function should be checked every 6 months

Question 13

What should patients be issued with to prevent bad consequences of lithium toxicity?

Answer 13

info booklet
alert card
record book

Question 14

Once established as stable, how often should lithium blood levels be checked?

Answer 14

every 3 months

Question 15

How often should thyroid and renal function be checked when a patient is on lithium?

Answer 15

every 6 months

Question 16

What can lithium do to the thyroid and kidneys?

Answer 16

nephrogenic diabetes insipidus

hypothyroidism!

Question 17

What can lithium do to your ECG?

Answer 17

T wave flattening / inversion

Question 18

Lithium can cause nephrogenic diabetes insipidus and hypothyroidism. What else can it have as side effects?

Answer 18

fine tremor
D+V
weight gain
leucocytosis
idiopathic intracranial HTN
hyperPTH--> hypercalcaemia

Question 19

A patient on lithium had a fine tremor and now they’ve got a coarse tremor. Are you worried?

Answer 19

yes! coarse tremor is a feature of lithium toxicity

… along with hyperreflexia, acute confusion, seizure and coma

Question 20

How do you treat lithium toxicity ? (just a bonus q)

Answer 20

IV fluids (dilate)
haemodialysis if bad

Question 21

Dehydration or analgesics can precipitate lithium toxicity. Becomes toxic at what level in the blood?

Answer 21

> 1.5 mmol/L

Question 22

10-20% of bipolar patients have rapid cycling. What’s this defined as?

Answer 22

four or more cycles of depression and mania a year, with no intervening asymptomatic episodes

Question 23

Anhedonia, anergia and low mood are the core triad of depression symptoms. Sleep disturbance, appetite and concentration are three biological symptoms of depression. What else would you ask about?

Answer 23

SEX
guilt
worthlessness
hopelessness
SELF HARM + SUICIDE

Question 24

What kind of MOOD-CONGRUENT delusion might you get in a manic psychosis

Answer 24

grandiose

Question 25

What kind of MOOD-CONGRUENT delusion might you get in a depressive psychosis

Answer 25

derogatory, nihilistic

Question 26

What can lithium do to a) kidneys b) thyroid

Answer 26

nephrogenic diabets insipidus | hypothyroidism

Question 27

``` fine tremor D+V weight gain leucocytosis idiopathic intracranial HTN hyperPTH--> hypercalcaemia ``` = all side effects of which drug?

Answer 27

lithium

Question 28

Hypomania is lesser form of mania that does not have psychotic symptoms and doesnt reallly impair function. What do the symptoms include?

Answer 28

``` elevation of mood overfamiliarity talkativeness irritabiliity decreased need for sleep more sexual energy ```

Question 29

Which anti-depressant is particularly bad for manic switch?

Answer 29

paroxetine

Question 30

Which is faster acting, lorzzepam or diazepam?

Answer 30

lorazepam

Question 31

Give me three features of the recovery model.

Answer 31

empowerment coping strategies commitment to wellness

Question 32

a rare mood disorder with “high” and “lows” - large swings in mood and energy levels that negatively affect their ability to function, lasting for more than 2yrs. What's this?

Answer 32

cyclothymia

Question 33

How long do depressive episodes tend to last in bipolar?

Answer 33

6 months

Question 34

How do you categorise mild depression?

Answer 34

2 core symps + 2 others

Question 35

How do you categorise moderate depression?

Answer 35

2 core symps + 3-4 others

Question 36

How do you categorise severe depression?

Answer 36

3 core symps + 4+ others

Question 37

Name 3 risk factors for suicide, according to SOCIAL characteristics?

Answer 37

male, <30 or >65, single / live alone

Question 38

Name 4 risk factors for suicide, according to HISTORICAL characteristics?

Answer 38

previous attempt FHx of suicide Hx of substance/alcohol misuse recently started on antidepressants

Question 39

Name 5 risk factors for suicide, according to CLINICAL characteristics?

Answer 39

``` severe depression hopelessness psychosis agitation / anxiety concurrent physical illness ```