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Yr4 - Psych > Mood Disorders > Flashcards

Mood Disorders Flashcards

(43 cards)

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1
Q

Core symptoms of depression

A

Continuous low mood for at least 2 weeks
Lack of energy
Lack of enjoyment/interest (anhedonia)

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2
Q

Somatic symptoms of depression

A 
Sleep changes - early morning waking, insomnia
Appetite and weight changes
Diurnal variation of mood 
Psychomotor retardation/agitation
Loss of libido
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3
Q

Cognitive symptoms of depression

A 
Low self esteem
Guilt/self blame
Hopelessness
Hypochondriacal thoughts
Poor concentration/attention
Suicidal thoughts
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4
Q

Severity of depression

A

Mild - 2 core + 2 others
Moderate - 2 core + 3/4 others
Severe - 3 core + at least 4 others
- can also have severe with psychotic symptoms

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5
Q

Features of postnatal depression

A

1-2 months postpartum
Usual symptoms of depression
- worries about baby’s health or ability to cope with baby

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6
Q

Risk factors for postnatal depression

A 
PHx or FHx of depression
Older age
Single mother
Unwanted pregnancy
Poor social support
Previous PND
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7
Q

Symptoms of hypomania

A

Several of following features with considerable interference with work/social activity for at least several days

  • mildly elevated, expansive or irritable mood
  • increased energy/activity
  • increased self esteem
  • sociability, talkativeness, over familiarity
  • increased sex drive
  • reduced need for sleep
  • difficulty focussing on one task alone
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8
Q

Symptoms of mania

A 
Elevated/expansive/irritable mood (at least 1 week)
Can occur with or without psychotic symptoms
Increased energy/activity
Grandiosity/increased self-esteem
Pressure of speech
Flight of ideas/racing thoughts
Distractible
Reduced need for sleep
Increased libido
Social inhibitions lost
Psychotic symptoms
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9
Q

Define bipolar affective disorder

A

Alternating periods of abnormal mood elevation and depression associated with change or impairment in functioning

  • manic episode
  • hypomanic episode
  • depressive episode
  • mixed episode
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10
Q

Types of persistent mood disorders

A 
Cyclothymia
- mild periods of elation/depression
- early onset/chronic course
- common in relative of BPD
Dysthymia
- chronic low mood not fulfilling the criteria of depression
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11
Q

Define cyclothymia

A

Period of at least 2 years of instability of mood involving several periods of both depression and hypomania with or without intervening periods of normal mood

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12
Q

Define dysthymia

A

Period of at least 2 years of contestant or constantly recurring depression mood

  • intervening periods of normal mood rarely last longer than a few weeks
  • no episodes of hypomania
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13
Q

Define mixed affective episode

A

Episode characterised by mixture or rapid alternation of hypomanic, manic and depressive symptoms
- usually within a few hours

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14
Q

ICD 10 classification of bipolar disorder

A

Requires at least 2 episodes

- one of which must be hypomanic, manic or mixed episode

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15
Q

Differential diagnosis of mood disorders

A 
Normal fluctuations in mood
Adjustments disorders/bereavement
PTSD
Dementia and other brain disorders
Personality disorders
Anxiety disorders
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16
Q

Causes of mood disorders

A 
Biological
- genetic
- brain illness
- physical illness
Psychological
- childhood experiences
- view of yourself and the world
- personality traits
Social
- work, housing, finance
- relationships/support
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17
Q

Treatment of mood disorders

A

Biological

  • pharmacological
  • ECT - electroconvulsive therapy
  • rTMS - repetitive transcranial magnetic stimulation
  • tDCS - transcranial direct current stimulation
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18
Q

Pharmacological treatment of depression

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A 
Antidepressants
- SSRIs
- SNRIs
- TCAs
- NASSAs
- MAOIs
- Melatonin receptor agonist
- NRI
- SARI
Mood stabilisers
- Lithium
- Valproate
- Carbamazepine
- Lamotrigine
Combination therapies
19
Q

Features of monoamine hypothesis

Study These Flashcards
A

Neurotransmitter change seen depression

- in particular nor-adrenaline and serotonin

20
Q

Indications for ECT

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A 
Severe depressive illness - where other treatments not affective
Life-threatening illness
Prolonged and severe manic episode
Catatonia
High suicide risk
Stupor
Severe psychomotor retardation
21
Q

Features of pharmacological treatment of bipolar disorder

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A

Mood stabilisers
Antipsychotics
- avoid antidepressants

22
Q

Psychological treatment of mood disorders

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A 
Psychoeducation - about illness, relapse signatures, medication
CBT
IPT
Psychodynamic
Mindfulness
23
Q

Social interventions for mood disorders

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A 
Targeted interventions
- family
- housing
- finance
- employment
General coping strategies
- importance of regular structured activities
24
Q

Define mood

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A

Patient’s sustained, experienced emotional state over a period of time

25
Define affect
Transient flow of emotion in response to a particular stimulus
26
Define mood disorder
Condition characterised by distorted, excessive or inappropriate moods or emotions for a sustained period of time
27
ICD-10 types of mood disorders
``` Manic episode Bipolar affective disorder Depressive episode Recurrent depressive disorder Persistent mood disorders ```
28
Types of mood disorders
Primary - does not result from another medical or psychiatric condition Secondary - results from another medical or psychiatric condition
29
Define depressive disorder
Affective mood disorder characterised by persistent low mood, loss of pleasure and/or lack of energy accompanied by emotional, cognitive and biological symptoms
30
Monoamine hypothesis for depression
Deficiency of monoamines (noradrenaline, serotonin and dopamine) causes depression Over-activity of HPA axis
31
Predisposing factors for depressive disorder
``` Biological - Female gender (2:1) - Postnatal period - Genetics - family history - Neurochemical: ↓ serotonin, ↓ noradrenaline, ↓ dopamine - Endocrine: ↑ activity of HPA axis - Physical co-morbidities - Past history of depression Psychological - Personality type - Failure of effective stress control mechanisms - Poor coping strategies - Other mental health co-morbidities (e.g. dementia) Social - Stressful life - Lack of social support - Asylum seeker and referee population ```
32
Precipitating factors for depression
``` Biological - Poor compliance with medication - Corticosteroids Psychological - Acute stressful life events - personal injury, loss of loved one, bankruptcy Social - Unemployment - Poverty - Divorce ```
33
Perpetuating factors for depression
``` Biological - Chronic health problems - diabetes, COPD, CCF, chronic pain Psychological - Poor insight - Negative thoughts about self, the world and future Social - Alcohol and substance misuse - Poor social support - Low social status ```
34
Investigations for depression
Diagnostic questionnaire - PHQ-9 Bloods - FBC, TFTs, U+Es, LFTs, calcium levels, glucose Imaging - MRI or CT scan
35
Other depressive disorders
Recurrent depressive disorder Seasonal affective disorder - depressive episodes recurring annually at same time of year Masked depression - depressed mood not particularly prominent Atypical depression - mild-moderate depression with reversal of symptoms Dysthymia - depressive state for at least 2 years which does not meet criteria for mild depression Cyclothymia - chronic mood fluctuations over at least a 2 year period with episodes of elation and depression which are insufficient to meet criteria for hypomanic or depressive disorder
36
Management of depression
``` Biological - antidepressants - adjuvants - antipsychotics - ECT Psychological - psychotherapies - self-help programmes - physical activity Social - social support groups ```
37
Treatment of mild-moderate depression
``` Watchful waiting - reassess in 2 weeks Antidepressants - not 1st line unless - lasted long time - past history of moderate-severe depression - failure of other interventions - depression complicates care of other physical health problems Self-help programmes CBT Physical activity programme Psychotherapies ```
38
Management of moderate-severe dpression
``` Suicide risk assessment Psychiatry referral - high suicide risk - severe depression - recurrent depression - unresponsive to initial treatment Mental health act Antidepressant - 1st line = SSRIs Adjuvants - lithium or antipsychotics Psychotherapy Social support ECT - acute treatment of severe life-threatening depression - rapid response required - psychotic features - severe psychomotor retardation - failure of other treatments ```
39
ICD-10 criteria for mania
3/9 symptoms present - grandiosity/inflated self-esteem - decreased sleep - pressure of speech - flight of ideas - distractibility - psychomotor agitation - reckless behaviour - loss of social inhibitions - marked sexual energy
40
ICD-10 criteria for bipolar
At least 2 episodes in which a person's mood and activity levels are significantly disturbed - one of which must be mania or hypomania
41
Investigations for bipolar
Self-rating scales - mood disorder questionnaire Blood tests - FBC, TFTs, U+Es, LFTs, glucose, calcium Urine drug test CT head - space occupying lesions
42
Management of bipolar
Full risk assessment Ask about driving Mental health act - hospitalisation required if - reckless behaviour causing risk to patient or others - significant psychotic symptoms - impaired judgement - psychomotor symptoms For bipolar depression offer CBT ECT - severe uncontrolled mania Mood stabilisers, benzodiazepines, antipsychotics
43
Pharmacological management of bipolar
First line = antipsychotics - olanzapine, risperidone, quetiapine Mood stabilisers - lithium Benzodiazepines Rapid tranquilisation - haloperidol or lorazepam Antidepressants for depressive episode Long term management = lithium - consider valproate

Yr4 - Psych (13 decks)

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