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PM3B > (PM3B) Depression + Bipolar Disorder > Flashcards

(PM3B) Depression + Bipolar Disorder Flashcards

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1
Q

In psychiatric terms, what is ‘affect’?

A

An objective description of a person’s emotional behaviour

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2
Q

In psychiatric terms, what is ‘mood’?

A

An individual’s prevailing subjective emotional state

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3
Q

What are some examples of affective disorders?

A

(1) Unipolar depression/ major depressive disorder

(2) Bipolar disorder

(3) Dysthymia (subthreshold depression)

(4) Cyclothymia

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4
Q

What is classification of affective disorders usually based on?

A

(1) Severity

(2) Presence/ absence of physical features (physical/ somatic)

(3) Presence/ absence of psychotic features

(4) Course (duration + recurrence)

(5) Presence/ absence of intervening manic phases

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5
Q

What is the system in the UK for classification of mood disorders?

A

(1) ICD-11

OR

(2) DSM-V

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6
Q

What is depression?

A

(1) Depressed mood

(2) Loss of pleasure in activities

(3) Definition relies on what a normal response to a situation should be (socially + culturally)

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7
Q

What percentage of the population have major depression?

A

~5%

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8
Q

What percentage of suicides are males?

A

~75%

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9
Q

What main groups of factors may give rise to depression?

A

(1) Brain regional changes

(2) Genes + environment

(3) Medical conditions + medications

(4) Biochemical

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10
Q

What effect can genes and environment have on causation of depression?

A

(1) Family history is common

(2) Genetic/ environmental factors

(3) Changes in temperament/ personality

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11
Q

How can depression be diagnosed?

A

(1) ICD-11 – must exhibit ≥2 key symptoms

(2) DSM-V – must exhibit ≥1 key symptoms

Key symptoms are
- Low mood
- Loss of interest/ pleasure
- Loss of energy (ICD-11 only)

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12
Q

What is the NICE guideline preference of depression diagnosis system?

A

DSM-V

Has more evidence

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13
Q

What scales are often used to formalise a potential diagnosis of depression?

A

(1) Hamilton Depression Scale Rating

(2) Beck Depression Inventory

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14
Q

What are two vitally important questions for a healthcare professional to ask a patient potentially suffering from depression?

A

(1) During the last month, have you often been bothered by feeling down, depressed, or hopeless?

(2) During the last month, have you often been bothered by having little interest/ pleasure in doing things?

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15
Q

What are some examples of important depression questionnaires?

A

(1) HADS

(2) BDI-II

(3) PHQ-9

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16
Q

How many symptoms present does DSM-V require to diagnose depression?

A

5 out of 9 symptoms present

1 of 2 KEY symptoms must be present

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17
Q

How many symptoms present does ICD-10 require to diagnose depression?

A

4 out of 10 symptoms

2 of 3 KEY symptoms must be present

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18
Q

What are the 10 symptoms used to categorise depression in ICD-10?

A

(1) Depressed mood

(2) Loss of interest

(3) Reduced energy

(4) Loss of confidence/ self-esteem

(5) Inappropriate guilt/ self-reproach

(6) Recurrent thoughts of death/ suicide

(7) Diminished ability to think/ concentrate (indecisiveness)

(8) Change in psychomotor activity with agitation/ retardation

(9) Sleep disturbance

(10) Change in appetite + weight change

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19
Q

What are the 9 symptoms used to categorise depression in DSM-V?

A

(1) Depressed mood (self-report or other’s observation

(2) Loss of interest or pleasure

(3) Fatigue/ loss of energy

(4) Worthlessness/ inappropriate or excessive guilt

(5) Recurrent thoughts of death/ suicidal thoughts/ suicide attempts

(6) Diminished ability to think/ concentrate (indecisiveness)

(7) Psychomotor agitation/ retardation

(8) Insomnia/ hypersomnia

(9) Significant appetite/ weight loss

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20
Q

How is sub-threshold depression diagnosed using the DSM-V or ICD-11 scale?

A

(1) DSM-V: 2-5 symptoms (inc. 1 key)

(2) ICD-11: Cannot be diagnosed

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21
Q

How is mild depression diagnosed using the DSM-V or ICD-10 scale?

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A

(1) DSM-V: >5 symptoms

(2) ICD-10: 4 symptoms

22
Q

How is moderate depression diagnosed using the DSM-V or ICD-10 scale?

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A

(1) DSM-V: Between mild + severe

(2) ICD-10: 5-6 symptoms

23
Q

How is severe depression diagnosed using the DSM-V or ICD-10 scale?

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A

(1) DSM-V: Several in excess of 5

(2) 7+ symptoms

24
Q

What are the treatment aims for treatment of depression?

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A

(1) Prevent suicide

(2) Identification of possible primary causes

(3) Provide symptomatic therapy

(4) Investigate adverse social, domestic, financial circumstances + provide support

(5) Initiate long-term therapy to prevent relapse/ recurrence

25
What are the 3 principle divisions of treatment for depression?
(1) Pharmacological (2) Psychological (3) Psychosocial
26
What is the stepped care model?
Helps with diagnosis + management of depression Begins at Step 1 and increases with severity (1) Assessment, support, monitoring, psychoeducation + referral for further assessment (2) For patients diagnosed with persistent sub-threshold depressive symptoms – low intensity psychosocial + psychological interventions + medications + further assessment + interventions (3) For persistent sub-threshold/ mild-moderate depression who have not responded to Step 2 interventions OR moderate-severe depression – medication + high-intensity psychological interventions + combined treatments + collaborative care (4) For severe + complex depression + risk to save life (severe self-neglect) – medication + high-intensity psychological interventions + combined treatments + multi-professional and inpatient care + crisis service
27
What are some examples of high-intensity psychological care?
(1) Individual cognitive behavioural therapy – CBT (2) Interpersonal therapy (3) Behavioural couples therapy
28
Name 4 types of antidepressants.
(1) Monoamine oxidase inhibitors (MAOIs) (2) Inhibitors of monoamine uptake - Selective Serotonin Reuptake Inhibitors (SSRIs) - Tricyclics (TCAs) (3) Modulators of serotonin (5HT) receptors and other NT receptors (4) St John's Wort
29
What is the typical first line medication given for treatment of depression?
Selective serotonin reuptake inhibitors (SSRIs)
30
What are SNRIs?
Serotonin and noradrenaline reuptake inhibitors Potent inhibitors SERT venlafaxine 75mg duloxetine 60mg
31
What are NaSSas?
Noradrenergic and specific serotonergic antidepressant ANTAGONISTS of 5HT mirtazapine 15-30mg, 2-4wks
32
What are SARIs?
Serotonin antagonist and reuptake inhibitor inhibits SERT trazodone 150mg
33
What are SMSs?
Serotonin modulator and stimulator e.g. vortioxetine – inhibits reuptake serotonin (SERT) + modulates many 5HT receptors
34
What are NRIs?
Noradenaline reuptake inhibitor e.g. reboxetine
35
Give some examples of SSRIs. S F P C E
(1) Sertraline 50-200mg, incr if req t (2) Fluoxetine 20mg incr up to 60mg/day interval 3-4 weeks (3) Paroxetine 20mg incr max up to 50mg (4) Citalopram 20 if req max 40mg (5) Escitalopram 10mg if req max 20mg
36
Why are SSRIs the preferred first line medication for the treatment of depression?
(1) Fewer side effects (2) No anticholinergic (3) Lack of toxicity in overdose (4) Less sedating than TCAs
37
What are RIMAs?
Subclass of MAOI Reversible inhibitor MAO-A Safer + fewer side effects than other MAOIs e.g. moclobemide
38
What is electroconvulsive therapy?
Associated with neuronal death – specific mechanism unknown For severe psychotic depression + bipolar disorder with psychotic symptoms
39
What is the important information for a patient when initiating therapy for depression?
(1) Full antidepressant effect takes time (e.g. 2-4 weeks) (2) Important to take as prescribed and continue after remission (e.g. 6 months+) (3) Possible side-effects (4) Potential interactions (5) Antidepressants are not addictive (6) Risk and nature of discontinuation symptoms with all antidepressants
40
What is the follow-up following initiation of therapy for depression?
Typically see patient after 2 weeks of initiation Every 2-4 weeks after for 3 months (may then extend)
41
What is mania?
Severe + recurrent psychotic affective disorder (1) Abnormally elevated mood, unwarranted optimism, exuberance, over-confidence, inflated self-esteem, hyperactivity, excessive libido and little sleep (2) Increased drive and extrovert behaviour but often socially tactless (3) Makes compliance problematic (4) Attacks last ≥1 week
42
What lasts longer, manic or depressive episodes?
Usually depressive
43
What are the classifications of bipolar?
(1) Bipolar I disorder – more severe mania (2) Bipolar II disorder – less severe mania (hypomania)
44
What are the aims of treatment of bipolar disorder?
(1) Control manic and depressive attacks (2) Minimise recurrence and stabilise mood
45
How are manic attacks normally controlled?
Sedative anti-psychotics
46
What is the long-term treatment for prophylaxis of bipolar disorder?
(1) Lithium (2) Anticonvulsants – e.g. sodium valproate (3) Other anticonvulsants – lamotrigine/ carbemazepine (4) Atypical antipsychotics – olanzapine or quetiapine (5) Benzodiazepines may be used short-term Antidepressants are not normally used
47
Why does lithium in the treatment of bipolar disorder require very careful monitoring?
Very narrow therapeutic window
48
Why are antipsychotics given in the treatment of bipolar disorder and mania?
Can give control of mania + some help to prevent relapse Mood stabiliser
49
What are some examples of antipsychotics given in the treatment of bipolar disorder and mania?
(1) Olanzapine (2) Quetiapine (3) Haloperidol (4) Risperidone
50
What are some antiepileptics and anticonvulsants given in the treatment of bipolar disorder and mania?
(1) Valproate – possible effects at voltage-gated sodium channels + GABA signalling (2) Carbamazepine – patients unresponsive to lithium (3) Lamotrigine – prophylaxis of bipolar disorder + depression (NOT mania)

PM3B (33 decks)

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