Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Psychiatry Block > Mood Disorders > Flashcards

Mood Disorders Flashcards

1
Q

physical symptoms a pt with depression might present with? (or somatic symptoms*)

A 
lack of energy
weight loss
appetite loss
early morning wakening, with diurnal mood variation-worse on a morning
fatigue
loss of libido
psychomotor agitation/retardation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

core symptoms of depression?

A

low mood-continuous for at least 2 weeks
lack of energy
anhedonia-inability to take pleasure in activities previously enjoyed by the pt. ask the pt if they can still enjoy doing things?

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

definition of mild depression?

A

2 core symptoms plus 2 others

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

depressive cognitions?

A

guilt and self blame
low self esteem
hopelessness
hypochondriacal thoughts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

how can the features of depression be distinguished from dementia?

A

dementia doesn’t cause depressive cognitions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

logical errors/cognitive distortions in depressive disorders?

A

exaggeration-small mistakes and problems are magnified, and so thought of as major failures or issues.
catastrophizing-expecting serious consequences of minor problems
minimization-minimizing or ignoring successes or personal positive qualities
mental filter-dwelling on personal shortcomings or on the unfavourable aspects of a situation while overlooking the favourable parts.
overgeneralizing-thinking that the bad outcome of 1 event will be repeated in every similar event in the future.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

what is dysthymia?

A

formerly depressive personality disorder.
person is persistently gloomy and pessimistic with little capacity for enjoyment. Chronic, constant or fluctuating mild depressive symptoms.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What appearance might you expect a manic patient to have?

A

dressed up too much for the setting
bright clothes, excessive makeup such as lipstick
restless, up and down?
pressure of speech

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

definition of moderate depression?

A

2 core symptoms plus 3-4 others

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

definition of severe depression?

A

3 cores symptoms plus at least 4 others

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

how does hypomania differ from mania?

A

manic symptoms in hypomania but without significant psychosocial or functional impairment
symptoms for at least 4 days, 1 week in mania

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

clinical features of mania?

A

mood: elated, euphoria, irritability or tendency to become angry may be apparent, elation can be interrupted by sudden, brief episodes of depression
appearance: suited to prevailing mood e.g. brightly coloured and ill assorted clothes, may appear tidy and dishevelled in severe disease
behaviour: overactivity, distractability, socially inappropriate behaviour, overfamiliarity, reduced sleep but wakes feeling lively and energetic, may rise early and engage in noisy activity, increased appetite and libido
thinking and speech: flight of ideas, expansive ideas, grandiose delusions, hallucinations-usually consistent with mood and fluctuating in content, pressure of speech
impaired insight

most patients can exert some control over their symptoms for a short time, so severity of disorder may be underestimated when being interviewed as they try to avoid treatment they deem unnecessary, so should try to interview an informant as well as the patient.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

what name is given to the rare state a severe manic pt can enter where they become immobile and mute?

A

manic stupor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

what is rapid cycling?

A

4 or more episodes of mood disorder (depressive, manic, hypomanic or mixed e.g.depressed mood with restlessness and overactivity of manic episode) occur within 1 year.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

what name is given if there is more or less an equal mixture of features of mania in bipolar and schizophrenia?

A

schizoaffective

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

what endocrine disorder may cause symptoms suggestive of mania?

A

hyperthyroidism
so should do TFTs and look for physical signs of elevated thyroid hormones e.g. weight loss, heat intolerance, tachycardia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

bipolar prevalence?

A

between 1 and 6 per 1000

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

how is risk of bipolar and other mood disorders affected by having a 1st degree relative with bipolar?

A

12% lifetime risk of bipolar
12% lifetime risk of recurrent depressive disorder
12% risk of dysthymic or other mood disorders

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

how long does each bipolar episode tend to last for?

A

generally several months, usually 3

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

what may be responsible for mildly disinhibited behaviour, other than mania?

A

intoxication with drugs or alcohol

frontal lobe lesion causes e.g. cerebral neoplasm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

what events may trigger a manic episode in bipolar?

A

an operation
physical illness
drug treatment, especially steroids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

specific treatments for mania?

A

antipsychotic-atypical e.g. olanzapine or risperidone, usually 1st choice treatment
lithium-used mainly if milder manic episode, espec. when intention to continue it in the LT to prevent relapse, can also be used in comb with antipsychotics-but caution if alongside haloperidol as EP effects e.g. tardive dyskinesia, occur commonly. effect may take several days to begin.
valproate-effective in acute mania, less effective than antipsychotics but causes less ADRs, so may be more useful if mild manic illness without psychotic features, can give high LD in contrast to lithium, so more rapid response and shorter hospital stay.
carbamazepine
ECT-NOT 1st line

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

specific tment for acute bipolar depression?

A

antidepressant e.g. SSRI
antipsychotic e.g. the atypical quetiapine-little risk of inducing manic symptoms, olanzapine may be effective but more so if combined with an SSRI
lithium-less effective than in mania, but sometimes used if less severe but recurring depression when lithium planned for prophylactic use after the acute episode, and may increase dose of lithium tment if already on this and experience a depressive episode
lamotrigine may be effective
ECT if alternatives not effective
CBT and interpersonal psychotherapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

tment of mixed mood episodes?

A

manic symptoms usually predominate over depressive, so treat as for manic with an antipsychotic alone or in comb with mood stabiliser, or may use mood stabiliser alone
may use an antidepressant if depressive symptoms predominate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

LT treatment to reduce risk of relapse in bipolar disorder?

A

lithium-more effective at preventing manic than depressive episodes, and benefits outweigh risks if pt at least at moderate risk of relapse-had 3 or more prev episodes, very severe prev. episodes, of strong FH of recurrent bipolar disorder)
valproate
carbamazepine
lamotrigine- effective at preventing depressive relapses
antipsychotics if recurrent antipsychotic symptoms or alternative tments not been effective

family therapy

26
Q

prodromal signs of manic relapse in bipolar that may alert patient to commence an agreed plan of action e.g. to take an antipsychotic which is kept at home?

A 
reduced need for sleep
increased physical activity
racing thoughts
elated mood
irritability or rage if plans or wishes are not satisfied
unrealistic plans
overspending
27
Q

what is bipolar I?

A

at least 1 manic episode for more than 1 week, or mixed episodes of mania and depression, and at least 1 major depressive episode

28
Q

what is bipolar II?

A

more than 1 episode of severe depression, and at least 1 mild manic episode-hypomania

29
Q

prevalence of bipolar in the UK?

A

1%

30
Q

therapeutic range of lithium in tment of acute manic episode?

A

0.8-1.0mmol/L

31
Q

how long should a mood stabiliser be continued for in bipolar?

A 
at least 2 yrs after 1 episode, and up to 5 if there have been:
frequent previous relapses
psychotic episodes
alcohol or substance misuse
continuing stress at home or at work
32
Q

usual length of psychological tment in bipolar?

A

16 1hr sessions over 6-9 months

33
Q

when is lithium safe in pregnancy?

A

after the 26th week

but should not breastfeed if taking lithium

34
Q

how many people with bipolar have a FH of the condition?

A

50%

35
Q

impacts on driving if diagnosed with bipolar?

A

MUST inform the DVLA of diagnosis

should not drive while manic- health professionals must advise not to drive.

36
Q

NICE recommendations on information and support to be given to bipolar patients?

A

identify and offer assistance with education, employment and finances
encourage them to develop advance statements when they’re well, in collaboration with carers if possible, to decide on how they would like to be treated when they become unwell
explain and discuss making a LPA if financial problems result from their mania or hypomania

37
Q

primary care treatment offered to patients with bipolar depression?

A

a psychological intervention that has been specifically developed for bipolar or CBT, interpersonal therapy or behavioural couples therapy in line with NICE guidelines on depression.

38
Q

components to yearly physical health check for patients with bipolar in primary care?

A

renal, thyroid function, and calcium levels if on long term lithium (hyperparathyroidism can occur with lithium)
weight/BMI, diet, nutritional status and levels of activity
CVS status includ pulse and BP
metabolic status-HbA1c, blood lipids, fasting blood glucose
liver function

39
Q

pharmacological management of mania or hypomania in secondary care?

A

if pt taking an antidepressant as monotherapy, consider stopping and offer an antipsychotic
if not already on an antipsychotic or mood stabiliser, offer haloperidol, olanzapine, quetiapine or risperidone, taking into account any advance statements-may be advance decision to refuse part. tment, preference and clinical context.
try an alternative antipsychotic if 1st at any dose is poorly tolerated or is ineffective at max licensed dose..
if 2nd not sufficiently effective at max tolerated dose, consider adding lithium. if ineffective or not suitable e.g. pt disagrees to routine blood monitoring, then consider valproate.
if pt already on lithium, consider adding an antipsychotic and check plasma lithium levels to optimise treatment (want between 0.8 and 1.0mmol/L as lithium narrow therapeutic range.)
if already on valproate or another mood stabiliser, consider increasing dose to max level in BNF if necessary, and if no improvement, consider adding an antipsychotic.
if mixed affective picture, treat as above but ensure monitor for depressive symptoms.
DO NOT offer lamotrigine to treat mania.

ensure access to calming environments and reduced stimulation
r/v within 4 wks of symptom resolution-?continuing tment or starting LT therapy
if continue, offer for further 3-6mnths then r/v

40
Q

why is quetiapine especially useful in treatment of acute mania?

A

it is an atypical antipsychotic (targets psychotic symptoms and has less EP side effects than typicals) with mood stabilising properties.

41
Q

when is ECT offered in mania?

A

if severe mania that has not responded to other interventions.

42
Q

bipolar depression management in secondary care?

A

offer psychological intervention
if person not taking a drug to treat their bipolar and develops moderate or severe bipolar depression, offer fluoxetine with olanzapine, or quetiapine on its own, depending on pt preference and previous tment response.
if pt prefers, consider olanzapine or lamotrigine on their own
if no response to fluoxetine with olanzapine, or quetiapine on its own, consider lamotrigine on its own.
if already taking lithium, measure plasma level and if inadequate increase. if at max, add either fluoxetine with olanzapine, or quetiapine alone. if no response, stop additional tment and consider adding lamotrigine to lithium. if already on valproate, consider increasing dose within therapeutic range. add additional tments if limited response.
r/v within 4 wks of symptom resolution-?continuing tment or starting LT therapy
if continue, offer for further 3-6mnths then r/v

43
Q

why is quetiapine useful in tment of acute bipolar depression in secondary care?

A

unlikely to cause mania

44
Q

ICD-10 requirement for bipolar affective disorder diagnosis?

A

2 or more episodes of mania or hypomania, or mania or hypomania and depression.
repeated episodes of hypomania or mania only are classified as bipolar. repeated episodes of depression= recurrent depressive disorder, if episodes as described for depressive episode without any independent episodes of elevated mood and increased energy (mania). However, pt may experience brief episodes of hypomania following a depressive episode, sometimes precipitated by antidepressant treatment.

45
Q

bipolar pharmacological management long term in secondary care?

A

lithium 1st line
consider adding valproate if lithium ineffective
if lithium poorly tolerated or not suitable e.g. pt doesn’t agree to routine blood monitoring, consider valproate or olanzapine instead, or if it has been effective in mania or bipolar depression tment acutely, quetiapine.

symptoms, mood and mental state must be monitored for 2 years after medication has been stopped entirely.

46
Q

how can responsibilities be transferred from secondary to primary care in managing bipolar patients whose symptoms have responded well to treatment and who remain stable?

A

via the care programme approach
ensure a care plan is made with the pt including clear, individualised social and emotional recovery goals, a crisis plan, an assessment of person’s mental state and a medication plan with a date for review by primary care, frequency and nature of monitoring for effectiveness and adverse effects, and what should happen in the event of a relapse.

47
Q

considerations in using psychotropic medication in bipolar for older adults?

A

use lower doses
take into account increased risk of drug interactions
take into account -ve impact anticholinergic medication can have on cognitive function and mobility e.g. olanzapine-dopamine, 5-HT and cholinergic antagonism.
ensure medical comorbidities have been recognised and treated

48
Q

what is psychomotor retardation?

A

visible slowing of physical activity such as movement and speech seen in mental disorders, specifically in unipolar and bipolar depression.

49
Q

characteristics of atypical depression?

A 
variably depressed mood
overeating
oversleeping
extreme fatigue and heaviness in the limbs
pronounced anxiety
50
Q

lifetime prevalence of depressive illness?

A

10-20%

51
Q

male to female ratio in depression?

A

1:2

52
Q

perpetuating factors in mood disorders?

A

difficult relationships
financial difficulties
substance use

53
Q

monoamine hypothesis of depression?**

A

low NT levels of 5-HT and NA, so treat with reuptake inhibitors to increase levels in synaptic cleft

54
Q

NICE stepped approach to depression management?

A

steps 1-4 depending on severity of depression*

55
Q

NICE tment of moderate to severe depression?

A

combination of antidepressant medication and high intensity psychological intervention with CBT or interpersonal therapy.

56
Q

‘conservative’ measures in depression?*

A

psychoeducation
sleep hygiene- establishing regular timings of going to bed, not eating or drinking alcohol before going to bed
smoking,alcohol,diet
increase physical activity

57
Q

when must there be particular caution in switching antidepressants in depression management?

A

from fluoxetine to other antidepressants, because fluoxetine has a long half-life (approximately 1 week)

from fluoxetine or paroxetine to a TCA, because both of these drugs inhibit the metabolism of TCAs; a lower starting dose of the TCA will be required, particularly if switching from fluoxetine because of its long half-life

to a new serotonergic antidepressant or MAOI, because of the risk of serotonin syndrome

from a non-reversible MAOI: a 2-week washout period is required (other antidepressants should not be prescribed routinely during this period)

58
Q

what can an AD be augmented with in depression?

A

lithium or

an antipsychotic such as aripiprazole, olanzapine, quetiapine* or risperidone* or

another antidepressant such as mirtazapine or mianserin

59
Q

specific mood disorder for use of carbamazepine?

A

rapid cycling- 4 or more affective episodes in 1 yr, normal in between episodes in contrast to cyclothymia.

60
Q

NICE recommendations for people with mild depression who don’t want an intervention or sub-threshold depressive symptoms who request an intervention, or those thought to be able to recover with no formal intervention?

A

discuss px and complains, explain the nature and coarse of depression
arrange a further assessment, usually within 2 weeks
make contact if they do not attend FU appointments
can advise on sleep hygiene-establish regular sleep and wake times, avoid excess eating, smoking or drinking alcohol before sleep, create a proper environment for sleep and take regular physical exercise.

Psychiatry Block (13 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions