2680318
Descripción
Fichas por Anna Walker, actualizado hace más de 1 año
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Creado por Anna Walker
hace más de 9 años
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| Pregunta | Respuesta |
| What conditions does "mood disorders" encompass? | |
| What are the core symptoms of depression? | Need all three to diagnose severe depression. Low mood. Loss of interest and enjoyment (anhedonia). Reduced energy (anergia). NB: Thoughts of self harm and suicide do not mean someone is definitely severely depressed or high risk. |
| What are the other symptoms of depression? | Reduced concentration Reduced self-esteem and confidence Ideas of guilt and unworthiness Pessimism about the future Ideas/acts of self-harm/suicide Disturbed sleep Changes in appetite (Thoughts of guilt, worthlessness and hopelessness = Beck's triad of cognitive symptoms). |
| What is the "somatic syndrome" of depression? | These patients are more likely to have a good response to antidepressants. Markedly reduced appetite. Weight loss (>5% of normal body weight in 1 month). Early morning wakening (at least 2hrs before usual time). Diurnal variation in mood. Psychomotor retardation/agitation. Loss of libido. Marked anhedonia. Lack of emotional reactivity. |
| Describe the features of psychotic depression. | Can only be diagnosed if severe depression. Delusions, which must be mood-congruent and not bizarre - worthlessness/guilt/ill health/poverty/imminent disaster. Nihilistic disorder (Cotard's syndrome). May have persecutory delusions. Hallucinations = 2nd person auditory - defamatory/accusatory. Olfactory - filth/rotting flesh. |
| What are the symptoms of hypomania? | Must have been present for at least 4 days. Mild elevation of mood/Irritablity. Increased energy. Mild overspending or risk taking. Sociability or overfamiliarity. Distractible. Increased sexual energy. Decreased need for sleep. |
| What are the symptoms of mania? | Must have been present for at least a week or have needed a hospital admission. Elevated, expansive or irritable. Increased activity. Reckless behaviour. Disinhibition. Distractible or constant changes. Marked increase in sexual energy. Markedly decreased need for sleep. Grandiosity. Flight of ideas. (NB: If there is ANY psychosis, must be mania not hypomania). |
| Describe the psychotic symptoms that may be associated with mania. | DELUSIONS: Mood congruent. Inflated self-esteem and ideation may develop into fully formed grandiose delusions. Irritability and suspiciousness may become delusions of persecution. HALLUCINATIONS: Less frequent. Mood congruent. Second person auditory. 10% have 1st rank symptoms. |
| What does this mood chart indicate? | Recurrent depression |
| What does this mood chart indicate? | Bipolar Affective Disorder |
| What does this mood chart indicate? | Dysthymia - >2 years, low mood with little variation, no depressive episodes |
| What does this mood chart show? | "Double" depression |
| What does this mood chart show? | "Cyclothymia" - >2 year history and no episodes reach threshold for depression or hypomania. |
| What is an adjustment reaction? | Reaction to stressful event or situation which usually lasts less than 6 months. Onset usually within 3 months of onset of stressor. Significant impairment in social, occupational or educational functioning. Once the stressor (or its consequences) has terminated, the symptoms do not persist for more than an additional 6 months. Often diagnosed post partum. |
| What is the epidemiology of depression? | M:F = 1:2 Lifetime prevalence of depressive symptoms 10 to 20% Point prevalence of major depressive illness 5%. Of these: 10% are referred to a psychiatrist 0.1% admitted to hospital |
| What are the potential biological causes of depression? | Genetic (~40%). Cortisol (stress-related). Serious illness. Substance misuse. Hormonal changes (postpartum). |
| What are the potential psychological causes of depression? | Negative thoughts. Psychodynamic (defence mechanisms). Learned helplessness. |
| What are the potential social causes of depression? | Life events. Social isolation. Bereavement or loss. Childhood abuse. Social adversity. |
| What is the prognosis of depression? | 50-60% recover within a year. Chronic depression (more than 2 years) occurs in 10-25%. 1 year later, 25% will have had another episode. 10 years later - 75% will have had another episode. Suicide 5-15%. |
| What is the epidemiology of bipolar affective disorder? | M=F. Lifetime risk 1%. Average age of onset 21 years. |
| What are the potential biological causes of bipolar? | Genetic (~70%). ? Substance misuse. |
| What are the potential social causes of bipolar? | Life events. Interpersonal conflict. |
| What is the prognosis for bipolar? | Typically 8-10 manic depressive episodes over lifetime in untreated cases. Following manic episode, there is 90% chance of further episodes. Depressive episodes are more common and longer than manic episodes. No cure but with treatment both intensity and frequency of episodes can be reduced. 30% will have residual symptoms between episodes. Suicide 10%. |
| Why might someone with bipolar have a relapse? | Non-concordance, especially lithium. Life events. Psychosocial stressors. Circadian rhythm disruption. Substance misuse. Childbirth (postpartum psychosis). Natural course of illness. |
| How should someone with depression be assessed? | Organic differentials - anaemia, hypothyroid, Cushing's, calcium, any metabolic disturbance, infection. Level of care often determined by risk: Usually managed by primary care Psychological services Crisis Resolution & Home Treatment Team (CRHT) Community mental health team In-patient (to manage significant risks). |
| What is the recommended management for NICE Step 1 - All known and suspected presentations of depression? | Assessment, active monitoring, support, psychoeducation, computerised CBT, sleep hygiene, guided self-help. |
| What is the recommended management for NICE Step 2 - Mild/moderate depression? | Primary care: Low-intensity psychological interventions, medication. |
| What is the recommended management for NICE Step 3 - Moderate/severe depression; other depression that has failed to respond to treatment. | Primary care: medication, high-intensity psychological interventions, to consider secondary care referral. |
| What is the recommended management for NICE Step 4 - Severe complex depression - life-threatening; severe self-neglect. | Secondary care: medication, high-intensity psychological interventions, ECT, CRHT, MDT, in-patient. |
| When does NICE say you should refer to a secondary mental health service with depression? | If there is significant risk, diagnostic uncertainty, possible pychotic depression, failure to respond to treatment (usually has tried 2 different antidepressants in primary care). Complex presentation. |
| What are some biological management options for depression? | Antidepressants. Lithium augmentation for resistant cases. Atypical antipsychotics augmentation. T3 augmentation. ECT. |
| What are some psychological management options for depression? | Psychoeducation, self-help materials, CBT, IPT, psychodynamic therapy. |
| What are some social management options for depression? | Education/employment. Financial security. Housing. Social inclusion. Relationships/carers. |
| How long should treatment for depression continue? | If recovered from a SINGLE episode: pharmacotherapy for 6 months. If a RECURRENT episode: pharmacotherapy for minimum 2 years. If the patient is experiencing a return of symptoms or chronic symptoms: revisit the bio/psycho/social management plan. |
| How should you assess someone with acute mania? | History often requires a collateral. Organic differentials - substance misuse, steroids, hyperthyroidism, Space-Occupying Lesion (especially frontal - frontal lobe has a lot of inhibitory action), seizure disorder, metabolic disorder. Due to risks and lack of insight the use of the MHA is not uncommon. Requires secondary care - CRHT and possible Earl Intervention of Psychosis team. In-patient to manage risks or behaviour. May require rapid tranquillisation. |
| What biological treatments are advised for acute mania? | Stop antidepressants. Antipsychotics (usually first line). Lithium or valproate. Benzodiazepines for behavioural disturbance. |
| What psychological treatments are advised for acute mania? | Psychoeducation. Psychological support (consider environment - less stimulation). |
| What are the principles of treating bipolar depression? | Recognition is important. Consider possible organic causes. Avoid routine use of antidepressants (never use unopposed antidepressants - use an antipsychotic as well). Consider increased dose of mood stabiliser. Consider early psychological treatment if possiible. Consider intervention to reduce social stressors. |
| What are the recommended biological treatment options for bipolar depression? | Mood stabiliser (lithium, valproate, lamotrigine). Atypical atipsychotic (olanzapine, quetiapine). Antidepressant (usually SSRI) with an anti-manic agent if not improvement. |
| What are the recommended psychological treatment options for bipolar depression? | Psychoeducation, CBT. |
| What medications would you use to prevent a bipolar relapse? | Antipsychotics/mood stabilisers (for at least 2 years - most people need longer). AVOID regular antidepressants. |
| What psychological therapies would you use to prevent a bipolar relapse | Psychoeducation. CBT: concordance, relapse prevention. Family therapy for high EE. |
| What physical health care should you give to someone with bipolar disorder? | Monitoring - annual checks. Weight - management and dietary advice. Contraception (lithium, carbamazepine and valproate are teratogenic). |
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