1
Q
Define euthymic?
A
- normal mood
2
Q
Define hyperthymic?
A
- elevated mood
3
Q
Define cyclothymic?
A
- variable mood
4
Q
Define anhedonia?
A
- loss of enjoyment
5
Q
Define stupor?
A
- absence of relational functions
- e.g. action and speech
6
Q
Presentation of depression?
A
- facial expression reduced
- insight preserved
- 2nd person hallucinations
- Reduced rate of speech
7
Q
Explain mood?
A
- prolonged prevailing state
- subjective
- how do you feel
8
Q
Explain Affect?
A
- how the patients feelings change in relation to their environment
- objective
9
Q
What is Cortard’s syndrome?
A
- nihilistic deliusions
- lost organs
- bloods
- body part
10
Q
Observations seen in depression
A
- slower movements
- fiddling
- defeated posture
- exhausted
- worrying
- mood low
11
Q
What is the main classification system used in the UK?
A
icd 10
in next year ICD 11
12
Q
How is depression diagnosed?
A
- at least 2 weeks
- no hypomanic or mani symptoms to meet that diagnosis
13
Q
2 out of 3 criteria for depression?
A
- depressed mood for that person
- loss of interest or pleasure
- decreased energy
14
Q
Minimum score for moderate episode of depression
A
- 2 core
- 4 others
- minimum of 6
15
Q
Minimum score for severe episode of depression?
A
- 3 core
- 5 others
- minimum 8 in total
16
Q
What is bipolar 1
A
- at least 1 previous episode of mania + depression
17
Q
What is bipolar 2
A
- current or past hypomanic episodes
- never met criteria for manic episodes
18
Q
What is hypomania
A
- elevated to a degree abnormal to the individual
- for 4 consecutive days
- 3/7 additional symptoms
19
Q
Additional hypomania symptoms
A
- increased activity
- increased talkative
- difficulty concentrating
- decreased need for sleep
- increased sexual energy
- mild spending spree
20
Q
What is a manic episode
A
- elevated or irritable mood
- sustained for 1 week
- severe interference with daily functioning
- 3/9 additional symptoms
21
Q
Additional symptoms of a manic episode
A
- increased activity
- pressure of speech
- flight of ideas
- loss of normal social inhibitions
- decreased need for sleep
- inflated self-esteem
- distractibility
- reckless behaviour
- marked sexual energy
22
Q
Average onset of bipolar disorder?
A
late teens
early 20s
23
Q
Bipolar 1 vs bipolar 2
A
- bipolar 2 more common - major depression to hypomania
- bipolar 1 - major depression to mania
24
Q
Co-morbidities of bipolar disorder?
A
- Anxiety disorders
- Alcohol and drug misuse
- Personality disorder
- Eating disorder
- Schizophrenia
- Schizoaffective disorder
25
Which has the bigger proportion of depression, bipolar 1 or 2?
- bipolar 2 has a larger proportion of the time with depression
25
Which has the bigger proportion of depression, bipolar 1 or 2?
- bipolar 2 has a larger proportion of the time with depression
26
Most common mood disturbance in bipolar?
- depression
| - causes the patient most issues
27
What is cyclothymia?
- cycling between hypomania and dysthymia
28
What is dysthymia?
- low mood
- persistent
- usually 2 years
- less severe than major depression
29
What is the mood spectrum?
- major depression
- dysthymia
- normal
- hypomania
- mania
30
What is an example of a self-rated scale for mood?
- IDS-30
31
What scaling system is used for ECT and is an observer rated scale?
- MADRS
- Montgomery-Asberg Rating scale
- good for ECT
- Observer rated
32
Often what is the first line pharmacological treatment for depression?
- sertaline
| - mirtazapine
33
Side effect of mirtazapine?
- increased appetite
| - increased weigh
34
Preventing relapse in depression
- 1st episode = continue antidepressants for 6mnths after full recovery
- 2nd episode = continue antidepressants for 1-2yrs after full recovery
- may require to be on antidepressants for life
35
Treatment of acute mania/hypomania in bipolar?
- stop antidepressants
- hospitalisation??
- antipsychotics = olanzapine, quetiapine
- others = lithium, valproate, carbamezpine
36
Treatment of acute depression in bipolar?
- anti-psychotics
- SSRIs (don't give anti-depressants alone)
- ECT
- Lithium
37
Gold standard for bipolar maintenance?
- lithium
38
Side effect of SSRIs and SNRI?
- Falls in elderly
| - hyponatraemia
39
What is ECT used for?
- depression
40
Explain ECT
- Bilateral bitemporal ECT
- 2 weekly
- 6-12treatments
- seizures last 15-30seconds
41
Side effects of ECT?
- Headaches
| - memory impairment
42
CBASP vs CBT?
- CBASP like CBT but with more emphasis of the childhood
43
What are the 4 Ps of psychiatric factors?
- Predisposing
- Precipitating
- Prolonging
- Protective
44
What are the 2 functional differentiations in the brain?
- appetitive/approach
| - aversive/deffensive
45
The appetitive differentiation of the brain mainly involves what neurotransmitter?
- dopamine
46
The aversive differentiation of the brain is mainly what neurotransmitter?
- serotonin
47
What is over secreted in depression? (endocrine)
- CRF
- Excess cortisol
- desensitisation of cortisol receptors
48
What is increased in blood works in depression?
- increased cytokines
49
What happens to the hippocampal volume in depression?
- reduction in hippocampal volume
50
What is the hippocampus connected to?
- prefrontal cortex (working memory, cognition, mood)
| - amygdala (emotion and fear)
51
What are potential aetiological theories of depression?
- genetic
- monoamines reduced
- increased cortisol
- increased cytokines
- hippocampal atrophy
- reduced BDNF
52
What is BDNF?
- Brain derived neurotrophic factor
- involved in neogenesis
- BDNF reduced in depression
