Mind Map Assignment - PF4014-2024

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Bipolar Disorder Mind Map

Fluoxetine Mind Map - Alternative SSRI Option

PF4013

PF3009

PF3010

PF4014

PT2448

Non-Pharmacological Advice

Talk to Family and Friends about SAD Diagnosis

Healthy, Balanced Diet

Increase Physical Activity

Increase Natural Sunlight Exposure

HSE SilverCloud

Light Therapy

Side Effects:

Agitation

Eye Strain

Tiredness

Blurred Vision

Light Box

30Mins - 1 Hour Exposure every Morning

Improves Mood during the Winter Months

Special Lamp

Contraindications:

Photosensitivity

Eye Condition/Eye Damage

Improve Mood

Increase Serotonin Production

Mood Hormone

Reduce Melatonin Production

Sleep Hormone

Antidepressants First line SSRIs e.g Sertraline

Counselling

Take in the morning

Do not stop abruptly

Gradual withdrawal

Caution in pregnancy

Not recommended in the first three months

Congenital birth defects

Loss of pregnancy

Discuss with doctor

Mechanism

Increase synaptic 5-HT levels

Downregulate 5-HT1A

Initiate treatment 4-6 weeks before symptoms

Inhibit SERT

Side Effects

Dry mouth

Headache

Diarrhoea

5-HT4

Nausea

5-HT3

Sexual dysfunction

5-HT2A/2C

Anxiety

5-HT2A/5-2C

Interactions

Drugs that increase bleeding risk e.g. NSAIDs, DOACs

Sertraline inhibits uptake of 5-HT into platelets

Impaired platelet aggregation

Drugs that increase hyponatraemia risk e.g. lithium, carbamazepine

Other antidepressants e.g. TCAs, MAOIs

Serotonin syndrome

Triptans

Grape fruit juice

CYP3A4 inducer

Metabolism

CYP2B9

CYP2C19

CYP2D6

CYP3A4

Limited evidence of efficacy

Cognitive Behavioural Therapy

Clinical

OVERVIEW

Risk Factors

Northern Latitudes

Distance from Equator

Shift Workers / Nurses

Female (4:1)

History

1980s Research

Tom Wehr

Alfred J. Lewy

Norman Rosenthal

Definition

Two Seasonal Types

Autumn / Winter (SAD)

Spring / Summer (S-SAD)

Seasonal Pattern to disease

"Specifier" of MDD / BPD

Self-Guided or Instructed

Self-Guided OR Instructed

Groups or One to One

Psychological Treatment

Purpose

Problem Breakdown

Actions

Altering future behaviours

Feelings

Dealing with them Strategically

Thoughts

Unhelpful?

Unrealistic?

Structure

Once Weekly/Every Two Weeks

30-60 Mins Session

6-20 Sessions

Inter-Patient Variability

PATHOPHYSIOLOGY

Serotonin

Vitamin D Deficiency

Serotonin Firing

Serotonin Production ↓

Increased SERT

↓ Serotonin Activity

↑ Serotonin Reuptake

Increased 5% (W)

Melatonin

Underproduction

High Intensity

Prolonged Sunlight

Overproduction

Poor Intensity

Lack of Sunlight

Circadian Rhythm

Physiology

Subtopic

Light-triggered

RHP axis

Phase-advanced (Summer)

Cortisol Overproduction

Melatonin Cessation

Phase-delayed (Winter)

Delayed Cortisol Release

Prolonged Melatonin

DIAGNOSIS

Differential Diagnosis

Viral Infections

Infectious Mononucleosis

Hypoglycaemia

Hypothyroidism

GP / Psychiatrist

No Current Blood Tests / Scans

Symptom Evaluation

Seasonal Pattern Assessment Questionnaire (SPAQ)

Final Diagnosis

S-SAD

less common

SAD

More common

Diagnostic Criteria

Frequent Depression in Specific Season(s)

Consecutive Seasonal Depressive Episode ≥ 2yrs

SAD and S-SAD Specific Symptoms

PRESENTATION / SYMPTOMS

Autumn/Winter SAD

Social Withdrawal (hibernating)

Fatigue - Low energy

Hypersomnia

Overeating → weight gain

Spring/Summer S-SAD

Increased Irritability

Agitation/Anxiety

Insomnia

Poor Appetite → Weight Loss

General symptoms

Difficulty Concentrating

Feeling Stressed/Anxious

Suicidal thoughts

Feeling Worthless

Anhedonia

Desmethylsertraline

α-hydroxyketone

Excreted in the urine and faeces

Summary

SEASONAL AFFECTIVE DISORDER