1.1. Affective (Mood) Disorders - Depression Flashcards
What are Mood Disorders?
Disorders of Mental Status and Function, where the Mood is a Core Feature:
1. Mania
2. Depression
Note - These are the Commonest Group of Mental Disorders
How can Affective (Mood) Disorders present?
- Primary Problem
- Secondary Problem - As a Consequence of another Disorder / Illness (Cancer / Dementia / Drug Misuse)
- Post-Natal Depression
What are Affective (Mood) Disorders associated with?
- Anxiety Symptoms
2. Anxiety Disorders
What are the 2 Classifications Systems for Affective (Mood) Disorders?
- ICD-10 - International Classification of Disease - 10th Edition
- DSM-5 - Diagnostic and Statistical Manual of Mental Disorders - 5th Edition
What is Depression?
- A Symptom - An emotion within the range of Normal Experience
- A Syndrome - A Constellation of Symptoms and Signs
- A Recurrent Illness - Recurrent Depressive Disorder
What are the Emphasized Areas in which Depression will become Abnormal?
- Persistence of Symptoms
- Pervasiveness of Symptoms
- Degree of Impairment
- Presence of Specific Symptoms / Signs
What are the 3 Spheres Symptoms of Depressive Illness can occur in?
- Psychological
- Physical
- Social
What are the Symptoms of Depression in the Psychological Sphere?
- Change in Mood - Depression / Anxiety / Perplexity / Anhedonia
- Change in Thought Content - Guilt / Hopelessness / Worthlessness / Neurotic Sympomatology / Ideas of Reference / Delusions and Hallucinations
What are the Symptoms of Depression in the Physical Sphere?
- Change in Bodily Function - Energy / Sleep / Appetite / Libido / Constipation / Pain
- Change in Psychomotor Functioning - Agitation / Retardation
What are the Symptoms of Depression in the Social Sphere?
- Loss of Interests
- Irritability
- Apathy
- Withdrawal / Loss of Confidence / Indecisive
- Loss of Concentration / Registration / Memory
What is the Definition of:
- Anhedonia?
- Apathy?
- Anxiety?
- Depression?
- Psychomotor Retardation?
- Loss of Ability to Derive Pleasure from Experience
- Loss of Interest in Surroundings
- An Unpleasant Emotion in which Thoughts of Apprehension and Fear Predominate
- An Unpleasant Emotion in which Sadness / Unhappiness Predominates
- A Slowing of the Motor Responses, Including Speech
What is Stupor?
A State of Extreme Psychomotor Retardation in which consciousness is intact. The patient stops Moving, Speaking, Eating, and Drinking.
On recovery can describe clearly events which occured whilst Stuporosed
What are the ICD-10 General Criteria for Depression?
- Depressed Mood that is Abnormal for most of the day, almost everyday, for 2 weeks
- Loss of Interest / Pleasure (Anhedonia)
- Decreased Energy / Increased Fatigability
What are the ICD-10 Additional Criteria for Depression?
- Loss of Confidence / Self-Esteem
- Unreasonable Feelings of Guilt / Self-Reproach
- Any Suicidal Behaviour (Recurrent thoughts of Death by Suicide)
- Decreased Concentration
- Agitation / Retardation
- Sleep Disturbance of any sort
- Change in Appetite
What is the ICD-10 Diagnosis Criteria for Mild Depression?
At least 2 of the General Criteria + At least 2 of the Additional Criteria
What is the ICD-10 Diagnosis Criteria for Moderate Depression?
At least 2 of the General Criteria + At least 4 of the Additional Criteria
What is the ICD-10 Diagnosis Criteria for Severe Depression?
All 3 of the General Criteria + At least 6 of the Additional Criteria
Note - Psychotic Symptoms / Stupor with Depression = Sever Depression with Psychotic Symptoms
What are the Features of Somatic Syndrome?
- Anhedonia
- Lack of Emotional Reactions to Events
- Waking 2 hours before normal Time
- Depression worse in the Morning
- Objective Psychomotor Agitation / Retardation
- Marked Loss of Appetite / Weight Loss
- Marked Loss of Libido
Note - This is a sub-group of depression
How long do Depressive Symptoms need to be happening for, to have a Diagnosis of Depression?
At Least 2 weeks - A Bad Couple of Days isn’t enough
What Criteria would Eliminate Depression as a Diagnosis?
- Hypomanic / Manic Episodes in Lifetime
- Attributable to Psychoactive Substance Use
- Attributable to Organic Mental Disorder
What are the Features of:
- Baby Blues?
- Post-Natal Depression?
- Puerperal Psychosis?
- Mild Depressive Symptoms which will pass
- Major Depressive Disorder
- Psychotic Condition - Admit to Hospital
What is the Differential Diagnosis for Depression?
- Normal Reaction to Life Event
- Seasonable Affective Disorder
- Dysthymia (Persistent Mild Depression)
- Cyclothymia (Less Severe than Bipolar)
- Bipolar
- Stroke / Tumour / Dementia
- Hypothyroidism / Addison’s / Hyperparathyroidism
- Infections
- Drugs
How is Depression Treated?
- Antidepressants - SSRI’s / TCA’s / MAOI’s / Others
- Psychological Treatments - CBT / IPT / Family Therapy / Individual Dynamic Psychotherapy
- Physical Treatments - Electroconvulsive Therapy (ECT) / Psychosurgery / Deep Brain Stimulation (DBS) / Venous Nerve Stimulation (VNS)
What are the Measurement Tools available for Depression?
Structured Interviews:
- Structured Clinical Interview for DSM Disorders (SCID)
- Schedules for Clinical Assessment in Neuropsychiatry (SCAN)
Questionnaires aimed at assessing Symptom Severity:
- Hamilton Depression Rating Scale (HDRS)
- Beck Depression Inventory - II (BDI-II)
- Hospital Anxiety and Depression Scale (HADS)
- Patient Health Questionnaire - 9 (PHQ-9)
