18) Mood Disorderes

Question 1

What are the features of Depression ?

Answer 1

A patient experiences core symptoms of
> Low Mood 
> Lack of Energy 
> Lack of Enjoyment / Interest 
\+
> Depressive thought 
> Biological Symptoms 
> Severe -> Psychotic Symptoms

Question 2

Outline the differences between an Adjustment Reaction and Depression

Answer 2

Adjustment Reaction:
> Symptoms develop after an "Event"
> Sx Fluctuate 
> Time limited 
> Preoccupation with "Event"
> Energy unaffected 
> No particular sleep disturbance 
> Reduced / Increased appetite 
> Feelings of anger and frustration more typical

Depression:
> Sx develop gradually 
> Sx Continuous 
> Last 2 weeks 
> Lack of Interest 
> Low Energy 
> Sleep disturbance with typically EMW 
> Loss of appetite and weight loss are typical 
> Low self Esteem and feelings of guilt and blame are typical

Question 3

What are the features of Mania ?

Answer 3

> Elated Mood 
> Increased Energy 
> Pressure of Speech 
> Decrease need for sleep 
> Flight of Ideas 
> Normal social Inhibitions are lost 
> Attention cannot be sustained 
> Self esteem is inflated often Grandiose 
> May have psychotic symptoms

Question 4

What is Bipolar Affective Disorder ?
> Type 1
> Type 2

Answer 4

Diagnosis is made following 2 episodes of a mood disorder one of which is mania or hypomania
1 => Discrete episodes of mania only or mania and depression
2=> Discrete episodes of Hypomania w/ or w/o depression

Question 5

What are some Physical Health Differentials for Depression ?

Answer 5

> Hormone disturbance, Hypothyroidism 
> Vitamin Deficiencies such as B12 
> Chronic Disease 
> Anaemia
> Substance Misuse 
> Hypoactive Delirium

Question 6

What are some Physical Health Differentials for Mania ?

Answer 6

> Iatrogenic e.g. Steroid Induced
> Hyperthyroidism 
> Delirium 
> Infection e.g. Encephalitis 
> Head Injury 
> Stimulants

Question 7

What structures are involved in mood disorders ?

Answer 7

> Limbic System - Function in emotion, memory and motivation
Frontal Lobe - Function in memory, mood, reasoning, attention and motor function
Basal Ganglia - Functions in Motor, Emotion, Cognition and Behaviour

Question 8

How is serotonin thought to be linked to Mood Disorders ?

Answer 8

Thought to be low in Depression.
> SSRIs, SNRIs, TCA’s & MAOis all successfully treat depression by increasing Serotonin in Synaptic Cleft
> 5HIAA (Metabolite Serotonin) is low in the CSF of patients with depression
> Tryptophan (Precursor for Serotonin) depletion causes depression

Question 9

How is Noradrenaline is thought to be linked to Mood Disorders ?

Answer 9

> Anti Depressants that increase NA successfully treat depression
Patients who recovered from depression showing low NA have higher rates or relapse
Postmortem studies of depressed patients vs Controls

Question 10

How is Depression Treated ?

> Following Bio-Psycho-Social model

Answer 10

Biological => SSRIs (1st)
Then SNRI’s, TCAs
IF life threatening: ECT

Psychological => CBT

Social => Help with

• Isolation
• Social Stressors

Question 11

How is Mania Treated ?

> Following Bio-Psycho-Social Model

Answer 11

Biological => Antipsychotics / Mood Stabilisers

Psychological => Acutely unlikely to be helpful, Long term Psycho education e.g. BPAD, Triggers and signs of relapse

Social => Treat in a place of safety

Question 12

How is Bipolar Depression treated ?

> Bio-Psycho-Social Model

Answer 12

Bio => Antidepressants but only with mood stabiliser to prevent patient getting high

• ECT
• Lithium

Psycho => CBT

Social => help with isolation, social stressors