1B mood disorders Flashcards
Define mood disorders
Where the fundamental disturbance is a change in affect or mood to depression (with or without anxiety) or to elation
What is mood change usually accompanied by?
Change in overall level of activity. Most of the other symptoms are either secondary to, or easily understood in the context of, the change in mood and activity.
What is the onset of mood disorder like?
Most of these disorders tend to be recurrent and onset of each episode is often related to stressful events or situations
What are the DSM-5 criteria for depressive episodes?
Occurrence of ≥2 weeks of depressed mood and presence of 4/8 of the following:
- Sleep alterations (insomnia or hypersomnia)
- Appetite alterations (increased or decreased)
- Diminished interest or anhedonia
- Low energy
- Decreased concentration
- Guilt
- Psychomotor changes (Agitation or retardation)
- Suicidal thoughts
What are the 3 core symptoms of depressive episodes?
- Low mood
- Anhedonia
- Low energy
What are the 3 biological symptoms/attributes affected in depressive episodes?
- Libido
- Sleep
- Appetite
What are the 3 psychological symptoms/attributes affected in depressive episodes?
- The world
- The future
- Oneself
Describe the typical cycle of low mood (unipolar and bipolar depression)
When is a longitudinal diagnosis of MDD formed?
If no manic or hypomanic episodes in the past are identified, then diagnosis of a current major depressive episode leads to the diagnosis
What are the 3 symptom subtypes in DSM-5 for MDD?
- Atypical features: represent mainly increased sleep and appetite, along with heightened mood reactivity
- Melancholic features: defined by no mood reactivity, along with marked psychomotor retardation and anhedonia
- Psychotic features: the presence of delusions/hallucinations
What are the criteria for manic episodes?
Euphoria or irritable mood and at least 3/7 manic criteria:
- Decreased need for sleep with increased energy
- Distractibility
- Grandiosity or inflated self-esteem
- Flight of ideas or racing thoughts
- Increased talkativeness of pressured speech
- Increased goal-directed activities or psychomotor agitation
- Impulsive behaviour (such as sexual impulsivity or spending sprees)
What’s diagnosed if symptoms for manic episodes are present for minimum 1 week with notable functional impairment?
A manic episode is diagnosed, leading to a DSM-5 diagnosis of type I bipolar disorder
What’s diagnosed if symptoms for manic episodes are present for minimum 4 days without notable functional impairment?
A hypomanic episode is diagnosed
What if a manic episode has never occurred but only hypomanic episodes and at least 1 major depressive episode, what’s diagnosed?
DSM-5 diagnosis of type II bipolar disorder is made
What’s diagnosed if manic symptoms occur for less than 4 days or specific thresholds not met for manic or hypomanic episodes?
Unspecified bipolar disorder
What can manic episodes be characterised by?
Psychotic features (presence of delusions/ hallucinations)
If psychotic features are present, can hypomania be diagnosed?
No, since such features involve notable impairment by definition.
Similarly, if a patient is hospitalized, irrespective of duration of manic symptoms, a manic episode is diagnosed, not a hypomanic episode
What diagnosis is made if manic of hypomanic episodes are caused by antidepressants?
If manic or hypomanic episodes are caused by antidepressants, then the diagnosis of bipolar disorder is still made in DSM-5.
(an important change from DSM-IV where antidepressant- related mania/hypomania was viewed as an exclusion factor)
What is the most consistent clinical features for diagnosis of bipolar disorders?
Psychomotor changes.
Mood is variable.
What does this diagram show and what is cyclothymia?
Diagram of bipolar disorders and which out of mania and depression they count for.
Cyclothymia is a rare mood disorder that causes emotional ups and downs that aren’t as severe as bipolar I or II
What type of episode is usually first with bipolar-I patients?
The majority of first episodes are depressive:
- 85% have a depressive as first episode
- 10% a manic episode
- 3-5% mixed episode
Most (90-100%) of patients will develop more episodes after their first manic episode.
Describe the symptoms of bipolar patients
Describe a typical cycle of high mood
How prevalent is anxiety in bipolar patients?
- Very prevalent → 30-70% of bipolar patients
- It has worse prognosis and outcomes