4) Mood (affective) disorders Flashcards
How long does the elevated/expansive/irritable mood have to go on for to be considered part of bipolar disorder?
1 week or more
Describe the clinical presentation of mania with reference to at least THREE common features.
Elevated/expansive/irritable mood and 3 or more of the following:
- Overinclusive/overfamiliar
- Increased energy/activity
- Rapid rate of talking, flight of ideas
- Distractible
- Reduced need to sleep
- Increased sex drive
Describe the treatment of bipolar disorder.
- Biological (lithium first line, then add valproate. Can use antipsychotics also such as quetiapine)
- Psychological (specific bipolar CBT and family therapy)
What are the THREE core symptoms of depression.
Beck’s:
- Low mood (more than 2 weeks)
- Anhedonia
- Lack of energy
Suggest TWO biological symptoms/signs of depression.
- Early morning waking, diurnal variation
- Reduced appetite
- Loss of libido
- Psychomotor agitation/retardation
Suggest THREE cognitive symptoms/signs of depression.
- Low self-esteem
- Guilt, self-blame
- Hopelessness
- Hypochondrial
- Poor concentration/attention
Describe how depression can be classified into categories based on symptoms.
- Mild (2 core symptoms + 2 others)
- Moderate (2 core + 3/4 others)
- Severe (3 core + 4 or more others)
How long do the symptoms of depression have to persist for a diagnosis of depression to be made.
2 weeks
Which score is used to assess the risk of a depressed person committing suicide?
SADPERSONs score
Which score is used to assess the severity of a persons depression?
PHQ-9 score
Name THREE risk factors for the development of post-natal depression.
- Personal/family history of depression
- Single mother
- Older mother
- Unwanted pregnancy
- Poor social support
- Previous post-natal depression
Describe the management of moderate depression.
- Supportive - Advice on sleep hygiene
- Psychological - Interpersonal therapy, behavioural therapy (CBT commonly used for less severe depression)
- Medical - SSRIs first line (try two of them before switching to SNRI/TCA)
How long do SSRIs take to work?
6 weeks
Suggest THREE features of bipolar disorder.
- Elevated/expansive/irritable mood - 1 week (CORE)
- Overinclusive/overfamiliar
- Increased energy/activity
- Pressured speech - uninterrupted
- Flight of ideas
- Distractible
- Reduced need for sleep
- Increased libido
How may bipolar disorder be classified?
Bipolar Type I - 1 or more manic/mixed episodes +/- 1 or more depressive episodes
Bipolar Type II - 1 or more depressive episodes with at least 1 hypomanic episode
Describe how atypical depression commonly presents, with, reference to how this is different to typical depression.
- Oversleep rather than undersleep
- Weight gain (usually get weight loss in depression)
- Leaden paralysis (heavy arms/legs)…not a common feature in typical
- Interpersonal rejection sensitivity - in English this means that the person is just waiting for the person they are talking with to reject/react negatively to them
Suggest TWO common specific features of psychotic depression.
- Auditory hallucinations
- Delusions are mood congruent - delusions of guilt, persecution, nihilism (feeling you’re dying or your world is ending), hypochondriasis (feeling you’re ill)
Describe how the psychological therapy differs for patients with mild depression compared to those patients with moderate/severe depression.
- Mild depression - CBT or group activities
- Moderate/severe depression - interpersonal therapy, behavioural activation, couples behavioural therapy
How long do SSRIs take to work?
6 weeks
How often should patients with newly diagnosed depression be seen in the first three months?
Every 2-4 weeks
What is the CORE symptom of mania? How long does it have to last to be considered diagnostic?
Elevated/expansive/irritable mood for one week or more.
Describe hypomania.
Three or more symptoms of mania for 4 days or more that are not severe enough to interfere with social/occupational functioning.
What screening tool can be used for bipolar disorder/mania?
Mood disorder questionnaire
Describe the management of bipolar disorder.
- Psychological - CBT and complex psychoeducation
- Pharmacological - antipsychotics for episodes of acute mania, second line add in another antipsychotic & third line is lithium
- Long term control - lithium first line, second line is sodium valproate
Define bipolar disorder in terms of its ICD-10 classification.
At least 2 episodes of mood disorder, one of which must be a hypomanic, manic or mixed episode. (don’t need a depressive episode)
You suspect a patient has bipolar disorder, suggest THREE other differentials you may consider.
- Normal fluctuations in mood
- Adjustment disorders/bereavement – like depression, but, resolves once stressor is removed
- PTSD
- Dementia and other brain disorders
- Anxiety disorders
Suggest THREE possible risk factors for developing mood disorders.
- Predisposing - genetics, family history, childhood trauma
- Precipitating - substance use/abuse, change in routine, major life events
- Perpetuating -difficult relationships, financial trouble
