Abnormal mood

Question 1

What are some of the key symptoms of depression?

Answer 1

Anhedonia (loss of enjoyment) 
Anergia 
Amotivation 
Diurnal variation 
Early morning wakenings 
Psychomotor retardation

Question 2

What kind of hallucinations do people with depression most commonly experience?

Answer 2

Auditory - second person derogatory

“You are a bad person”

Question 3

What are the 3 key symptoms that are important for diagnosis of depression?

Answer 3

Depressed mood
(present for most of the day almost every day and persistent for at least 2 weeks)

Loss of interest and pleasure

Decreased energy

Question 4

Antidepressants are no better than placebo for mild depression. T/F?

Answer 4

True

Question 5

What criteria is there for diagnosis of moderate Vs severe depression?

Answer 5

Moderate = at least 2/3 of the key symptoms +additional symptoms to =6

Severe = all 3 key symptoms + additional symptoms to= 8

Question 6

What is atypical depression?

Answer 6

Depression in which mood reactivity is preserved

Question 7

What is psychotic depression?

Answer 7

Depression with paranoia

Question 8

What is cotard’s syndrome?

Answer 8

A type of psychotic depression which is more common in the elderly.

Involved nihilistic delusions

E.g “I can’t eat because my bowels have turned to dust”

Question 9

When does bipolar disorder usually present?

Answer 9

Late teens/ early 20s - very rare to present after age 60

Question 10

What is meant by ‘rapid cycling’ and ‘ultra-rapid cycling’ in bipolar disorder?

Answer 10

4+ episodes in a year (rapid cycling)

4+ episodes in a month (ultra-rapid cycling)

Episodes may be of depression/ hypomania/ mania

Question 11

What are some predictors of poor outcome in patients with bipolar disorder?

Answer 11

Early-onset
Low socio-economic status
Comorbid disorders

Question 12

What is the difference between Bipolar I and Bipolar II as classified by DSM?

Answer 12

Bipolar I
= Manic episodes

Bipolar II
= Hypomanic episodes

Both forms still have depression as their biggest component

Question 13

What is the definition of bipolar disorder as classified by ICD 10?

Answer 13

2+ episodes in which the patient’s mood and activity levels are significantly disturbed; consisting of hypomania or mania and depression

Question 14

What is the definition of a hypomanic episode?

Answer 14

Mood is elevated to an abnormal degree for the patient for at least 4 consecutive days

Question 15

What is the definition of a manic episode?

Answer 15

Mood is elevated and definitely abnormal for the patient for at least 1 week (unless severe enough to require hospital admission)

Question 16

What are the differences between hypomania and mania?

Answer 16

Behaviour is more reckless and foolish in mania

Hallucinations and delusions occur in mania

Question 17

What is the first line management for bipolar depression?

Answer 17

Antipsychotics

Question 18

How is acute mania managed in bipolar disorder?

Answer 18

Maximise the antimanic dose if the patient is already on maintenance treatment

Discontinue antidepressants

First line intervention is antipsychotics

Benzodiazepines can be used for symptoms control

Question 19

What % of time do patients with bipolar I vs bipolar II spend hypomanic/ manic?

Answer 19

Bipolar I - patients spend 15% of their time hypomanic/ manic

Bipolar II - patients spend 5% of their time hypomanic

Question 20

What is the mean duration of a manic episode?

Answer 20

2 months

Question 21

What % of women with bipolar disorder relapse within 2 weeks of giving birth?

Answer 21

25%

Question 22

What is cyclothymia?

Answer 22

Mild cycling of moods

(never truly depressed or manic)

Often seen in family members of people with depression

Question 23

What is incongruity of affect?

Answer 23

Mismatch between emotion felt and emotion expressed

E.g laughing when upset