Affective disorder Flashcards

1
Q

Mood disorder

A
  • Mental disorder involving altered mood as the core feature
  • Refers to states of depression and of elevated mood → mania
  • Commonest group of mental disorder
  • Can be primary or secondary to other disorder → cancer, dementia, drug misuse
  • Associated with anxiety symptoms and anxiety disorder
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2
Q

Classification systems

A
  • ICD 10 → international classification of Disease (WHO)
  • DSM-5 → diagnostic and statistical Manual of Mental Disorders (American Psychiatric Association)
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3
Q

Depression

A
  • Symptom
    • State of feeling, mood, range from normal experience to severe and life-threatening
    • Often systemic → similarities to pain and fatigue and not just an absence of happiness
  • Syndrome → cluster of signs and symptoms
  • Recurrent illness → recurrent depressive disorder
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4
Q

When does depression become abnormal

A
  • No hard and fast rule
  1. Persistence of symptoms
  2. Pervasiveness of symptoms
  3. Degree of impairment
  4. Presence of specific signs and symptoms
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5
Q

Presentation of depression

A
  • Psychological
    • Depression → diurnal variaiton
    • Anxiety → inability to relax
    • Perplexity → feeling overwhelmed
    • Anhedonia → loss of interest
    • Guilt
    • Hopelessness
    • Worthlessness
    • Neurotic symptoms
      • Agoraphonbia
      • Hypochondriasis
      • Obsessions and compulsions
      • Panic attacks
    • Ideas of reference
    • Delusions and hallucinations → psychotic symptoms
  • Physical
    • Energy → fatigue
    • Sleep
    • Appetite → weight loss
    • Libido
    • Constipation
    • Pain
    • Psychomotor functioning → agitation/ retardation
  • Social
    • Loss of interest
    • Irritability
    • Apathy
    • Withdrawal, loss of confidence, indecisive
    • Loss of concentration, registration and memory
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6
Q

Key definition

A
  • Agitation → restless overactivity
  • Anhedonia → loss of pleasure from experience
  • Apathy → loss of interest in surroundings
  • Anxiety → feeling of apprehension and fear
  • Depression → feeling of sadness/ unhappiness
  • Retardation → feeling of slowing motor responses including speech
  • Stupor → state of extreme retardation with intact consciousness
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7
Q

ICD-10 criteria for depression

A
  • Last for at least 2 weeks
  • No hypomania or manic episodes
  • Not related to psychoactive substance use or organic mental disorder
  • No psychotic symptoms or stupor → must rule out schizoprenia or other psychotic illness
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8
Q

Somatic syndrome

A
  • Marked loss of interest or pleasure in activities
  • Lack of emotional reaction → events or activities that normally produce emotional response
  • Waking 2 hours before normal time
  • Depression worst in the morning
  • Marked loss of appetite
  • Weight loss (5% BM in a month)
  • Marked loss of libido
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9
Q

Criteria for mild, moderate and severe depression

A
  • Depressed mood
  • Loss of interest or pleasure
  • Decreased energy or increased fatiguability
  • Mild depression → 2
  • Moderate depression → 2
  • Severe → 3
  • At least 4 of the following criteria
  • Loss of confidence/ self-esteem
  • Unreasonable guilty
  • Recurrent thoughts of suicide
  • Decreased concentration
  • Agitation/ retardation
  • Altered appetite
  • Mild depression → 4
  • Moderate depression → 6
  • Severe depression → 8
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10
Q

Post-natal depression

A
  • Increased risk of admission 30 days following birth
  • 75% experience ‘blues’ within 2 weeks
  • 10% develop MDD within
  • Not associated with hormonal changes go puerperium
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11
Q

Differential diagnosis of depression

A
  • Situational depression
  • Seasonal Affective Disorder
  • Dysthymia
  • Cyclothymia
  • Bipolar disorder
  • Organic mental illness → stroke, tumour, dementia
  • Hypothyroidism, Addison’s hyperparathyroidism
  • Infection → influenza, mononucleosis hepatitis, HIV/AIDS,
  • Drugs
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12
Q

Management of depression

A
  • Antidepressants
    • Selective Serotonin Reuptake Inhibitor
    • Tricyclic antidepressants (TCA)
    • Monoamine Oxidase Inhibitors
    • Atypicals
  • Psychotherapy → CBT, IPT, individual dynamic therapy, family therapy
  • Physical therapy → ECT, psychosurgery, Deep brain stimulation, vagal nerve stimulation
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13
Q

Measurement tools

A
  • SCID → Structured Clinical Interview for DSM disorder
  • SCAN → Schedules for Clinical Assessment in Neuropsychiatry)
  • HDRS → Hamilton Depression Rating Scale
  • BDI-II → Beck Depression Inventory II
  • HADS → Hospital Anxiety and Depression Scale
  • PHQ-9 → Patient Health Questionnaire 9
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14
Q

Mania

A
  • State of feeling, mood, ranging from near-normal to severe and life-threatening
  • Rarely a symptom
  • Associated with grandiose ideas, disinhibition, loss of judgement
  • Similar to the mental effects of taking stimulant drugs (amphetamines and cocaine)
  • Pathological and inappropriate elevated mood
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15
Q

Characteristics of mania

A
  • Similar to classification of depression
  1. Persistent
  2. Pervasive
  3. Degree of impairment
  4. Presence of specific signs or symptoms
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16
Q

Types of mania (ICD-10)

A
  • Hypomania
  • Mania without psychotic symptoms
  • Mania with psychotic symptoms
  • Other manic episodes
  • Manic episode, unspecified
17
Q

Hypomania

A
  • Mild degree of mania without psychosis
  • Mild mood elevation → several days
  • Increased energy, activity and feeling of wellbeing
  • Increased sociability, talkativeness, overfamiliarity, increased sexual energy, decreased need for sleep
  • Irritability
  • Reduced concentration, new interests, mild overspending
  • Minimal disruption to work/ social life
18
Q

Mania (with/ without psychosis)

A
  • 1 week, severe enough to disrupt normal work and social life
  • Elevated mood, increased energy, overactivity, pressure of speech, decreased need for sleep
  • Disinhibition
  • Grandiosity
  • Alteration of sense
  • Extravagant spending
  • Irritable rather than elated
19
Q

Differentials for mania

A
  • Mixed affective state
  • Schizoaffective disorder
  • Schizophrenia
  • Cyclothymia
  • ADHD
  • Drugs and alcohol
  • Stroke, MS, tumour, epilepsy
  • AIDS, neurosyphilis
  • Cushings, hyperthyroidism
  • SLE
20
Q

Treatments for mania

A
  • Antipsychotics
    • Olanzapine
    • Risperidone
    • Quetiapine
  • Mood stabiliser (anticonvulsant)
    • Sodium valproate
    • Lamotrigine
    • Carvamazepine
  • Lithium
  • ECT
21
Q

Criteria for Bipolar Affective Disorder (ICD-10)

A
  • Repeated episodes (2+) of depression and mania/ hypomania
  • No mania/ hypomania → recurrent depression
  • No depression → hypomania/ bipolar disorder
  • 1 episode of mania sufficiency for bipolar diagnosis
22
Q

Epidemiology of BAD

A
  • Consistent prevalence amongst incomes, occupation, educational status
  • Same rates between males and females
  • Young mean age of onset → 21
  • Earlier onset and increased prevalence with positive FH
23
Q

Epidemiology of depression

A
  • Higher rates amongst females
  • Highest risk from ages 18-55
  • Mean age of onset → 27
  • Not unusual during old age
  • Not associated with socioeconomic status
  • MDD less common in employed and financial independent
  • Associated with lower education attainment
  • Increased risk amongst 1st relatives
    *