Affective Disorders Flashcards
What is a mood disorder?
A disorder of mental status and function where an altered mood is the core feature.
If someone has depression and anxiety, what should be done?
The depression should be focused on first, this will help (hopefully) relieve the anxiety.
What are the 2 classification systems for mood disorders?
ICD-10 = European DSM-5= North American
What is depression?
A symptom and syndrome and disability and recurrent illness.
Considered as a form of sadness NOT just an absence of hapiness.
What is low mood/absence of happiness classed as depression?
Symptoms > 2 weeks.
Symptoms experienced most of the time.
Normal life tasks are restricted
What are the 4 categories looked at when considering if someone has a mood disorder?
- persistence of symptoms
- pervasiveness of symptoms
- degree of impairment
- presence of specific symptoms or signs
What are the psychological symptoms of depression?
change in mood depression anxiety perplexity (feeling of being overwhelmed) Anhedonia Guilt Hopelessness Worthlessness Ideas of reference Delusions and hallucinations
What is ideas of reference?
When someone believes that random things that happen in the world is directly linked to them.
Eg - people laughing across the street, you would believe they were laughing at you.
What are delusions?
= Belief
A strong unshakeable belief about something even when theres no evidence.
What are hallucinations?
= Sensation.
When you have a sensory experience regarding something that’s not there (can be any of the 5 senses).
What does the diurnal symptom of depression mean?
Known as morning depression.
When the person feels depressed in the morning but gets gradually better as the day goes on.
What does anhedonia mean?
Lack of interest in something you previously enjoyed.
Loss of ability to derive pleasure from experience.
What are the physical symptoms of depression?
Lack of energy Sleep - too much, too little or disturbed Apetite (usually loss) Libido (usually reduced) Constipation Pain Agitation Retardation Chronic pain experience
What are the social symptoms of depression?
Anhedonia Irritability Apathy (not caring) withdrawal Loss of confidence Indecisive Loss of concentration, registration and memory
What is retardation?
Slow motor responses including speech
What is stupor?
Extreme retardation where consciousness is intact put patients can’t move, eat, speak etc.
When they recover they can remember the events.
(an extreme version of psychomotor retardation).
How long most depressive feelings last before it is classed as depression?
At least 2 weeks
When is an illness classed as depression (and not something else)?
When its feelings of low mood only.
What is low mood + manic episodes called?
Bipolar disorder
What are the psychotic symptoms?
Delusion
Hallucination
What is low mood + psychotic symptom classed as?
Depression with psychotic symptoms
(MUST exclude other psychotic illness - schizophrenia).
What is somatic syndrome depression?
Most people with depression have varying symptoms, somatic is a specific type with set symptoms.
What are the symptoms of somatic syndrome depression?
Anhedonia
Waking 2hrs before normal time
Depression worse in morning (diurnal variation)
psychomotor agitation/retardation
loss of apetite
weight loss (5% of bodyweight in a month)
Loss of libido
What is the criteria used to diagnose depression?
ICD-10
What are the 3 things on the general criteria for depression?
- Depressed mood most of the day, for over 2 weeks, uninfluenced by surroundings
- Anhedonia
- Decreased energy/Increased fatigue
What are the 7 things on the additional list of symptoms for depression diagnosis?
- loss of confidence/self esteem
- unreasonable feelings of guilt
- any suicidal behaviour/thoughts
- decreased concentration
- agitation or retardation
- sleep disturbance
- change in apetite
m
m
How many of the criteria must a person meet? Both core and additional symptoms?
Mild - 4 total
Moderate - 6 total
Severe - 8 Total
How many women experience baby blues?
75% within 2 weeks of birth
How many women develop major depressive disorder after childbirth?
10% within 3-6 months
What is a severe condition which can affect new mothers?
Puerperal psychosis.
What are common differential diagnosis of depression?
Seasonal affective disorder Dysthymia Cyclothymia Bipolar Stroke tumour dementia Hypothyroidism Hyperparathyroidism Addisons Infections - HIV/AIDS, hepatitis, flu, mononucleosis Drugs
What is the treatment for depression?
Mild - psychological therapy
Moderate/severe - Psychological therapy + medication (SSRI)
Severe - Psychological therapy + medication (SSRI) + can augment with lithium
Severe/life threatening - ECT.
What are the side effects of ECT?
Temporary or permanent memory loss headache muscle aches nausea confusion
How should antidepressants be stopped?
Over 4 weeks
Not until at least 6 months after remission.
What are the medications for depression?
1st choice - SSRI (sertraline)
2nd choice - Tricyclic antidepressants (if someone isn’t getting on well with SSRI)
- Monamide oxidase inhibitors
What are the psychological treatments for depression?
CBT
Interpersonal therapy
Individual dynamic psychotherapy
family therapy
What are the physical treatments for depression?
ECT
Deep brain stimulation
Vagus nerve stimulation
Psychosurgery
What are the main measurement tools for depression?
SCID
SCAN
Why is a manic episode classed as bipolar and not mania?
Because its very rare to get mania on its own, it will usually come with depression.
But you get depression on its own.
What is mania?
A mental illness marked with euphoria, delusions and overactivity.
Hypomania vs mania?
Hypomania:
symptoms last at least 4 days
Mania:
symptoms last at least 1 week
What are the signs and symptoms of mania?
elevated mood talkative increased libido reduced need for sleep reduced concentration increased money spending overfamiliarity Disinhibition Grandiosity (elevated sense of yourself) *Can be irritable instead of elevated
What is mania (with or without psychosis)?
LASTS FOR 1 WEEK.
This has a higher threshold than hypomania.
It is severe enough to disrupt work etc completely.
Can come with hallucinations and/or delusion
What are differential diagnosis of bipolar disorder?
Schizophrenia ADHD Cyclothymia Drugs Alcohol
What are the tool used to measure bipolar disorder?
SCID
SCAN
YMRS - young mania rating scale
What is the main difference between mania and hypomania?
In hypomania there will be no psychosis, hospitalisation and there will not be a big impact on social or occupational functioning
What is the treatment for bipolar disorder?
Mania = Antipsychotics - haloperidol, olanzapine, risperidone, quetiapine
Mood stabilizers - (1st choice - lithium), sodium valproate, lamotrigine, carbamazepine
ECT
Depression - usually talking therapies, fluoxetine is medication of choice
What is the epidemiology of bipolar disorder?
Male = Female (affected equally)
mean age of onset = 21 (will usually be before 30).
Old age diagnosis not common
What is the epidemiology of depression?
Female:male
2:1
mean age of onset = 27
Old age diagnosis common
What are the main differences between depression and bipolar disorder?
Depression: 4-6 months 80% have recurrent episode 15% die by suicide 54% recovery at 26 weeks
Bipolar/Mania: 1-3 months 60% recovered at 10 weeks 90% have further episodes 10% die by suicide
What happens if you have psychotic symptoms?
You will always be classified as having severe depression, regardless of the other criterias.
What is middle feeling (not manic or depressive) called?
Euthymic
Which test might you consider if you think someone might have depression?
Blood tests - incase it is physical like hyperthyroidism or hypothyroidism.
Which antidepressant can be used safely after cardiac events?
Sertraline.
What antidepressant is given often to the elderly patients (and can make them sleepy)?
Mirtazapine.
What is bipolar disorder most likely to present with?
Depression (more likely than mania).
What is one of the most common presentation of a psychotic episode?
LACK OF INSIGHT - they often don’t know how ill they are so stop taking their medication.
What blood test should be done when trying to diagnose Generalised anxiety disorder?
Thyroid function tests - to rule out hyperthyroidism.
What is the first line treatment for mild OCD?
Exposure response prevention therapy.
What are the cognitive symptoms of generalised anxiety disorder?
agitation
feeling of impending doom
repetitive thoughts
difficulty sleeping
What are the somatic symptoms of generalised anxiety disorder?
Muscle tension Trembling Sweating Hyperventilation Nausea Globus hystericus - lump in throat
What are behavioural symptoms of generalised anxiety disorder?
Avoidance
Reassurance seeking
Dependence
What positive factor automatically puts you into the ‘severe depression’ category?
Psychotic illness.
What are the types of delusion?
Persecuted (to harass or punish)
Prosecuted (to bring legal action)
Paranoia
Grandiose (believes they have a super talent)
Erotomanic (believes people are involve with them)
Jealous
Somatic (believes something is wrong with their body)
Mixed
Unspecified
What is the difference between bipolar type 1 and bipolar type 2?
Type 1: Depression + mania
Type 2: Depression + hypomania
Which neurotransmitters are thought to play a role in depression?
Serotonin
Dopamine
Norepinephrine
What are some differential diagnosis for depression?
Thyroid dysfunction Hyperadrenalism Hypoadrenalism Dementia Multiple sclerosis
Which medications can cause depression?
Alcohol Beta-blockers Benzodiazepines Isotretinoin/roacutane Methyldopa
Which medical conditions can cause depression?
Pancreatic cancer
Chronic conditions
What are the sub divisions of anxiety?
Generalised anxiety disorder Phobias Panic disorder PTSD OCD
If patients present after 40yrs old with anxiety what is the likely cause?
More likely to be caused by depression or organic disease
How long should benzodiazepines be prescribed for in generalised anxiety disorder?
NO MORE than 10 days
What is the first line treatment for generalised anxiety disorder?
SSRI (+ CBT)
What are second line treatments for generalised anxiety disorder?
Busipirone (short term)
Beta blocker
Low dose antipsychotics
Which two age groups are most likely to suffer from panic disorder?
20s
50s
How much more common is panic disorder in females compared to males?
2-3x
What is 1st line treatment for panic disorder?
CBT
What is 2nd line treatment for panic disorder?
SSRI
+ Can add on clomipramine (TCA)
What is the 1st line treatment for phobias?
CBT - social and agoraphobia and panic disorder
Flooding - for other phobias
If someone has anxiety, what should be treated first?
The primary disorder - either depression or substance misuse.
Then treat anxiety.
For most mental health conditions, how long should medication be continued for?
At least 6 months after remission.
What is the first line treatment for mania?
Either lithium or an antipsychotic
What are the classification of mild, moderate and severe depression?
(the additional symptoms are used to make up the numbers)
Mild - 4 (2 being core)
Moderate - 5 or 6 (2 being core)
Severe - 7 or more (3 being core)
What medication would you use in rapid cycling bipolar disorder?
Antipsychotics
How many episodes do you have to have in a year to be diagnosed with rapid cycling bipolar disorder?
4 or more episodes in 1 year
What is confabulation?
The person has a memory loss - so they unintentionally make up a story and fabricate it.
They believe they are telling the truth and they aren’t lying deliberately.
What is a nihilistic delusion?
Its a negative delusion
When must the onset of depression be to classify as postnatal?
Within 6 months of giving birth
When does postpartum psychosis occur?
Within days of giving birth
which medication is very good for affective disorder prophylaxis?
Lithium
What is a key difference between affective disorders and delirium?
People with affective disorders will be orientated to the time and place, even if they are experiencing delusions.
What are risk factors for depression?
Previous depression History of other mental illness History of substance misuse FH of depression or suicide Domestic violence Unemployment Poor social support network Recent stressful life event
What are the 2 key questions to ask when screening for depression?
- During the last month, how often have you been bothered by feeling down, depressed or hopeless.
- During the last month, have you been bothered by having little interest or pleasure in doing things.
When should the DVLA be informed about an affective disorder?
If it falls into the severe category - severe depression or severe anxiety
How often should patients with depression be followed up in general practice if taking medication?
- after 2 weeks of starting
- every 2-4 weeks for 3 months
- after 1 week if <30yrs or high risk
which medication can’t be used to treat bipolar in women of child bearing age?
Sodium valproate - if its used then women most be on contraception due to teratogenicity.
Which SSRI is most effective in generalised anxiety disorder?
First line is sertraline.
How long should medication for generalised anxiety disorder be continued for?
At least 12 months after initiation
Which SSRI should NOT be used in panic disorder?
Fluoxetine
What is the treatment for social anxiety?
1st line - CBT
2nd line - Sertraline or escitalopram
How long should treatment be continued for in social anxiety?
6 months once treatment has become effective
What is the main difference between grief and depression?
Grief causes longing for a loved one but the person can still experience positive emotions in other areas.
Grief - want to be with people.
Depression - want to be alone.
What is prolonged grief disorder?
Distress and disability is caused by the grief reaction.
This distress and disability lasts for more than 6months after the person has passed away.
What are the treatment options for prolonged grief disorder?
Counselling - Cruse
Antidepressants for comorbid depression
CBT
Referral
What is the 1st line treatment for OCD?
CBT including exposure and response prevention
What Is the 2nd line treatment for OCD?
SSRI
- Often required at a higher dose
- Often takes about 12 weeks to see a response
