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y3 - psychiatry > affective disorders > Flashcards

affective disorders Flashcards

1
Q

what are mood disorders

A

disorders of mental status and function where altered mood is the core feature

term referring to states of depression and mania

commonest group of mental disorders

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2
Q

how can mood disorders present

A

can present as a 1y problem or as a consequence of other disorder or illness e.g. cancer, dementia, drug misuse, medical treatment

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3
Q

what are mood disorders often associated with

A

anxiety symptoms and anxiety disorders

focus on the depressive disorders when treating - the treatment of this often helps with the anxiety symptoms

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4
Q

what is depression - symptom

A

an emotion within the range of normal experience

describes a mood that can range from normal experience to severe life-threatening illness

systemic symptoms with similarities to fatigue and pain

typically considered as a form of sadness, not just an absence of happiness

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5
Q

depression as an illness

A

combination of symptoms and signs

can be recurrent

leading cause of disability worldwide

common

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6
Q

when does depression become abnormal

A

no clear and convenient division

generally:
- persistence of symptoms (at least 2 wks)
- pervasiveness of symptoms (most of the time)
- degree of impairment
- presence of specific symptoms or signs

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7
Q

3 areas of symptoms of depressive illness

A

psychological
physical
social

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8
Q

psychological symptoms of depression

A

CHANGES IN MOOD

  • depression (may find diurnal variation)
  • anxiety (inability to relax)
  • perplexity (feeling of being overwhelmed, particularly in puerperal illness)
  • anhedonia (inability to experience pleasure in things you normally would)

CHANGE IN THOUGHT CONTENT

  • guilt
  • hopelessness
  • worthlessness
  • any neurotic symptoms (hypochondriasis, agoraphobia, obsessions and compulsions, panic attacks)
  • ideas of reference
  • psychotic symptoms: delusions and hallucinations if severe
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9
Q

what are ideas of reference

A

an individual is thinking that in their environment something is happening that is specifically relating to them, even when there may be no evidence to suggest that’s true

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10
Q

physical symptoms of depression

A

CHANGE IN BODILY FUNCTION

  • energy (fatigue)
  • sleep (too much or disturbed)
  • appetite (weight gain/loss)
  • libido
  • constipation
  • pain

CHANGE IN PSYCHOMOTOR FUNCTIONING

  • agitation
  • retardation
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11
Q

social symptoms of depression

A

loss of interests
irritability
apathy
withdrawal, loss of confidence, indecisive
loss of concentration, registration and memory

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12
Q

define agitation

A

a state of restless overactivity, aimless or ineffective

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13
Q

define anhedonia

A

loss of ability to derive pleasure from experience

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14
Q

define apathy

A

loss of interest in own surroundings

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15
Q

define anxiety

A

an unpleasant emotion in which thoughts of apprehension or fear predominate

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16
Q

define retardation

A

a slowing of motor responses including speech

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17
Q

define stupor

A

a state of extreme retardation in which consciousness is intact

patient stops moving, speaking, eating and drinking

on recovery can describe clearly events which occurred whilst stuporose

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18
Q

depression ICD 10

A

symptoms last for at least 2 wks
no hypomanic or manic episodes in lifetime
not attributable to psychoactive substance use or organic mental disorder

if psychotic symptoms or stupor then severe depression w/ psychotic symptoms
- need to exclude other psychotic illnesses first e.g. Sz

19
Q

depression ICD 10 - somatic syndrome

A

marked loss of interest/pleasure in activities that are normally pleasurable

lack of emotional reactions to events/activities that normally produce an emotional response

waking 2hrs before the normal time

depression worse in the morning

objective evidence of psychomotor agitation or retardation

marked loss of appetite

weight loss (5%+ of body weight in a month)

marked loss of libido

20
Q

mild depression ICD 10

A

general criteria

at least 2 of:

  • depressed mood that is abnormal for most of the day almost everyday for the past 2 weeks, largely uninfluenced by circumstances
  • loss of interest/pleasure
  • decreased energy/increased fatiguability

additional from this list to give at least 4:

  • loss of confidence or self esteem
  • unreasonable feelings of guilt/self reproach or excessive guilt
  • recurrent thoughts of death by suicide or any suicidal behaviour
  • decreased concentration
  • agitation or retardation
  • sleep disturbance of any sort
  • change in appetite
21
Q

moderate depression ICD 10

A

general criteria

at least 2 of:

  • depressed mood that is abnormal for most of the day almost everyday for the past 2 weeks, largely uninfluenced by circumstances
  • loss of interest/pleasure
  • decreased energy/increased fatiguability

additional from this list to give at least 6:

  • loss of confidence or self esteem
  • unreasonable feelings of guilt/self reproach or excessive guilt
  • recurrent thoughts of death by suicide or any suicidal behaviour
  • decreased concentration
  • agitation or retardation
  • sleep disturbance of any sort
  • change in appetite
22
Q

severe depression ICD10

A

general criteria

all of:

  • depressed mood that is abnormal for most of the day almost everyday for the past 2 weeks, largely uninfluenced by circumstances
  • loss of interest/pleasure
  • decreased energy/increased fatiguability

additional from this list to give at least 8:

  • loss of confidence or self esteem
  • unreasonable feelings of guilt/self reproach or excessive guilt
  • recurrent thoughts of death by suicide or any suicidal behaviour
  • decreased concentration
  • agitation or retardation
  • sleep disturbance of any sort
  • change in appetite
23
Q

postnatal depression

  • when is risk of admission increased
  • how common is it
  • puerperal psychosis
A

increased risk of psychiatric admission in the 30 days following childbirth (risk for 24mths)

  • 75% of women experience blues within 2wks
  • 10% develop major depressive disorder within 3-6mths
  • puerperal psychosis (1/500 deliveries, risk of recurrence of 1-3 w/ subsequent deliveries)
  • no demonstrated associated w/ hormonal changes
24
Q

depression - differential diagnosis

A 
normal reaction to life event 
SAD
dysthymia 
cyclothymia 
bipolar
stroke, tumour, dementia 
hypothyroidism, Addison's, hyperparathyroidism 
infections - flu, infectious mononucleosis, hepatitis, HIV/AIDS
drugs
25
Q

treatments for depression

A

ANTIDEPRESSANTS

  • selective serotonin reuptake inhibitors (SSRIs)
  • tricyclic antidepressants (TCAs)
  • monamine oxidase inhibitors
  • others

PSYCHOLOGICAL
- CBT, IPT, individual dynamic psychotherapy, family therapy

PHYSICAL
- ECT, psychosurgery, DBS, VNS

26
Q

measurement tools for depression and other psychiatric disorders

A

SCID - structured clinical interview for DSM disorders
SCAN - schedules for clinical assessment in neuropsychiatry
- structured ways of diagnosing depressive disorders and other psychiatric disorders

HRDA - hamilton depression rating scale
BDI-II - beck depression inventory II
HADS - hospital anxiety and depression scale
PHQ-9 - patient health questionnaire 9
- self-completed checklists to measure severity of depressive symptoms

27
Q

what is mania

A

a mood that can range from near-normal experience to severe, life-threatening illness

rarely a symptom - often associated w/ grandiose ideas, disinhibition, loss of judgement; w/ similarities to the mental effects of stimulant drugs (AMPH, cocaine)

typically considered as a form of pathological, inappropriate elevated mood

28
Q

when does mania become abnormal

A

no clear devision

generally emphasis is on:

  • persistence of symptoms
  • pervasiveness of symptoms
  • degree of impairment
  • presence of specific symptoms or signs
29
Q

ICD 10 - different manic disorders

A 
hypomania
mania w/o psychotic symptoms 
mania w/ psychotic symptoms
other manic episodes
unspecified manic episode
30
Q

ICD classification of hypomania

A
  • lesser degree of mania, no psychosis
  • mild elevation of mood for several days on end
  • increased energy and activity, marked feeling of wellbeing
  • increased sociability, talkativeness, overfamiliarity, increased sexual energy, decreased need for sleep
  • may be irritable
  • concentration reduced, new interests, mild overspending
  • not to the extent of severe disruption of work or social rejection
31
Q

ICD 10 mania classification (w/ or w/o psychosis)

A
  • 1 week, severe enough to disrupt ordinary work and social activities more or less completely
  • elevated mood, increased energy, overactivity, pressure of speech, decreased need for sleep
  • disinhibition
  • grandiosity
  • alteration of senses
  • extravagant spending
  • can be irritable rather than elated
32
Q

differential diagnosis for manic/hypomanic episode

A

PSYCHIATRIC

  • mixed affective state
  • schizoaffective disorder
  • schizophrenia
  • cyclothymia
  • ADHD
  • drugs and alcohol

MEDICAL

  • stroke, MS, tumour, epilepsy, AIDS, neurosyphilis
  • endocrine - cushing’s, hyperthyroidism
  • SLE
33
Q

tools to measure mania

A

SCID
SCAN

YMRS - young mania rating scale - measure changes in severity of symptoms

34
Q

treatment for mania

A

ANTIPSYCHOTICS

  • olanzapine
  • risperidone
  • quetiapine

MOOD STABILISERS

  • sodium valproate
  • lamotrigene
  • carbamazepine
  • lithium
  • ECT
35
Q

ICD 10 diagnosis for bipolar affective disorder

A

consists of repeated (2+) episodes of depression and mania or hypomania
if no mania/hypomania then diagnosis is recurrent depression
if no depression the diagnosis is hypomania or bipolar disorder

in DSM 5 a single episode of mania is sufficient to diagnose bipolar disorder

36
Q

epidemiology of mood disorder - why have there been difficulties and how have improvements been made

A

studies hindered by differences in diagnostic classification

greatest agreement for most severe forms

greater agreement as a result from improved case definition and funding for large scale community surveys

structured, standardised interview schedules have shown greater agreement

37
Q

epidemiology of bipolar disorder - prevalence

difference between countries and gender

A

lifetime prevalence rate 0.7-1.6/100
point prevalance rate of mania 0.08-0.8

industrialised nations = non-industrialised
M=F
no differential prevalence according to income, occupation or educational status

prevalence consistently increased in 1st degree relatives

other forms of depression also more common

38
Q

age of onset of bipolar disorder

A

mean age of onset = 21, unusual >30, some studies 1/3 onset <20

early onset (15-19) usually w/ +ve FHx

39
Q

prevalence of depression

lifetime risk

A

lifetime prevalence rate 2.9-12/100
point prevalence rate of depression 3.7-7.7

lifetime risk for less severe manifestations - 20
rates for F>M (2:1)

40
Q

age of onset of depression

A

highest risk from age 18-44 (median 25)
mean age of onset = 27
onset during old age isn’t unusual

41
Q

prevalence of depression and financial, educational and relationship status

A

no overall association w/ socioeconomic status

MDD less common in those employed
MDD less common in those financially independent

association w/ lower educational attainment
stable marriage -vely associated w/ MDD

42
Q

risk of depression in families

onset of depression

A

increased risk in 1st degree relatives where proband has MDD (3x) or BPD (2x)

twin studies: MZ vs DZ 27% vs 12%

onset of depression (1st episode) associated w/ XS of adverse life events
- exit events e.g. separations, losses

43
Q

clinical course and outcome for major depression

A 
typical episode lasts 4-6mths
54% recovered at 26wks
12% fail to recover
≥80% have further episodes (40% for those treated within 1y care)
15% die by suicide
44
Q

clinical course and outcome for bipolar disorder/mania

A 
typical manic episode lasts 1-3mths
60% recovered at 10wks
5% fail to recover
90% have further episodes
1/3 have poor outcome 
1/3-1/4 have good outcome 
10% die by suicide

y3 - psychiatry (27 decks)

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