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psychiatry > Affective Disorders > Flashcards

Affective Disorders Flashcards

1
Q

what are mood disorders?

A

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

refer to states of depression and of mania

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2
Q

How can mood disorders present?

A

primary

or

secondary: consequence of another disorder/illness

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3
Q

What are mood disorders often associated with?

A

Anxiety symptoms and anxiety disorders

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4
Q

give 2 examples of classification systems

A

ICD10

DSM5

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5
Q

what is depression when thought of as a symptom?

A

state of feeling or mood that can range from normal experience to a severe, life-threatening illness

typically associated as a form of sadness

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6
Q

What is depression when thought of as a syndrome?

A

A constellation of symptoms and signs

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7
Q

What is depression when thought of as a recurrent illness?

A

Recurrent depressive disorder

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8
Q

when does depression become abnormal?

A

not clear cut but psychiatry places emphasis on

  • symptoms: persistent, pervasive
  • degree of impairment
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9
Q

What are the 3 spheres that depressive illness symptoms occur in?

A
  • Psychological
  • Physical
  • Social
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10
Q

What changes can occur in the psychological sphere with depression?

A
  • Changes in mood

- Changes in thought content

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11
Q

What changes in mood can occur with depression?

A
  • Depression (can have diurnal variation)
  • Anxiety
  • Perplexity
  • Anhedonia
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12
Q

What changes in thought content can occur with depression?

A
  • Undue guilt
  • Hopelessness
  • Worthlessness
  • Any neurotic symptomatology
  • Ideas of reference
  • Delusions and hallucinations
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13
Q

What changes can occur in the physical sphere with depression?

A
  • Change in bodily function

- Change in psychomotor functioning

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14
Q

what changes with bodily function can occur with depression?

A

changes in

  • energy
  • sleep
  • apetite
  • libido
  • constipation
  • pain
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15
Q

What changes with psychomotor functioning occur with depression?

A
  • Agitation

- Retardation

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16
Q

what changes can occur to the social sphere in depression?

A
  • loss of interests
  • loss of concentration
  • loss of confidence
  • irritability
  • apathy, withdrawal
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17
Q

Agitation

A

A state of restless over activity, aimless or ineffective

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18
Q

Anhedonia

A

Loss of ability to derive pleasure from experience

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19
Q

Anxiety

A

An unpleasant emotion in which thoughts of apprehension or fear predominate

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20
Q

Apathy

A

Loss of interest in own surroundings

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21
Q

depression

A

unpleasant emotion in which sadness or unhappiness predominates

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22
Q

Retardation

A

A slowing of motor responses including speech

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23
Q

Stupor

A

A state of extreme retardation in which consciousness is intact.

The patient stops moving, speaking, eating and drinking.

On recover, they can describe clearly events which occurred whilst stuporose

24
Q

What is the ICD10 criteria for depression?

A
  • at least 2 week history
  • no hypomanic/manic episodes ever
  • not attributable to substances/organic mental disorder
  • excluded other diagnosis if presents with psychosis
25
Q

What occurs in somatic syndrome?

A

loss in:

  • energy
  • sleep: waking up 2 hrs earlier, depression worse in morning
  • apetite - weight loss
  • libido
  • psychomotor - agitation or retardation
26
Q

What is the general criteria for depression.

A
  • low mood
  • low energy
  • loss of interest/pleasure
27
Q

what is the additional criteria for depression?

A

change in

  • confidence
  • concentration
  • sleep
  • apetite
  • guilt, suicidal thoughts, agitation or retardation
28
Q

According to ICD10, what is the criteria for mild depression.

A
  • At least 2 general criteria

- Additional criteria to give score of at least 4

29
Q

According to ICD10, what is the criteria for moderate depression?

A
  • At least 2 general criteria

- Additional criteria to give score of at least 6

30
Q

according to ICD10, what is the criteria for severe depression?

A
  • all of the general criteria
  • additional criteria to give score of at least 8
  • if psychotic symptoms or stupor then severe depression
31
Q

How many people experience post-natal depression?

A

75% of women within 2 weeks

32
Q

examples of differential diagnosis for depression

A

normal reaction to life event

seasonal affective disorder (SAD)

dysthymia, cyclothymia, bipolar

stroke, tumour, dementia

hypothyroidism, Addison’s, hyperparathyroidism

infections: influenza, infectious mononucleosis, hepatitis, HIV/AIDS

drugs

33
Q

what treatment options are there for depression?

A
  • antidepressants
  • psychological treatments
  • physical treatments
34
Q

types of antidepressants

A
  • selective serotonin reuptake inhibitors (SSRIs)
  • tricyclic antidepressants (TCAs)
  • monamine oxidase Inhibitors
35
Q

what forms of psychological treatment are there for depression?

A
  • CBT
  • IPT
  • individual dynamic psychotherapy
  • family therapy
36
Q

physical treatments for depression

A
  • ECT
  • psychosurgery
  • DBS
  • VNS
37
Q

what are the 2 main measurement tools used in depression?

A

SCID (Structured Clinical Interview for DSM disorders)

SCAN (Schedules for Clinical Assessment in Neuropsychiatry)

38
Q

what is mania?

A

a state of feeling, or mood, that ranges from near-normal experience to severe, life-threatening illness

inappropriate elevated mood

39
Q

What is mania often associated with?

A
  • disinhibition
  • loss of judgement
  • grandiose ideas
40
Q

examples of classifications of mania

A

hypomania

mania without psychotic symptoms

mania with psychotic symptoms

other manic episodes

manic episode, unspecified

41
Q

1

A

1

42
Q

what is the ICD10 criteria for hypomania

A

lesser degree of mania, no psychosis

mild elevation of mood for several days on end

increased energy: activity, marked feeling of wellbeing

increased sociability: talkativeness, overfamiliarity, sexual energy, decreased need for sleep

may be irritable

decreased concentration: new interests, mild overspending

not severe enough to disrupt ordinary work and social activities more or less completely

43
Q

what is the ICD10 criteria for mania (with or without 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
  • may be irritable rather than elated
44
Q

examples of differential diagnosis for mania

A

mixed affective state

schizoaffective disorder, schizophrenia

cyclothymia, ADHD

stroke, MS, epilepsy, AIDS, neurosyphilis

cushing’s, hyperthyroidism, SLE

drugs and alcohol

45
Q

What measurement tools are there for mania?

A
  • SCID
  • SCAN
  • Young mania rating scale (YMRS)
46
Q

What treatment options are there for mania?

A

antipsychotics: olanzapine, risperidone, quetiapine

mood stabilisers: sodium valproate, lamotrigine, carbamazepine

lithium

ECT

47
Q

Give examples of ICD10 classifications of bipolar disorder.

A
  • BAD, currently hypomanic
  • BAD, current manic without psychosis
  • BAD, current manic with psychosis
  • BAD, Current mild/mod depression
  • BAD, current severe depression without psychosis
  • BAD, current severe depression with psychosis
  • BAD, current episode mixed
  • BAD, current episode in remission
  • Other bipolar affective disorders
  • Bipolar affective disorder, unspecified
48
Q

What is bipolar affective disorder?

A

It is a condition which consists of repeated (2+) episodes of depression and mania or hypomania

49
Q

If a patient presents with no episodes of mania or hypomania, what is the diagnosis?

A

Recurrent depression

50
Q

If a patient presents with no depression, what is the diagnosis?

A

Hypomania or bipolar disorder

51
Q

What is the epidemiology of bipolar disorder?

A
  • Lifetime prevalence rate: 0.7-1.6
  • M=F
  • Mean age of onset= 21 (unusual after 30)
  • 1/3 have onset <20 years
52
Q

When does early onset of bipolar disorder usually occur?

A

When there is a family history

53
Q

What is the epidemiology of depression?

A

-Lifetime prevalence risk: 2.9-12 (less severe manifestations= 20)
-F:M 2:1
-highest risk 18-44 (median 25)
-Mean age of onset =27
-

54
Q

What is the typical outcome of major depression?

A
  • Typical episode 4-6 months
  • 80% have further episodes
  • 54% have recovered by 26 weeks
  • 15% die by suicide
  • 12% do not recover
55
Q

What is the typical outcome of bipolar disorder/mania?

A
  • Typical manic episode 1-3months
  • 90% have further episodes
  • 60% recovered by 10 weeks
  • 10% die by suicide
  • 5% fail to recover

psychiatry (23 decks)

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