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Psychiatry (Brian) > Affective Disorders > Flashcards

Affective Disorders Flashcards

1
Q

What are mood disorders?

A

Is any disorder of mental status and function where altered mood is the core feature:

  • Can be primary or can be consequence of other illness
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2
Q

What classification system is used for mood disorders?

A
  • International Classification of Disease (ICD-10)
    • WHO
  • Diagnostic and Statistical Manual of Mental Disorders (DSM-5)
    • American Psychiatric Association
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3
Q

What are the different meanings of the word depression?

A
  • Symptom
    • An emotion within normal range of experience, is a form of sadness
  • Syndrome
    • A constellation of symptoms and signs involved
  • Recurrent illness
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4
Q

Aetiology/risk factors - depression

A
  • Not employed
  • Not financially independent
  • Not in stable marriage
  • Lower educational attainment
  • Family history
  • Exit events
    • Separations, losses
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5
Q

Epidemiology - depression

(how common, sex, age)

A
  • Leading cause of disability
  • Common
    • Lifetime prevalence 3-12/100 people
  • M:F 1:2
  • Age 20-40
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6
Q

When does psychiatry consider depression to become abnormal?

A
  • Not clear
  • Psychiatry places emphasis on
    • 1 persistence of symptoms
    • 2 pervasiveness of symptoms
    • 3 degree of impairment
    • 4 presence of specific symptoms or signs
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7
Q

What are the 4 things psychiatry puts emphasis on for depression to be considered abnormal?

A
  • 1 persistence of symptoms
  • 2 pervasiveness of symptoms
  • 3 degree of impairment
  • 4 presence of specific symptoms or signs
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8
Q

What are the symptoms of depressive illness?

A
  • Change in mood
    • Depression
    • Anxiety
    • Perplexity
    • Anhedonia
  • Change in thought content
    • Guilt
    • Hopelessness
    • Worthlessness
    • Any neurotic symptomatology
    • Delusions and hallucinations
  • Change in bodily function
    • Energy (fatigue)
    • Sleep
    • Appetite (weight loss)
    • Libido
    • Constipation
    • Pain
  • Change in psychomotor functioning
    • Agitation
    • Retardation
  • The social sphere
    • Loss of interests
    • Irritability
    • Apathy
    • Withdrawal, loss of confidence, indecisive
    • Loss of concentration, registration and memory
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9
Q

What possible changes in mood can be seen in depression?

A
  • Depression
  • Anxiety - inability to deal with or understand something.
  • Perplexity
  • Anhedonia
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10
Q

What possible changes in thought content can be seen in depression?

A
  • Guilt
  • Hopelessness
  • Worthlessness
  • Any neurotic symptomatology
  • Delusions and hallucinations
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11
Q

What changes in bodily function can be seen in depression?

A
  • Energy (fatigue)
  • Sleep
  • Appetite (weight loss)
  • Libido
  • Constipation
  • Pain
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12
Q

What changes in psychomotor functioning can be seen in depression?

A
  • Agitation
  • Retardation
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13
Q

What change can be seen in the social sphere in depression?

A
  • Loss of interests
  • Irritability
  • Apathy - lack of interest, enthusiasm or concern.
  • Withdrawal, loss of confidence, indecisive
  • Loss of concentration, registration and memory
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14
Q

What is required to be diagnosed with depression in general?

A
  • Last for at least 2 weeks
  • No hypomanic or manic episodes in lifetime
    • Consider diagnose of bipolar disorder if have
  • Not attributable to psychoactive substance use
  • If psychotic symptoms need to exclude illnesses like schizophrenia
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15
Q

What is the criteria to be diagnosed with mild depression?

A
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16
Q

What are some measurement tools that can be used to help diagnose depression?

A
  • SCID (Structured clinical interview for DSM disorders)
  • SCAN (Schedules for clinical assessment inn neuropsychiatry)
  • HDRS (Hamilton depression rating scale)
  • BDI-II (Beck depression inventory II)
17
Q

Treatment - depression

A
  • Antidepressants
    • Selective serotonin reuptake inhibitors (SSRIs)
    • Tricyclic antidepressants (TCAs)
    • Monamine oxidase inhibitors
    • Other antidepressants
  • Psychological treatments
    • CBT, IPT, individual dynamic psychotherapy, family therapy
  • Physical treatments
    • ECT, psychosurgery, DBS, vagas nerve stimulation (VNS)
18
Q

What is somatic syndrome?

A

Type of depression with characteristic symptoms, unlike regular depression which varies between people

19
Q

Somatic syndrome - presentation

A
  • Loss of interest
  • Lack of emotional reactions
  • Waking 2 hours before normal time
  • Depression worse in morning
  • Evidence of psychomotor agitation or retardation
  • Marked loss of appetite
    • Weight loss, 5% of body weight in month
  • Marked loss of libido
20
Q

What is post-natal depression?

A

Increased risk of psychiatric admission in 30 days following childbirth

21
Q

Epidemiology - postnatal depression

A
  • 75% woman experience ‘blues’ within 2 weeks
  • 10% develop major depressive disorder (MDD) within 3-6 months
22
Q

Differential diagnosis - depressive disorder

A
  • Normal reaction to life event
  • Seasonal affective disorder
  • Dysthymia
  • Cyclothymia
  • Bipolar
  • Stroke, tumour, dementia
  • Hypothyroidism, Addison’s, hyperparathyroidism
  • Infections
    • Influenza, infectious mononucleosis, hepatitis, HIV/AIDs
  • Drugs
23
Q

What is mania?

A

Mania = describes state of feeling, or mood, that can range from near-normal experience to severe, life-threatening illness

24
Q

What is mania associated with?

A
  • Loss of judgement
  • Grandiose ideas
  • Disinhibition
  • With similar effects of stimulant drugs like cocaine
25
Q

When is behaviour considered to be mania?

A
  • Not clear
  • Same 4 psychiatric emphasis as depressive disorders
    • 1 persistence of symptoms
    • 2 pervasiveness of symptoms
    • 3 degree of impairment
    • 4 presence of specific symptoms or signs
26
Q

Classifications of mania?

A
  • Hypomania
  • Mania without psychotic symptoms
  • Mania with psychotic symptoms
  • Other manic episodes
  • Manic episode, unspecified
27
Q

What tools can be used to measure mania?

A
  • SCID
  • SCAN
  • Young mania rating scale (YMRS)
28
Q

What is hypomania?

A

Lesser degree of mania with no psychosis

29
Q

Presentation - hypomania

A
  • Mild elevation of mood for several days on end
  • Increased energy and activity
  • Increased sociability and talkativeness
  • Increased libido
  • Decreased need for sleep
  • May be irritable
  • Concentration reduced, new interests, mild overspending
  • Not to extent of severe disruption of work or social rejection
30
Q

What is required to be diagnosed with mania?

A
  • Symptoms for a week that are enough to disrupt normal activates like work
  • Symptoms
    • Elevated mood, increased energy, over activity, pressure of speech, decreased need for sleep
    • Disinhibition
    • Grandiosity
    • Alteration of senses
    • Extravagant spending
    • Can be irritable rather than elated
31
Q

Differential diagnosis - mania

A
  • Psychiatric
    • Mixed affective state
    • Schizoaffective disorder
    • Scizophrenia
    • Cyclothymia
    • ADHD
    • Drugs and alcohol
  • Medical
    • Stroke
    • MS
    • Tumour
    • Epilepsy
    • AIDS
    • Neurosyphilis
    • Endocrine
      • Cushing’s, hyperthyroidism
    • SLE
32
Q

Treatment - mania

A
  • Antipsychotics
    • Olanzapine
    • Risperidone
    • Quetiapine
  • Mood stabilisers
    • Sodium valproate
    • Lamotrigene
    • Carbamazepine
  • Lithium
  • ECT
33
Q

Aetiology/risk factors - bipolar disorder

A
  • Family history
34
Q

Epidemiology - bipolar disorder

(prevalence, sex, age)

A
  • Prevalence 1/100 to have in lifetime
  • M=F
  • Age usually <30
35
Q

What is the diagnostic criteria for bipolar disorder?

A
  • 2 episodes of depression and either mania or hypomania
  • If no mania or hypomania then diagnosis is recurrent depression
  • If no depression then diagnosis is hypomania or bipolar disorder
36
Q

Compare depression and mania:

  • how long episode lasts
  • how many recovery and how long
  • how many have further episodes
  • how many die by suicide
A

Psychiatry (Brian) (16 decks)

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