Affective Disorders Flashcards
What are mood disorders?
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
What classification system is used for mood disorders?
- International Classification of Disease (ICD-10)
- WHO
- Diagnostic and Statistical Manual of Mental Disorders (DSM-5)
- American Psychiatric Association
What are the different meanings of the word depression?
- Symptom
- An emotion within normal range of experience, is a form of sadness
- Syndrome
- A constellation of symptoms and signs involved
- Recurrent illness
Aetiology/risk factors - depression
- Not employed
- Not financially independent
- Not in stable marriage
- Lower educational attainment
- Family history
- Exit events
- Separations, losses
Epidemiology - depression
(how common, sex, age)
- Leading cause of disability
- Common
- Lifetime prevalence 3-12/100 people
- M:F 1:2
- Age 20-40
When does psychiatry consider depression to become abnormal?
- 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
What are the 4 things psychiatry puts emphasis on for depression to be considered abnormal?
- 1 persistence of symptoms
- 2 pervasiveness of symptoms
- 3 degree of impairment
- 4 presence of specific symptoms or signs
What are the symptoms of depressive illness?
- 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
What possible changes in mood can be seen in depression?
- Depression
- Anxiety - inability to deal with or understand something.
- Perplexity
- Anhedonia
What possible changes in thought content can be seen in depression?
- Guilt
- Hopelessness
- Worthlessness
- Any neurotic symptomatology
- Delusions and hallucinations
What changes in bodily function can be seen in depression?
- Energy (fatigue)
- Sleep
- Appetite (weight loss)
- Libido
- Constipation
- Pain
What changes in psychomotor functioning can be seen in depression?
- Agitation
- Retardation
What change can be seen in the social sphere in depression?
- Loss of interests
- Irritability
- Apathy - lack of interest, enthusiasm or concern.
- Withdrawal, loss of confidence, indecisive
- Loss of concentration, registration and memory
What is required to be diagnosed with depression in general?
- 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
What is the criteria to be diagnosed with mild depression?
What are some measurement tools that can be used to help diagnose depression?
- 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)
Treatment - depression
- 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)
What is somatic syndrome?
Type of depression with characteristic symptoms, unlike regular depression which varies between people
Somatic syndrome - presentation
- 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
What is post-natal depression?
Increased risk of psychiatric admission in 30 days following childbirth
Epidemiology - postnatal depression
- 75% woman experience ‘blues’ within 2 weeks
- 10% develop major depressive disorder (MDD) within 3-6 months
Differential diagnosis - depressive disorder
- 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
What is mania?
Mania = describes state of feeling, or mood, that can range from near-normal experience to severe, life-threatening illness
What is mania associated with?
- Loss of judgement
- Grandiose ideas
- Disinhibition
- With similar effects of stimulant drugs like cocaine
When is behaviour considered to be mania?
- 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
Classifications of mania?
- Hypomania
- Mania without psychotic symptoms
- Mania with psychotic symptoms
- Other manic episodes
- Manic episode, unspecified
What tools can be used to measure mania?
- SCID
- SCAN
- Young mania rating scale (YMRS)
What is hypomania?
Lesser degree of mania with no psychosis
Presentation - hypomania
- 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
What is required to be diagnosed with mania?
- 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
Differential diagnosis - mania
- Psychiatric
- Mixed affective state
- Schizoaffective disorder
- Scizophrenia
- Cyclothymia
- ADHD
- Drugs and alcohol
- Medical
- Stroke
- MS
- Tumour
- Epilepsy
- AIDS
- Neurosyphilis
- Endocrine
- Cushing’s, hyperthyroidism
- SLE
Treatment - mania
- Antipsychotics
- Olanzapine
- Risperidone
- Quetiapine
- Mood stabilisers
- Sodium valproate
- Lamotrigene
- Carbamazepine
- Lithium
- ECT
Aetiology/risk factors - bipolar disorder
- Family history
Epidemiology - bipolar disorder
(prevalence, sex, age)
- Prevalence 1/100 to have in lifetime
- M=F
- Age usually <30
What is the diagnostic criteria for bipolar disorder?
- 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
Compare depression and mania:
- how long episode lasts
- how many recovery and how long
- how many have further episodes
- how many die by suicide
