Affective Disorders Flashcards
What is a mood disorder?
Disorders of mental status and function where altered mood is the core feature
Refers to states of depression and elevated mood
Commonest group of mental disorders
What 2 systems classify these disorders?
ICD-11
DSM-5
What is the spectrum of mood disorders?
Mania with psychosis - hypomania - elated - normal - dysthymia - depression - severe depression with pyschosis
Bipolar spans the whole spectrum
What is cyclothymia?
From elation to dysthymia on the spectrum of mood disorders
What is the symptom depression?
An emotion within the range of normal experience
Describes a state of feeling or mood
Form of sadness
What is depression as a syndrome?
Constellation of symptoms and signs
Can be single episode or recurrent illness
Leading cause of disability worldwide
When does depression become abnormal?
Persistence of symptoms
Pervasiveness of symptoms
Degree of impairment
Presence of specific symptoms or signs
What is the definition of depression from ICD-11?
Low mood or reduced interest/ pleasure
Most of the day and nearly every day
Lasts for at least 2 weeks
No hypomanic or manic episodes in lifetime
What does SIG E CAPS stand for in depression?
S - sleep problems
I - interest deficit
G - guilt, worthlessness and hopelessness
E - energy deficit
C - concentration deficit
A - appetite disorder
P - psychomotor retardation or agitation
S - suicidality
Describe mild depression
Individual is usually distressed by the symptoms to a mild extent
Some difficulty in continuing to function
No delusions or hallucinations
Managed at GP level
Describe moderate depression
Several symptoms of a depressive episode are present to a marked degree or large number of symptoms
Considerable difficulty functioning in multiple domains
Managed in psychiatric outpatient clinic
Describe severe depression
Many or most symptoms are present or smaller number in an intense degree
Have serious difficulty continuing to function in most domains
With/ without psychosis
Often requires inpatient admission
Describe post-natal depression
10-15% of women having babies
Often within a month or two of giving birth
Can start several months postpartum
75% of women experience blues in first 2 weeks
What is the risk of puerperal psychosis?
1 in 1000 deliveries with a risk of recurrence with subsequent deliveries
What is the differential diagnosis for depression?
Normal reaction to life event, seasonal affective disorder, dysthymia, cyclothymia, bipolar, stroke, tumour, dementia, hypothyroidism, infections and drugs
What is the treatment for depression?
Antidepressants
Antipsychotics
Mood stabilisers
Psychological treatments - CBT, IPT and individual dynamic psychotherapy
Physical treatments - ECT, TMS, psychosurgery and ketamine
What antidepressants are used in depression?
SSRIs
SNRIs
TCAs - tricyclic antidepressants
MAOIs - monamine oxidase inhibitors
Mirtazapine
What are some measurement tools for depression?
SCID, SCAN, HDRS, BDI-II, HADS and PHQ-9
What is mania?
Extreme mood state lasting at least one week unless shortened by treatment
Euphoria, irritability, increased activity, pressured speech, flight of ideas, delusions of grandeur and decreased need for sleep
What does DIG FAST mean for mania?
D - distractibility
I - impulsivity, poor judgement, spending sprees..
G - grandiosity
F - flight of ideas
A - activities
S - sleep decreased
T - talkativeness
What is a mixed affective state?
Presence of several prominent manic and several prominent depressive symptoms which occur simultaneously or alternate rapidly
Lasts most of day, every day for at least 2 weeks
What are classifications of mixed affective disorders?
Bipolar type 1
Bipolar type 2
Cyclothymic disorder
Substance induced mood disorder
Describe bipolar type 1
At least one manic or mixed episode
Characterised by recurrent depressive and manic/ mixed episodes
Have to be history of at least one manic or mixed episode
Describe bipolar II
One or more hypomanic episodes
At least one depressive episode
No history of manic or mixed episodes
What is psychosis?
Usually mood congruent
Paranoia and persecutory experiences more suggestive of schizophrenia
What are examples of depressive psychosis?
Body is rotting - cotards
Delusions of guilt
Voices telling them to hurt themselves
Voices of family members saying horrible things
What is some examples of mania psychosis?
Religious
Grandiose
De clerambault syndrome - delusions someone is in love with them
What is the definition of cyclothymia?
Persistent instability of mood over a period of at least 2 years
Numerous periods of hypomania
Depressive symptoms more present
What are differential diagnosis for mixed affective disorders?
Schizoaffective disorder, schizophrenia, ADHD, drugs and alcohol
Stroke, MS, tumour, epilepsy, AIDS, neurosyphilis, endocrine and SLE
What are tools to measure mixed affective disorders?
SCID, SCAN and young mania rating scale (YMRS)
What is the treatment for bipolar disorder?
Benzodiazepines
Antipsychotics - olanzapine
Mood stabilisers - sodium valproate, lithium and carbamazepine
ECT
What is the epidemiology of bipolar disorder?
Lifetime prevalence rate is 0.7 - 1.6
Rate of males = females
Mean age of onset is 21
Early onset usually positive FH
What is the epidemiology of depression?
Lifetime prevalence rate is 2.9-12
Rates of females exceeds males 2:1
Mean age of onset is 27
What is the clinical course and outcome of major depression?
Typical episodes lasts 4-6 months
54% recovered at 26 weeks
15% die by suicide
80% have further episodes
What is the clinical course and outcome of bipolar disorder/ mania?
Typical manic episode lasts 1-3 months
60% recovered at 10 weeks
90% have further episodes
10% die by suicide
