Affective disorders

Question 1

What factors should be considered when assessing whether or not depression/elation are abnormal?

Answer 1

Persistence of symptoms
Pervasiveness of symptoms
Degree of impairment
Presence of specific symptoms or signs

Question 2

What are the features of somatic syndrome?

Answer 2

Anhedonia
Emotional bluntness
Early morning wakening
Psychomotor retardation
Anorexia and weight loss
Loss of libido

Question 3

What are the core symptoms in the ICD-10 criteria for a diagnosis of depression?

Answer 3

• Depressed mood that is abnormal for most of the day almost everyday for the past two weeks, largely uninfluenced by circumstances
• Loss of interest or pleasure (anhedonia)
• Decreased energy or increased fatigability

Question 4

What are the additional symptoms in the ICD-10 criteria for a diagnosis of depression?

Answer 4

• Loss of confidence or self esteem
• Unreasonable feelings of guilt or 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

Question 5

Define mild depression, according to ICD-10

Answer 5

At least 2 core symptoms PLUS at least 2 additional symptoms

Question 6

Define moderate depression, according to ICD-10

Answer 6

At least 2 core symptoms PLUS at least 4 additional symptoms

Question 7

Define severe depression, according to ICD-10

Answer 7

All 3 core symptoms PLUS at least 5 additional symptoms.

Question 8

What is the differential diagnosis for someone presenting with depressive symptoms?

Answer 8

• Normal reaction to life event
• SAD
• Dysthymia
• Cyclothymia
• Bipolar
• Stroke, tumour, dementia
• Hypothyroidism, Addison’s, Hyperparathyroidism
• Infections – Influenza, infectious mononucleosis, hepatitis, HIV/AIDS
• Drugs

Question 9

Define dysthymia

Answer 9

Chronic depression, but with less severity than a major depression
- lasts at least two years

Question 10

Define cyclothymia

Answer 10

Mood swings which aren’t severe enough to be bipolar disorder

Question 11

What pharmacological treatments are available for depression?

Answer 11

o Selective Serotonin Reuptake Inhibitors (SSRIs)
o Tricyclic antidepressants (TCAs)
o Monamine Oxidase Inhibitors
o Other antidepressants

Question 12

Describe the non-pharmacological treatment options that are available for treating depression

Answer 12

• Psychological Treatments
o CBT, IPT, Individual dynamic psychotherapy, family therapy
• Physical Treatments
o ECT, Psychosurgery, DBS, VNS

Question 13

List the features of mania

Answer 13

• 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.

Question 14

What is meant by “grandiosity”?

Answer 14

The idea or feeling of being superior

May also feel invincible

Question 15

List the range of possible diagnoses for a patient with mania, according to the ICD-10

Answer 15

• F30.0 Hypomania
• F30.1 Mania without psychotic symptoms
• F30.2 Mania with psychotic symptoms
• F30.8 Other Manic episodes
• F30.8 Manic episode, unspecified.

Question 16

What is the suicide rate in patients with major depression?

Answer 16

15% die by suicide

Question 17

What is the suicide rate in patients with bipolar disorder?

Answer 17

10% die by suicise

Question 18

How long does a typical episode of major depression last?

Answer 18

4 - 6 months

Question 19

In bipolar disorder, how long does a typical manic episode last?

Answer 19

1 - 3 months

Question 20

What psychiatric conditions can present with mania?

Answer 20

Bipolar affective disorder
Mixed affective state
Schizoaffective disorder
Schizophrenia
Cyclothymia
ADHD
Drugs and Alcohol

Question 21

What medical conditions can present with mania?

Answer 21

Stroke, MS, Tumour, epilepsy, AIDS, Neurosyphilis
Endocrine – Cushing’s, hyperthyroidism
SLE

Question 22

Describe the pharmacological treatment options for mania / BAD

Answer 22

• Antipsychotics - good for anxious patients
o Olanzapine
o Risperidone
o Quetiapine
• Mood Stabilisers
o Sodium Valproate - good for patients who are high
o Lamotrigene - good for patients who are low
o Carbamazepine
• Lithium

Question 23

What is the diagnostic criteria for bipolar affective disorder?

Answer 23

ICD-10: At least two episodes of depression and mania/hypomania
OR at least two episodes of mania/hypomania

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

Question 24

What is the therapeutic index for lithium?

Answer 24

0.4 - 1.0 mmol/litre (serum level)

Question 25

Describe how lithium levels should be monitored

Answer 25

• samples must be taken 12 hours after administration of dose
• monitor weekly after initiation and after dose change
• once concentrations are stable, check level every three months

Question 26

What is a major side effect of Lamotrigine?

Answer 26

Steven-Johnson syndrome (severe dermatological reaction)