Affective Disorders Flashcards
What are mood disorders?
Disorders of mental status and function where altered mood is the/a core feature
A term referring to states of depression and of elevated mood
Used interchangeable with affective disorders
Mood disorders are the commonest group of mental disorders, true or false?
True
How can disordered mood present?
As a primary problem or as a consequence of another disorder or illness e.g. cancer, dementia, drug misuse
What are mood disorders often associated with?
Anxiety symptoms and anxiety disorders
What can depression be thought of as?
A symptom, syndrome and recurrent illness
Features of depression as a symptom
An emotion within the range of normal experience
Describes a state of feeling or mood that can range from near-normal experience to severe life-threatening illness
Systemic symptom with similarities to fatigue and pain
Typically considered as a form of sadness, not just an absence of happiness
Features of depression as a syndrome
Constellation of symptoms and signs
Features of depression as a recurrent illness
Recurrent depressive disorder
When does depression become abnormal?
No clear/convenient division Consensus is problematic, often a matter of perspective Psychiatry places emphasis on; - persistence of symptoms - pervasiveness of symptoms - degree of impairment - presence of specific symptoms or signs
What spheres do symptoms of depressive illnesses occur in?
Psychological
Physical
Social
Psychological sphere of depression
Change in mood
- depression
- anxiety, inability to relax
- perplexity, particularly in Puerperal illness
- anhedonia
Change in thought content
- guilt
- hopelessness
- worthlessness
- any neurotic symptomatology e.g. hypochondriasis, agoraphobia, obsessions and compulsions, panic attacks
- ideas of reference
- delusions and hallucinations (if severe)
Physical sphere of depression
Change in bodily function
- energy, fatigue most common
- sleep, commonly insomnia with early wakening, disturbed sleep and difficulty falling asleep
- appetite, more commonly reduced with weight loss
- libido
- constipation
- pain
Changes in psychomotor functioning
- agitation
- retardation
Social sphere of depression
Loss of interests Irritability Apathy Withdrawal, loss of confidence, indecisive Loss of concentration
What is agitation?
State of restless over-activity, aimless or ineffective
What is anhedonia?
Loss of ability to derive pleasure form experience
What is apathy?
Loss of interest in own surroundings
What is anxiety?
Unpleasant emotion in which thoughts of apprehension and fear predominate
What is depression?
Unpleasant emotion in which sadness or unhappiness predominate
What is retardation?
Slowing of motor responses, including speech
What is stupor
State of extreme retardation in which consciousness is intact
The patient stops moving, speaking, eating and drinking
On recovery, can describe clearly events which occurred while stuporose
ICD 10 classification of depression
Symptoms must last for at least 2 weeks
No hypomanic or manic episodes in lifetime
Not attributable to psychoactive substance use or organic mental disorder
If psychotic symptoms or stupor then diagnosis is severe depression with psychotic symptoms - need to exclude other psychotic illnesses first before reaching this diagnosis
Features of somatic syndrome
Marked loss of interest or pleasure in activities that are normally pleasurable
Lack of emotional reactions to events or activities that normally produce an emotional response
Waking 2 hours before normal time
Depression worse in the morning
Objective evidence of psychomotor agitation or retardation
Marked loss of appetite
Weight loss (5% body weight in a month)
Marked loss of libido
ICD 10 core symptoms of depression
Depressed mood that is abnormal for most of the day almost every day for the past two weeks, largely uninfluenced by circumstances
Loss of interest or pleasure
Decreased energy or increased fatiguability
ICD 10 additional symptoms of depression
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
Sleep disturbance of any sort
Change in appetite
How many ICD 10 core symptoms and how many additional symptoms are needed to diagnose mild, moderate and severe depression?
At least 2 core symptoms and at least 2 additional symptoms for mild depression
At least 2 core symptoms and at least 4 additional symptoms for moderate depression
All core symptoms and at least 5 additional symptoms for severe depression
When is the risk of post-natal depression?
Increased risk of psychiatric admission in the 30 days following childbirth, risk for 24 months
What percentage of women experience baby blues within 2 weeks of childbirth?
75%
What percentage of women develop MDD within 3-6 months of childbirth?
10%
What is the incidence and risk of recurrence or puerperal psychosis?
1 in 500 deliveries
Risk of recurrence of 1-3 x with subsequent deliveries
Differential diagnoses for depression
Normal reaction to life event SAD Dysthymia Cyclothymia Bipolar affective disorder Stroke, tumour, dementia Hypothyroidism, Addison's, hyperparathyroidism Infections e.g. flu, infectious mononucleosis, hepatitis, AIDS/HIV Drugs
Treatment options for depression
Antidepressants
Psychological treatments
Physical treatments
Antidepressant types for use in depression
Selective serotonin reuptake inhibitors (SSRIs)
Tricyclic antidepressants (TCAs)
Monoamine oxidase inhibitors (MAOIs)
Others
Psychological treatments for depression
Cognitive behavioural therapy
IPT
Individual dynamic psychotherapy
Family therapy
Physical treatments for depression
ECT
Psychosurgery
DBS
VNS
Measurement tools for depression
SCID SCAN HDRS BDI-II HADS PHQ-9
What is mania?
A term to describe a state of feeling or mood that can range from near-normal experience to severe life-threatening illness
Often associated with grandiose ideas, disinhibition, loss of judgement, with similarities to the mental effects of stimulant drugs
ICD 10 - categories of mania
Hypomania Mania without psychotic symptoms Mania with psychotic symptoms Other manic episodes Manic episode, unspecified
Features of hypomania
Lesser degree of mania with no psychosis
Mild elevation of mood for several days on end
Increased energy and activity, marked feeling of wellbeing
Increased sociability, talkativeness, over-familiarity, increased sexual energy, decreased need for sleep
May be irritable
Concentration reduced, new interests, mild over-spending
Differentiated from more severe mania as symptoms are not to the extent of severe disruption of work or social rejection
Features of mania (with or without psychosis)
1 week, severe enough to disrupt ordinary work and social activities more or less completely
Elevated mood, increased energy, over-activity, pressure of speech, decreased need for sleep
Disinhibition
Grandiosity
Alteration of sense
Extravagant spending
Can be irritable rather than elated
Differential diagnoses for mania
Psychiatric
- mixed affective state
- schizoaffective disorder
- schizophrenia
- cyclothymia
- ADHA
- drugs and alcohol
Medical
- stroke
- MS
- tumour
- epilepsy
- AIDS
- neurosyphilis
- Endocrine e.g. Cushing’s, SLE, hyperthyroidism
Measurement tools for mania
SCID
SCAN
Young mania rating scale
Treatment options for mania
Antipsychotics
- olanzapine
- risperidone
- quetiapine
Mood stabilisers
- sodium valproate
- lamotrigin
- carbamazepine
Other treatment
- lithium
- ECT
What is bipolar disorder?
Bipolar disorder consists of repeated (2+) episodes of depression and mania or hypomania
If there is no mania/hypomania then diagnosis is recurrent depression
If no depression then diagnosis is hypomania or bipolar disorder
What is the lifetime prevalence rate of bipolar disorder?
0.7-1.6 n per 100
What is the point prevalence rate of mania?
0.08-0.8
What is the mean age of onset of bipolar disorder?
21
What is early onset bipolar disorder?
Onset 15-19 years, usually positive FH
What is the lifetime prevalence rate of depression?
2.9-12 n per 100
What is the point prevalence rate of depression?
3.7-7.7
What sex is more affected by depression?
Females 2 : 1 males
What is the mean age of onset of depression?
27
Range 18-44 for highest risk
In what people is MDD less common?
Employed
Financially dependent
What is the onset of depression associated with?
Adverse life events
How long does the typical episode of major depression last?
4-6 months
What percentage of people with major depression will recover by 26 weeks?
54%
What percentage of people with major depression fail to recover?
12%
What percentage of people with major depression have further episodes?
80+%
What percentage of people with major depression die by suicide?
15%
How long does the typical manic episode last?
1-3 months
What percentage of people with bipolar disorder will recover by 10 weeks?
60%
What percentage of people with bipolar disorder/mania fail to recover?
5%
What percentage of people with bipolar disorder/mania have further episodes?
90%
What number of people with bipolar disorder/mania have a poor outcome and good outcome?
1/3 poor outcome
1/3-1/4 good outcome
What percentage of people with bipolar disorder/mania die by suicide?
10%
