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Psychiatry > Affective Disorders > Flashcards

Affective Disorders Flashcards

1
Q

What are mood disorders?

A

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

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2
Q

Mood disorders are the commonest group of mental disorders, true or false?

A

True

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3
Q

How can disordered mood present?

A

As a primary problem or as a consequence of another disorder or illness e.g. cancer, dementia, drug misuse

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4
Q

What are mood disorders often associated with?

A

Anxiety symptoms and anxiety disorders

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5
Q

What can depression be thought of as?

A

A symptom, syndrome and recurrent illness

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6
Q

Features of depression as a symptom

A

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

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7
Q

Features of depression as a syndrome

A

Constellation of symptoms and signs

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8
Q

Features of depression as a recurrent illness

A

Recurrent depressive disorder

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9
Q

When does depression become abnormal?

A 
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
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10
Q

What spheres do symptoms of depressive illnesses occur in?

A

Psychological
Physical
Social

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11
Q

Psychological sphere of depression

A

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)
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12
Q

Physical sphere of depression

A

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
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13
Q

Social sphere of depression

A 
Loss of interests 
Irritability 
Apathy 
Withdrawal, loss of confidence, indecisive 
Loss of concentration
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14
Q

What is agitation?

A

State of restless over-activity, aimless or ineffective

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15
Q

What is anhedonia?

A

Loss of ability to derive pleasure form experience

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16
Q

What is apathy?

A

Loss of interest in own surroundings

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17
Q

What is anxiety?

A

Unpleasant emotion in which thoughts of apprehension and fear predominate

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18
Q

What is depression?

A

Unpleasant emotion in which sadness or unhappiness predominate

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19
Q

What is retardation?

A

Slowing of motor responses, including speech

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20
Q

What is stupor

A

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

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21
Q

ICD 10 classification of depression

A

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

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22
Q

Features of somatic syndrome

A

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

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23
Q

ICD 10 core symptoms of depression

A

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

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24
Q

ICD 10 additional symptoms of depression

A

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

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25
Q

How many ICD 10 core symptoms and how many additional symptoms are needed to diagnose mild, moderate and severe depression?

A

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

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26
Q

When is the risk of post-natal depression?

A

Increased risk of psychiatric admission in the 30 days following childbirth, risk for 24 months

27
Q

What percentage of women experience baby blues within 2 weeks of childbirth?

A

75%

28
Q

What percentage of women develop MDD within 3-6 months of childbirth?

A

10%

29
Q

What is the incidence and risk of recurrence or puerperal psychosis?

A

1 in 500 deliveries

Risk of recurrence of 1-3 x with subsequent deliveries

30
Q

Differential diagnoses for depression

A 
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
31
Q

Treatment options for depression

A

Antidepressants
Psychological treatments
Physical treatments

32
Q

Antidepressant types for use in depression

A

Selective serotonin reuptake inhibitors (SSRIs)
Tricyclic antidepressants (TCAs)
Monoamine oxidase inhibitors (MAOIs)
Others

33
Q

Psychological treatments for depression

A

Cognitive behavioural therapy
IPT
Individual dynamic psychotherapy
Family therapy

34
Q

Physical treatments for depression

A

ECT
Psychosurgery
DBS
VNS

35
Q

Measurement tools for depression

A 
SCID
SCAN
HDRS
BDI-II
HADS
PHQ-9
36
Q

What is mania?

A

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

37
Q

ICD 10 - categories of mania

A 
Hypomania
Mania without psychotic symptoms
Mania with psychotic symptoms 
Other manic episodes
Manic episode, unspecified
38
Q

Features of hypomania

A

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

39
Q

Features of mania (with or without psychosis)

A

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

40
Q

Differential diagnoses for mania

A

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
41
Q

Measurement tools for mania

A

SCID
SCAN
Young mania rating scale

42
Q

Treatment options for mania

A

Antipsychotics

  • olanzapine
  • risperidone
  • quetiapine

Mood stabilisers

  • sodium valproate
  • lamotrigin
  • carbamazepine

Other treatment

  • lithium
  • ECT
43
Q

What is bipolar disorder?

A

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

44
Q

What is the lifetime prevalence rate of bipolar disorder?

A

0.7-1.6 n per 100

45
Q

What is the point prevalence rate of mania?

A

0.08-0.8

46
Q

What is the mean age of onset of bipolar disorder?

A

21

47
Q

What is early onset bipolar disorder?

A

Onset 15-19 years, usually positive FH

48
Q

What is the lifetime prevalence rate of depression?

A

2.9-12 n per 100

49
Q

What is the point prevalence rate of depression?

A

3.7-7.7

50
Q

What sex is more affected by depression?

A

Females 2 : 1 males

51
Q

What is the mean age of onset of depression?

A

27

Range 18-44 for highest risk

52
Q

In what people is MDD less common?

A

Employed

Financially dependent

53
Q

What is the onset of depression associated with?

A

Adverse life events

54
Q

How long does the typical episode of major depression last?

A

4-6 months

55
Q

What percentage of people with major depression will recover by 26 weeks?

A

54%

56
Q

What percentage of people with major depression fail to recover?

A

12%

57
Q

What percentage of people with major depression have further episodes?

A

80+%

58
Q

What percentage of people with major depression die by suicide?

A

15%

59
Q

How long does the typical manic episode last?

A

1-3 months

60
Q

What percentage of people with bipolar disorder will recover by 10 weeks?

A

60%

61
Q

What percentage of people with bipolar disorder/mania fail to recover?

A

5%

62
Q

What percentage of people with bipolar disorder/mania have further episodes?

A

90%

63
Q

What number of people with bipolar disorder/mania have a poor outcome and good outcome?

A

1/3 poor outcome

1/3-1/4 good outcome

64
Q

What percentage of people with bipolar disorder/mania die by suicide?

A

10%

Psychiatry (21 decks)

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