Affective disorders Flashcards
Process of diagnosing an affective illness
- Patient presents with symptoms in their chronology
- A psychiatric history is taken
- Takes into account how symptoms have presented overtime - A mental state examination is taken
Features of the mental state examination
Appearance and behaviour
Speech
Mood
Thought
Perception
Cognition
Insight
Appearance and behaviour
- Mental state examination
- Lack of personal care can indicate self neglect [depression
- Body language
- Psychomotor retardation [depression]
- Agitation
Speech assessment for mental status examination
The production of spontaneous speech is assessed
- Rhythm [fast in mania, slow in depression]
- Pace [can be slow in depression]
- Loudness [Loud in mania, quiet in depression]
- Articulation
- Latency
- Phonation
- Intonation
Thought assessment for MSE
Assesses one’s thought contents and how it adheres to reality
Can have a flight of ideas
- Thoughts so rapid that speech becomes incoherent
Delusions:
Of guilt- Can rarely present in depression
Suicidal thoughts
Overvalued ideas
Obsessions
Phobias
Preoccupations.
Perception assessment for MSE
Assesses the presence of:
- Hallucinations
- Illusions
Auditory hallucinations can appear in depression
- Congruent to one’s mood
Cognitive assessment for MSE
Assesses:
- Memory [impaired in depression]
- Attention [Impaired in depression]
- Intelligence
- Orientation
- Executive functions
Insight assessment for MSE
Assesses one’s understanding of their illness.
- Depressed individuals usually have a great understanding of their depression
- Psychotic believe their hallucination + delusions
Mood assessment for MSE
Assessed by the individual describing what their mood is
- Anhedonia [cannot experience pleasure/ motivation]
-
Affect
Apparent emotion that can be observed from a person
- Can be congruent or incongruent to one’s thoughts
Congruent- suggestive of depression
Incongruent- suggestive of schizophrenia
Major depressive episode
- Symptoms [9]
- DSM V criteria
MUST occur to be diagnosed as depressive
- Depression of mood
- Anhedonia
Others [at least 3 more to concur with depression, for at least 2 weeks]
- Insomnia/ hypersomnia
- Weight gain/loss/ change in appetite
- Feeling of inappropriate guilt/ worthlessness
- Inability to concentrate or be decisive
- Suicidal thoughts/ attempt
- Fatigue/ loss of energy
- Psychomotor agitation/ retardation
Melancholic depression [7]
Depressive disorder characterised by:
- Loss of pleasure in all or almost all activities
- Lack of reactivity
Despondent
Excessive guilt
Early morning awakening, better at night
Psychomotor retardation
Anorexia/ weight loss
Atypical depression
Type of depressive order characterised mainly by mood reactivity.
Also includes:
- Hypersomnia
- Weight gain/ increased appetite
- Leaden paralysis
- Interpersonal rejection sensitivity
Manic episode DSM V diagnosis
Persistent presentation of an elevated, expansive or irritable mood.
- At leat a week, most of the day
- Severe enough to cause functional impairment or hospitalisation
At least 3 symptoms:
- Grandiosity
- Decreased need for sleep
- Very talkative
- Flight of idea/ racing of thoughts
- Distractibility
- Increased goal-directed activity
- Excessive involvement in high risk activity.
Hypomanic episode diagnostic criteria
Less severe form of mania–> At least days
- Does not cause functional impairment of hospitalisation
At least 3 symptoms:
- Grandiosity
- Talkative
- Racing of thoughts/ flight of ideas
- Psychomotor agitation
- High risk activities
- Decreased need for sleep
