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Systems: Psychiatry AB > Affective Disorders > Flashcards

Affective Disorders Flashcards

1
Q

What are mood disorders?

A
  • They are disorders of mental status and function where altered mood is a core feature
  • It is a term that refers to states of depression and of mania
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2
Q

How can mood disorders present?

A

Disordered mood can present as a primary problem or as a consequence of another disorder or illness

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3
Q

What are mood disorders often associated with?

A

Anxiety symptoms and anxiety disorders

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4
Q

Give 2 examples of classification systems.

A
  • ICD10

- DSM5

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5
Q

What is depression when thought of as a symptom?

A

A state of feeling or mood that can range from normal experience to a severe, life-threatening illness, typically associated as a form of sadness

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6
Q

What is depression when thought of as a syndrome?

A

A constellation of symptoms and signs

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7
Q

What is depression when thought of as a recurrent illness?

A

Recurrent depressive disorder

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8
Q

When does depression become abnormal?

A

Not clear cut but psychiatry places emphasis on

  • Persistence of symptoms
  • Pervasiveness of symptoms
  • Degree of impairment
  • Presence of specific symptoms or signs
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9
Q

What are the 3 spheres that depressive illness symptoms occur in?

A
  • Psychological
  • Physical
  • Social
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10
Q

What changes can occur in the psychological sphere with depression?

A
  • Changes in mood

- Changes in thought content

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11
Q

What changes in mood can occur with depression?

A
  • Depression (can have diurnal variation)
  • Anxiety
  • Perplexity
  • Anhedonia
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12
Q

What changes in thought content can occur with depression?

A
  • Undue guilt
  • Hopelessness
  • Worthlessness
  • Any neurotic symptomatology
  • Ideas of reference
  • Delusions and hallucinations
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13
Q

What changes can occur in the physical sphere with depression?

A
  • Change in bodily function

- Change in psychomotor functioning

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14
Q

What changes with bodily function can occur with depression?

A
  • Energy decline (fatigue)
  • Sleep disturbance
  • Appetite changes (most often results in weight loss)
  • Libido loss
  • Constipation
  • Pain
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15
Q

What changes with psychomotor functioning occur with depression?

A
  • Agitation

- Retardation

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16
Q

What changes can occur to the social sphere in depression?

A
  • Loss of interests
  • Irritability
  • Apathy
  • Withdrawal, loss of confidence, indecisive
  • Loss of concentration, registration and memory
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17
Q

Agitation

A

A state of restless over activity, aimless or ineffective

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18
Q

Anhedonia

A

Loss of ability to derive pleasure from experience

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19
Q

Anxiety

A

An unpleasant emotion in which thoughts of apprehension or fear predominate

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20
Q

Apathy

A

Loss of interest in own surroundings

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21
Q

Depression

A

An unpleasant emotion in which sadness or unhappiness predominates

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22
Q

Retardation

A

A slowing of motor responses including speech

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23
Q

Stupor

A

A state of extreme retardation in which consciousness is intact. The patient stops moving, speaking, eating and drinking. On recover, they can describe clearly events which occurred whilst stuporose

24
Q

What is the ICD10 criteria for depression?

A
  • At least 2 week history
  • No hypomanic/manic episodes ever
  • Not attributable to substances or organic mental disorder
  • Must have excluded other diagnosis if presents with psychosis
25
Q

What occurs in somatic syndrome?

A
  • Loss of interest in liked activities
  • Loss of emotional response
  • Waking 2 hours earlier than usual
  • Depression worse in the morning
  • Psychomotor agitation or retardation
  • Marked loss in appetite
  • Weight loss
  • Marked loss of libido
26
Q

What is the general criteria for depression.

A
  • 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
  • Decreased energy or increased fatigability
27
Q

What is the additional criteria for 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
  • Agitation or retardation
  • Sleep disturbance of any sort
  • Change in appetite
28
Q

According to ICD10, what is the criteria for mild depression.

A
  • At least 2 general criteria

- Additional criteria to give score of at least 4

29
Q

According to ICD10, what is the criteria for moderate depression?

A
  • At least 2 general criteria

- Additional criteria to give score of at least 6

30
Q

According to ICD10, what is the criteria fro sever depression?

A
  • All of the general criteria
  • Additional criteria to give score of at least 8
  • If psychotic symptoms or stupor then severe depression
31
Q

How many people experience post-natal depression?

A
  • 75% of women will experience the baby blues within 2 weeks
  • 10% will develop MDD within 3-6 months
  • Puerperal psychosis occurs in 1 in 500 deliveries with risk of recurrence of 1-3 with subsequent deliveries
32
Q

Give examples of differential diagnosis for depression.

A
  • Normal reaction to life event
  • SAD
  • Dysthymia
  • Cyclothymia
  • Bipolar
  • Stroke, tumour, dementia
  • Hypothyroidism, Addison’s, Hyperparathyroidism
  • Infections – Influenza, infectious mononucleosis, hepatitis, HIV/AIDS
  • Drugs
33
Q

What treatment options are there for depression?

A
  • Antidepressants
  • Psychological treatments
  • Physical treatments
34
Q

What types of antidepressants are there?

A
  • Selective Serotonin Reuptake Inhibitors (SSRIs)
  • Tricyclic antidepressants (TCAs)
  • Monamine Oxidase Inhibitors
  • Other antidepressants
35
Q

What forms of psychological treatment are there for depression?

A
  • CBT
  • IPT
  • Individual dynamic psychotherapy
  • Family therapy
36
Q

What forms of physical treatment are there for depression?

A
  • ECT
  • Psychosurgery
  • DBS
  • VNS
37
Q

What are the 2 main measurement tools used in depression?

A
  • SCID (Structured Clinical Interview for DSM disorders)

- SCAN (Schedules for Clinical Assessment in Neuropsychiatry)

38
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
  • Typically considered as a form of pathological, inappropriate elevated mood
39
Q

What is mania often associated with?

A
  • Grandiose ideas
  • Disinhibition
  • Loss of judgement
  • Similarities to the mental effects of stimulant drugs
40
Q

Give examples of classifications of mania.

A
  • Hypomania
  • Mania without psychotic symptoms
  • Mania with psychotic symptoms
  • Other manic episodes
  • Manic episode, unspecified
41
Q

What is hypomania?

A
  • A lesser degree of mania

- Psychosis is absent

42
Q

What is the ICD10 criteria for hypomania

A
  • Mild elevation of mood for several days on end
  • Increased energy and activity, marked feeling of wellbeing
  • Increased sociability, talkativeness, overfamiliarity, increased sexual energy, decreased need for sleep
  • May be irritable
  • Concentration reduced, new interests, mild overspending
  • Not to the extent of severe disruption of work or social rejection
43
Q

What is the ICD10 criteria for 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, overactivity, pressure of speech, decreased need for sleep
  • Disinhibition
  • Grandiosity
  • Alteration of senses
  • Extravagant spending
  • Can be irritable rather than elated.
44
Q

Give examples of differential diagnosis for mania.

A
  • Mixed affective state
  • Schizoaffective disorder
  • Schizophrenia
  • Cyclothymia
  • ADHD
  • Drugs and Alcohol
  • Stroke, MS, epilepsy, AIDS, neurosyphilis
  • Cushing’s, hyperthyroidism, SLE
45
Q

What measurement tools are there for mania?

A
  • SCID
  • SCAN
  • Young mania rating scale (YMRS)
46
Q

What treatment options are there for mania?

A

Antipsychotics

  • Olanzapine
  • Risperidone
  • Quetiapine

Mood stabilisers

  • Sodium valproate
  • Lamotrigine
  • Carbamazepine

Lithium

ECT

47
Q

Give examples of ICD10 classifications of bipolar disorder.

A
  • BAD, currently hypomanic
  • BAD, current manic without psychosis
  • BAD, current manic with psychosis
  • BAD, Current mild/mod depression
  • BAD, current severe depression without psychosis
  • BAD, current severe depression with psychosis
  • BAD, current episode mixed
  • BAD, current episode in remission
  • Other bipolar affective disorders
  • Bipolar affective disorder, unspecified
48
Q

What is bipolar affective disorder?

A

It is a condition which consists of repeated (2+) episodes of depression and mania or hypomania

49
Q

If a patient presents with no episodes of mania or hypomania, what is the diagnosis?

A

Recurrent depression

50
Q

If a patient presents with no depression, what is the diagnosis?

A

Hypomania or bipolar disorder

51
Q

What is the epidemiology of bipolar disorder?

A
  • Lifetime prevalence rate: 0.7-1.6
  • M=F
  • Mean age of onset= 21 (unusual after 30)
  • 1/3 have onset <20 years
52
Q

When does early onset of bipolar disorder usually occur?

A

When there is a family history

53
Q

What is the epidemiology of depression?

A

-Lifetime prevalence risk: 2.9-12 (less severe manifestations= 20)
-F:M 2:1
-highest risk 18-44 (median 25)
-Mean age of onset =27
-

54
Q

What is the typical outcome of major depression?

A
  • Typical episode 4-6 months
  • 80% have further episodes
  • 54% have recovered by 26 weeks
  • 15% die by suicide
  • 12% do not recover
55
Q

What is the typical outcome of bipolar disorder/mania?

A
  • Typical manic episode 1-3months
  • 90% have further episodes
  • 60% recovered by 10 weeks
  • 10% die by suicide
  • 5% fail to recover

Systems: Psychiatry AB (18 decks)

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