Affective Disorders Flashcards
What are mood disorders?
- 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
How can mood disorders present?
Disordered mood can present as a primary problem or as a consequence of another disorder or illness
What are mood disorders often associated with?
Anxiety symptoms and anxiety disorders
Give 2 examples of classification systems.
- ICD10
- DSM5
What is depression when thought of as a symptom?
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
What is depression when thought of as a syndrome?
A constellation of symptoms and signs
What is depression when thought of as a recurrent illness?
Recurrent depressive disorder
When does depression become abnormal?
Not clear cut but psychiatry places emphasis on
- Persistence of symptoms
- Pervasiveness of symptoms
- Degree of impairment
- Presence of specific symptoms or signs
What are the 3 spheres that depressive illness symptoms occur in?
- Psychological
- Physical
- Social
What changes can occur in the psychological sphere with depression?
- Changes in mood
- Changes in thought content
What changes in mood can occur with depression?
- Depression (can have diurnal variation)
- Anxiety
- Perplexity
- Anhedonia
What changes in thought content can occur with depression?
- Undue guilt
- Hopelessness
- Worthlessness
- Any neurotic symptomatology
- Ideas of reference
- Delusions and hallucinations
What changes can occur in the physical sphere with depression?
- Change in bodily function
- Change in psychomotor functioning
What changes with bodily function can occur with depression?
- Energy decline (fatigue)
- Sleep disturbance
- Appetite changes (most often results in weight loss)
- Libido loss
- Constipation
- Pain
What changes with psychomotor functioning occur with depression?
- Agitation
- Retardation
What changes can occur to the social sphere in depression?
- Loss of interests
- Irritability
- Apathy
- Withdrawal, loss of confidence, indecisive
- Loss of concentration, registration and memory
Agitation
A state of restless over activity, aimless or ineffective
Anhedonia
Loss of ability to derive pleasure from experience
Anxiety
An unpleasant emotion in which thoughts of apprehension or fear predominate
Apathy
Loss of interest in own surroundings
Depression
An unpleasant emotion in which sadness or unhappiness predominates
Retardation
A slowing of motor responses including speech
Stupor
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
What is the ICD10 criteria for depression?
- 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
What occurs in somatic syndrome?
- 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
What is the general criteria for depression.
- 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
What is the additional criteria for 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
- Agitation or retardation
- Sleep disturbance of any sort
- Change in appetite
According to ICD10, what is the criteria for mild depression.
- At least 2 general criteria
- Additional criteria to give score of at least 4
According to ICD10, what is the criteria for moderate depression?
- At least 2 general criteria
- Additional criteria to give score of at least 6
According to ICD10, what is the criteria fro sever depression?
- All of the general criteria
- Additional criteria to give score of at least 8
- If psychotic symptoms or stupor then severe depression
How many people experience post-natal depression?
- 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
Give examples of differential diagnosis for depression.
- Normal reaction to life event
- SAD
- Dysthymia
- Cyclothymia
- Bipolar
- Stroke, tumour, dementia
- Hypothyroidism, Addison’s, Hyperparathyroidism
- Infections – Influenza, infectious mononucleosis, hepatitis, HIV/AIDS
- Drugs
What treatment options are there for depression?
- Antidepressants
- Psychological treatments
- Physical treatments
What types of antidepressants are there?
- Selective Serotonin Reuptake Inhibitors (SSRIs)
- Tricyclic antidepressants (TCAs)
- Monamine Oxidase Inhibitors
- Other antidepressants
What forms of psychological treatment are there for depression?
- CBT
- IPT
- Individual dynamic psychotherapy
- Family therapy
What forms of physical treatment are there for depression?
- ECT
- Psychosurgery
- DBS
- VNS
What are the 2 main measurement tools used in depression?
- SCID (Structured Clinical Interview for DSM disorders)
- SCAN (Schedules for Clinical Assessment in Neuropsychiatry)
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
- Typically considered as a form of pathological, inappropriate elevated mood
What is mania often associated with?
- Grandiose ideas
- Disinhibition
- Loss of judgement
- Similarities to the mental effects of stimulant drugs
Give examples of classifications of mania.
- Hypomania
- Mania without psychotic symptoms
- Mania with psychotic symptoms
- Other manic episodes
- Manic episode, unspecified
What is hypomania?
- A lesser degree of mania
- Psychosis is absent
What is the ICD10 criteria for hypomania
- 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
What is the ICD10 criteria for mania (with or without psychosis)?
- 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.
Give examples of differential diagnosis for mania.
- Mixed affective state
- Schizoaffective disorder
- Schizophrenia
- Cyclothymia
- ADHD
- Drugs and Alcohol
- Stroke, MS, epilepsy, AIDS, neurosyphilis
- Cushing’s, hyperthyroidism, SLE
What measurement tools are there for mania?
- SCID
- SCAN
- Young mania rating scale (YMRS)
What treatment options are there for mania?
Antipsychotics
- Olanzapine
- Risperidone
- Quetiapine
Mood stabilisers
- Sodium valproate
- Lamotrigine
- Carbamazepine
Lithium
ECT
Give examples of ICD10 classifications of bipolar disorder.
- 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
What is bipolar affective disorder?
It is a condition which consists of repeated (2+) episodes of depression and mania or hypomania
If a patient presents with no episodes of mania or hypomania, what is the diagnosis?
Recurrent depression
If a patient presents with no depression, what is the diagnosis?
Hypomania or bipolar disorder
What is the epidemiology of bipolar disorder?
- Lifetime prevalence rate: 0.7-1.6
- M=F
- Mean age of onset= 21 (unusual after 30)
- 1/3 have onset <20 years
When does early onset of bipolar disorder usually occur?
When there is a family history
What is the epidemiology of depression?
-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
-
What is the typical outcome of major depression?
- Typical episode 4-6 months
- 80% have further episodes
- 54% have recovered by 26 weeks
- 15% die by suicide
- 12% do not recover
What is the typical outcome of bipolar disorder/mania?
- Typical manic episode 1-3months
- 90% have further episodes
- 60% recovered by 10 weeks
- 10% die by suicide
- 5% fail to recover
