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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 core feature
  • A term referring to states of depression and of elevated mood (mania)
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2
Q

What are the commonest group of mental disorders?

A

Mood disorders

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3
Q

In what ways can mood disorders present?

A
  • As a primary problem
  • As a consequence of other disorder or illness (cancer, dementia, drug misuse)
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4
Q

What other symptoms and disorders are often associated with mood disorders?

A

Anxiety symptoms and disorders

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5
Q

What classification systems are used in the treatment of mood disorders?

A

ICD-10 - Europe

DSM-5 - America

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6
Q

What is depression?

A
  • A state of feeling or mood, that can range from normal experience to severe, life threatening illness
  • A systemic symptom with similarities to fatigue and pain
  • Considered as a form of sadness, not just an absence of happiness
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7
Q

At what point does depession become abnormal?

A
  • No clear and convenient division
  • Psychiatry places emphasis on the following:

1 - Persistence of symptoms

2 - Pervasiveness of symptoms

3 - Degree of impairement

4 - Presence of specific symptoms or signs

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8
Q

What are the main categories of symptoms experience in depression?

A
  • Psychological
  • Physical
  • Social
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9
Q

What are the psychological symptoms that can be experienced by someone suffering with depession?

A

Change in Mood:

  • Low mood (may be worse in morning and slightly better in evenings)
  • Anxiety
  • Perplexity (puerperal illness)
  • Anhedonia (loss of enjoyment in things previously enjoyed)

Change in Thought Content:

  • Guilt
  • Hopelessness
  • Worthlessness
  • Ideas of reference (believing people are talking/laughing about you)
  • Delusions & hallucinations (in severe depression)
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10
Q

What are the physical symptoms that can be experienced by patients with depression?

A
  • Reduced energy levels (leading to fatigue)
  • Sleep disturbances
  • Reduced appetite (leading to weight loss)
  • Reduced libido
  • Constipation
  • Pain
  • Agitation (restlessness and anger)
  • Retardation (cognitive function, speech, movements)
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11
Q

What are the social symptoms that patients with depression can suffer from?

A
  • Loss of interests
  • Irritability
  • Apathy
  • Withdawal
  • Loss of confidence
  • Loss of concentration
  • Indecisive
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12
Q

What is the definition of agitation?

A

A state of restless overactivity, aimless or ineffective

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13
Q

What is the definition of anhedonia?

A

Loss of ability to derive pleasure from experience

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14
Q

What is the definition of apathy?

A

Loss of interest in own surroundings

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15
Q

What is the definition of anxiety?

A

An unpleasant emotion in which thoughts of apprehension or fear predominate

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16
Q

What is the definition of depression?

A

An unpleasant emotion in which sadness or unhappiness predominates

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17
Q

What is the definition of retardation?

A

A slowing of motor responses including speech

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18
Q

What is the definition of stupor?

A

A state of extreme retardation in which consciousness is intact

The patient stops moving, speaking, eating & drinking

On recovery can desribe clearly events which occured whilst stuporose

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19
Q

Accoding to ICD-10, what are the requirements for someone to be diagnosed with depression?

A

1 - The depression has lasted for at least 2 weeks

2 - No hypomanic or manic episodes in lifetime

3 - Not attributable to psychoactive substance use or organic mental disorder

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20
Q

Accoding to ICD-10, if psychotic symptoms or stupor are present what is the diagnosis?

A

Severe depression with psychotic symptoms

21
Q

If a patient presents with psychotic symptoms or stupor, what other psychotic illnesses must be excluded before making a diagnosis of depression?

A

Schizophrenia

22
Q

What are the symptoms of somatic syndrome?

A

1 - Loss of interest o pleasure in activities that are normally pleasurable

2 - Lack of emotional reactions to events that normally produce an emotional response

3 - Waking 2hrs before normal time

4 - Depession worse in the morning

5 - Objective evidence of psychomotor agitation or retardation

6 - Marked loss of appetite

7 - Weight loss

8 - Loss of libido

23
Q

What is the criteria for someone to be diagnosed with mild depression?

A

2 of the following:

  • Depressed mood lasting most of the day, everyday for the past 2 weeks uninfluenced by cicumstances
  • Loss of interest or pleasure
  • Decreased energy or fatigability

Plus an additional 2 from this list:

  • Loss of confidence or self esteem
  • Unreasonable feelings of guilt
  • Recurrent thoughts of death by suicide
  • Decreased concentration
  • Agitation on retardation
  • Sleep disturbance
  • Change in appetite
24
Q

Depression can take the form of a symptom, syndrome or as a recurrent illness: give a description of each one

A

Depression symptom - an emotion within the range of normal experience

Depression syndrome - a variety of symptoms and signs associated with the depression

Recurrent depression - recurrent depressive disorder

25
Q

What is the criteria for someone to be diagnosed with moderate depression?

A

2 of the following:

  • Depressed mood lasting most of the day, everyday for the past 2 weeks uninfluenced by cicumstances
  • Loss of interest or pleasure
  • Decreased energy or fatigability

Plus an additional 4 from this list:

  • Loss of confidence or self esteem
  • Unreasonable feelings of guilt
  • Recurrent thoughts of death by suicide
  • Decreased concentration
  • Agitation on retardation
  • Sleep disturbance
  • Change in appetite
26
Q

What is the criteria for someone to be diagnosed with severe depression?

A

2 of the following:

  • Depressed mood lasting most of the day, everyday for the past 2 weeks uninfluenced by cicumstances
  • Loss of interest or pleasure
  • Decreased energy or fatigability

Plus an additional 6 from this list:

  • Loss of confidence or self esteem
  • Unreasonable feelings of guilt
  • Recurrent thoughts of death by suicide
  • Decreased concentration
  • Agitation on retardation
  • Sleep disturbance
  • Change in appetite
27
Q

What is the epidemiology of post-natal depression?

A

1 - Highest risk of psychiatric admission in 30 days following childbirth

2 - 75% of woman experience ‘blues’ within 2 weeks of delivery

3 - 10% of woman develop

4 - 10% of woman develop Major Depressive Disorder within 3-6 months

5 - Puerperal psychosis occurs in 1 in 500 deliveries

6 - No association with hormonal changes have been demonstrated

28
Q

What can be the differential diagnosis for depression?

A

1 - Normal reaction to life event

2 - Seasonal affective disorder (SAD)

3 - Dysthymia

4 - Cyclothymia

5 - Bipolar disorder

6 - Stroke, tumour, dementia

7 - Hypothyroidism, Addison’s, Hyperparathyroidism

8 - Infections (Hepatitis, HIV/AIDS)

9 - Drugs

29
Q

What are the treatment options available for depression?

A

1 - Antidepressants (SSRI’s, Tricyclic, Monamine Oxidase Inhibitors)

2 - Psychological Treatments (CBT, IPT, family therapy)

3 - Physical treatments (ECT, Psychosurgery, Deep brain stimulation, Vagal Nerve Stimulation)

30
Q

What are the various measurement tools used by psychiatrists to assess affective disorders?

A

SCID - Structured Clinical Interview for (DSM) disorders

SCAN - Schedules for Clinical Assessment in Neuropsychiatry

HDRS - Hamilton Depression Rating Scale

BDI-II - Beck Depression Inventory II

HADS - Hospital Anxiety & Depression Scale

PHQ-9 - Patient Health questionnaire 9

31
Q

What is mania?

A
  • A state of feeling, or mood, that can range from near-normal experience to severe, life-threatening illness
  • Considered as a form of pathological, inappropriate elevated mood
32
Q

What type of ideas amd behaviours are often associated with mania?

A

1 - Grandiose ideas

2 - Disinhibition

3 - Loss of judgment

33
Q

What are the important questions that psychiatrists should ask when deciding if a patient is suffering with mania or not?

A

1 - Persistence of symptoms

2 - Pervasiveness of symptoms

3 - Degree of impairment

4 - Presence of specific symptoms or signs

34
Q

What are the different classifications of mani according to ICD-10?

A

1 - Hypomania

2 - Mania without psychotic symptoms

3 - Mania with psychotic symptoms

4 - Other manic episodes

5 - Manic episode, unspecified

35
Q

What is the ICD-10 classification of hypomania?

A

1 - Lesser degree of mania

2 - No psychosis

3 - Mild elevation of mood for several continuous days

4 - Increased energy and activity with a marked feeling of wellbeing

5 - Increased sociability, talkativeness, sexual energy and a decreased need for sleep

6 - Irritable

7 - Reduced concentration, new interests

8 - Not severely disrupting work or social activities

36
Q

What is the ICD-10 classification of mania (with or without psychosis)?

A

1 - 1 week of significantly elevated mood which is strong enough to disrupt work and social activities

2 - Overactivity, pressure of speech, decreased need for sleep

3 - Disinhibition

4 - Grandiosity

5 - Alteration of senses

6 - Extravagant spending

7 - Irritable

37
Q

What are the psychiatric differential diagnosis for someone suffering with mania?

A

1 - Mixed affective state

2 - Schizoaffective disorder

3 - Schizophrenia

4 - Cyclothymia

5 - ADHD

6 - Drugs and alcohol

38
Q

What are the medical differential diagnosis for someone suffering with mania?

A

1 - Stroke

2 - MS

3 - Tumour

4 - Epilepsy

5 - AIDS

6 - Cushings

7 - Hyperparathyroidism

39
Q

What are the tools used by psychiatrists to measure the symptoms of mania?

A

1 - SCID

2 - SCAN

3 - Young Mania Rating Scale

40
Q

What are the treatment options for mania?

A

1 - Antipsychotics

2 - Mood stabilisers

3 - Lithium

4 - ECT

41
Q

What are examples of some commonly used antipsychotic drugs?

A

Olanzapine

Risperidone

42
Q

What are examples of some commonly used mood stabilisers?

A

Sodium Valproate

Lamotrigene

Carbamazepine

43
Q

What is the ICD-10 classification of Bipolar disorder?

A
  • 2 or more repeated episodes of depression and mania or hypomania
  • If no mania or hypomania then diagnosis = recurrent depression
  • If no depression then diagnosis = hypomania or bipolar
44
Q

What is the epidemiology of bipolar disorder?

A

1 - Lifetime prevalence rate = 0/7-1.6 per 100

2 - Point prevalence rate of mania - 0.08-0.8

3 - Industrialised nations = non-industrialised nations

4 - Males = females

5 - Mean age of onset = 21

6 - Early onset (15-19) = +ve FH

7 - No difference depending on income, occupation, education status

8 - Prevalence increased in 1st degree relatives

45
Q

What is the epidemiology of depression?

A

1 - Lifetime prevalence rate: 2.9-12 per 100

2 - Point prevalence rate: 3.7-7.7%

3 - Lifetime risk for less severe depression: 20%

4 - Females: Males = 2:1

5 - Highest risk age (18-44)

6 - Mean age of onset = 27

7 - Onset of 1st depressive episode associated with excess adverse life events

46
Q

What social/personal factors have a positive (reductive) effect on depression?

A

1 - Employment

2 - Financial independency

3 - High educational attainment

4 - Stable marriage

47
Q

What is the clinical course and outcomes for patients suffering with major depression?

A
  • Typical episode lasts 4-6 months
  • 54% recovered at 26 weeks
  • 12% fail to recover
  • 80% have further episodes
  • 15% die by suicide
48
Q

What is the clinical course and outcomes for patients suffering with bipolar disorder/mania?

A
  • Manic episodes last 1-3 months
  • 60% recovered at 10 weeks
  • 5% fail to recover
  • 90% have further episodes
  • 1/3 have poor outcome
  • 1/3-1/4 have good outcome
  • 10% die by suicide

Psychiatry (18 decks)

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