Affective Disorders Flashcards
What are mood disorders?
- 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)
What are the commonest group of mental disorders?
Mood disorders
In what ways can mood disorders present?
- As a primary problem
- As a consequence of other disorder or illness (cancer, dementia, drug misuse)
What other symptoms and disorders are often associated with mood disorders?
Anxiety symptoms and disorders
What classification systems are used in the treatment of mood disorders?
ICD-10 - Europe
DSM-5 - America
What is depression?
- 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
At what point does depession become abnormal?
- 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
What are the main categories of symptoms experience in depression?
- Psychological
- Physical
- Social
What are the psychological symptoms that can be experienced by someone suffering with depession?
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)
What are the physical symptoms that can be experienced by patients with depression?
- 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)
What are the social symptoms that patients with depression can suffer from?
- Loss of interests
- Irritability
- Apathy
- Withdawal
- Loss of confidence
- Loss of concentration
- Indecisive
What is the definition of agitation?
A state of restless overactivity, aimless or ineffective
What is the definition of anhedonia?
Loss of ability to derive pleasure from experience
What is the definition of apathy?
Loss of interest in own surroundings
What is the definition of anxiety?
An unpleasant emotion in which thoughts of apprehension or fear predominate
What is the definition of depression?
An unpleasant emotion in which sadness or unhappiness predominates
What is the definition of retardation?
A slowing of motor responses including speech
What is the definition of stupor?
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
Accoding to ICD-10, what are the requirements for someone to be diagnosed with depression?
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
Accoding to ICD-10, if psychotic symptoms or stupor are present what is the diagnosis?
Severe depression with psychotic symptoms
If a patient presents with psychotic symptoms or stupor, what other psychotic illnesses must be excluded before making a diagnosis of depression?
Schizophrenia
What are the symptoms of somatic syndrome?
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
What is the criteria for someone to be diagnosed with mild depression?
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
Depression can take the form of a symptom, syndrome or as a recurrent illness: give a description of each one
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
What is the criteria for someone to be diagnosed with moderate depression?
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
What is the criteria for someone to be diagnosed with severe depression?
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
What is the epidemiology of post-natal depression?
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
What can be the differential diagnosis for depression?
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
What are the treatment options available for depression?
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)
What are the various measurement tools used by psychiatrists to assess affective disorders?
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
What is mania?
- 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
What type of ideas amd behaviours are often associated with mania?
1 - Grandiose ideas
2 - Disinhibition
3 - Loss of judgment
What are the important questions that psychiatrists should ask when deciding if a patient is suffering with mania or not?
1 - Persistence of symptoms
2 - Pervasiveness of symptoms
3 - Degree of impairment
4 - Presence of specific symptoms or signs
What are the different classifications of mani according to ICD-10?
1 - Hypomania
2 - Mania without psychotic symptoms
3 - Mania with psychotic symptoms
4 - Other manic episodes
5 - Manic episode, unspecified
What is the ICD-10 classification of hypomania?
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
What is the ICD-10 classification of mania (with or without psychosis)?
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
What are the psychiatric differential diagnosis for someone suffering with mania?
1 - Mixed affective state
2 - Schizoaffective disorder
3 - Schizophrenia
4 - Cyclothymia
5 - ADHD
6 - Drugs and alcohol
What are the medical differential diagnosis for someone suffering with mania?
1 - Stroke
2 - MS
3 - Tumour
4 - Epilepsy
5 - AIDS
6 - Cushings
7 - Hyperparathyroidism
What are the tools used by psychiatrists to measure the symptoms of mania?
1 - SCID
2 - SCAN
3 - Young Mania Rating Scale
What are the treatment options for mania?
1 - Antipsychotics
2 - Mood stabilisers
3 - Lithium
4 - ECT
What are examples of some commonly used antipsychotic drugs?
Olanzapine
Risperidone
What are examples of some commonly used mood stabilisers?
Sodium Valproate
Lamotrigene
Carbamazepine
What is the ICD-10 classification of Bipolar disorder?
- 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
What is the epidemiology of bipolar disorder?
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
What is the epidemiology of depression?
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
What social/personal factors have a positive (reductive) effect on depression?
1 - Employment
2 - Financial independency
3 - High educational attainment
4 - Stable marriage
What is the clinical course and outcomes for patients suffering with major depression?
- Typical episode lasts 4-6 months
- 54% recovered at 26 weeks
- 12% fail to recover
- 80% have further episodes
- 15% die by suicide
What is the clinical course and outcomes for patients suffering with bipolar disorder/mania?
- 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
