Affective Disorders Flashcards
Definition of mood disorders
Disorders of the mental status and function where altered mood is (or a) core feature
How can a disordered mood present?
As a primary problem
As a consequence of other disorder/illness e.g. cancer, dementia, drug misuse or medical treatment (steroids)
Two classification systems of affective disorders
ICD-10 (WHO)
DSM-5 (American)
What can depression be seen as?
A STATE OF FEELING OR MOOD, that can range from normal experience to severe, life threatning illness
A SYSTEMIC SYMPTOM (complaint) with similarities to fatigue and pain
A FORM OF SADNESS, not just the absence of happiness
A SYNDROME - constellation of symptoms and signs
A RECURRENT ILLNESS - if had it once then likely to recur again
When does depression become abnormal?
No clear and convenient division
Consensus problematic, often matter of perspective
What does psychiatry place emphasis on?
Persistence of symptoms
Pervasiveness of symptoms
Degree of impairment
Presence of specific symptoms or signs
Symptoms of depressive illness occurs in 3 spheres
Social
Physical
Psychosocial
Symptoms of depression
Diurnal variation - worse in the morning Anxiety - inability to relax Perplexity - particularly in puerperal illness. - feeling a bit bewildered/overwhelmed Anhedonia Guilt (not really justified, unduly) Hopelessness/worthlessness Any neurotic symptoms e.g. - hydrochondriasis, agoraphobia, obsessions and compulsions, panic attacks Ideas of reference Delusions and hallucinations if severe Fatigue Sleep - insomnia or early wakening Loss of appetite leading to weight loss Loss of libido Constipation Pain Psychomotor function - agitation (restless sort of anxiety) - retardation (severe = stupor) Loss of interests Irritability Apathy Withdrawal Loss of confidence Indecisive Loss of concentration, registration and memory
Definition of anhedonia
Not being able to experience pleasure in the things that you like doing
Definition of ‘ideas of reference’
Where there is a casual event e.g. group of friends laughing across the street - and you believe that they are laughing at you - so connecting things to negative things about you
Delusion vs Hallucination example
Delusion - actually believe their organs are rotting inside of them
Hallucination - they may smell the rotting flesh (olfactory hallucination)
What is usually wrong with sleep in depression?
Early wakening
Definition of agitation
A state of relentless overactivity, aimless or ineffective
Definition of anheondia
Loss of ability to derive pleasure from experience
Definition of anxiety
An unpleasant emotion in which thoughts of apprehension or fear predominate
Definition of depression
An unpleasant emotion in which sadness or unhappiness predominate
Definition of retardation
A slowing of motor responses including speech
What is stupor?
A state of extreme psychomotor retardation in which consciousness is in tact, but the patient stops moving, speaking, eating and drinking
On recovery of stupor, what can the patient do?
Can clearly describe the events which occurred whilst stuporose
Which gender is more affected by depression?
F > M 2:1
Highest age risk of depression
18-44 (median 25)
Mean age of onset of depression
27
What can the onset of depression (first episode) be associated with?
Excess of adverse life events
‘exit events’ - separations and loses
Depression ICD-10 criteria that needs to be met to be diagnosed with depression
Lasts for at least 2 weeks
No hypomania or manic episodes in lifetime
Not attributable to psychoactive substance use or organic mental disorder
Somatic syndrome
What is somatic syndrome?
Mood disorder which is characterised by physical symptoms more
Presentation of somatic syndrome
Marked loss of interest or pleasure in activities that are normally pleasurable
Lack of emotional reactions to event or activities that normally produce an emotional response
Waking 2 hours before normal time
Depression worse in the morning
Objective evidence of psychomotor agitation or retardation
Marked loss of appetite
Weight loss (5% + of body weight in a month)
Marked loss of lidio
When diagnosing depression and how severe it is, what is the criteria used?
At least a number of
- depressed abnormal mood for most of the day almost everyday for past 2 weeks, largely uninfluenced by circumstances
- loss of interest/pleasure
- decreased energy or increased fatigability
Addition features from this list to give a number
- loss of confidence/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
Criteria to diagnose MILD depression
At least 2 from first list AND
Additional from second list to make 4
Criteria to diagnose MODERATE depression
At least 2 from first list AND
additional from second list to make 6
Criteria to diagnose SEVERE depression
ALL from the first list AND
Additional from the second list to give 8
How many days after childbirth is there increased risk of psychiatric admission?
30 days following childbirth
How many women experience ‘blues’ in the first 2 weeks after childbirth?
75%
