Affective disorders Flashcards
What are mood disorders?
disorders of mental status and function where altered mood is the (or a ) core feature
Examples of affective disorders
States of depression and of mania
What are the most common group of medical disorders?
affective/mood disorders
Secondary causes of altered mood
consequence of other disorder or illness eg cancer, steroids, drug misuse, dementia
2 classification systems for affective disorders
ICD-10
DSM-5
3 ways to classify depression
symptom
syndrome
recurrent illness
Depression as a symptom
can e systemic eg fatigue
form of sadness
depression as a syndrome
constellation of symptoms and signs
Depression as a recurrent illness
recurrent depressive disorder
The 4 things which indicate if depression or bipolar becomes abnormal
persistence of symptoms
pervasiveness
degree of impairment
specific symptoms or signs
3 spheres of symptoms of depressive illness
psychological
physical
social
2 main parts of the psychological sphere of depression
change in mood
change in thought content
Change in mood - depression
depression - diurnal variation
anxiety
perplexity - puerperal illness
anhedonia
Change in thought content - depression
unjustified guilt hopelessness worthlessness neurotic eg hypochondriasis, obsessions, phobias delusions and hallucinations if severe
2 categories of the physical sphere of depression
change in bodily function
change in psychomotor function
change in bodily function - depression
energy - fatigue sleep libido appetite constipation pain
Change in psychomotor functioning - depression
agitation
retardation
Change in social sphere - depression
loss of interests irritability apathy withdrawal, loss of confidence and indecisive loss of concentration and memory
Agitation
A state of restless overactivity, aimless or ineffective
anhedonia
loss of ability to derive pleasure from experience
Apathy
Loss of interest in own surroundings
anxiety
An unpleasant emotion in which thoughts of apprehension and fear predominate
Depression
An unpleasant emotion in which sadness or unhappiness predominate
Retardation
Slowing of motor responses including speech
Stupor
A state of extreme retardation in which consciousness is intact but stop speaking, eating moving
Remember the events after recovery
How long must depression symptoms last to diagnose?
2 weeks
If there have been hypomanic or manic episodes in their life, can depression be diagnosed?
no - bipolar etc
Psychoactive substances and organic mental disorder- depression
Must not be attributable to these for ICD-10
If psychotic symptoms or stupor what must you exclude before diagnosing depression?
other psychotic illnesses eg schizophrenia
Components of depression - somatic syndrome
anhedonia lack of emotional reactions waking 2 hours before normal time depression worse in morning psychomotor agitation or retardation loss of appetite weight loss loss of libido
3 general criteria for depression
ICD-10
depressed mood, most of the day, almost everyday for atleast 2 weeks
anhedonia
decreased energy or increased fatigability
Additional criteria for depression: ICD-10
loss of confidence and self esteem unreasonable guilt suicidal thoughts decreased concentration agitation or retardation sleep disturbance change in appetite
mild depression - ICD-10 : how many criteria?
at least 2 general
additional list to give 4
moderate depression: ICD-10: how many criteria?
at least 2 general
additional list to give 6
severe depression: ICD-10: how many criteria?
all of general
additional list to give 8
% of women who experience the blues within 2 weeks after birth
75
% of women who develop MDD within 3-6 months
10
Differential diagnosis for depression
SAD normal reaction to life event dysthymia cyclothymia bipolar stroke, tumour, dementia hypothyroidism infections drugs
Treatments for depression - broadly in 3 categories
antidepressants eg SSRI, SnRI, MAOI, TCA etc
psychological eg CBT, IPT
physical eg ECT, DBS, VNS
Measurement tools for depression - main 2
SCID and SCAN
Other measurement tools for depression
HDRS
BD1-11
HADS
PHQ-9
What is mania often associated with?
grandiose ideas
disinhibition
loss of judgement
Mania
pathological, inappropriate elevated mood
Hypomania - ICD-10
Lesser degree of mania, no psychosis mild elevation of mood increased energy and activity increase sociability concentration reduced
Does hypomania affect work or social circumstances?
not severely
ICD-10, mania - how long?
1 week
ICD-10, mania
classification
disrupt work and social elevated mood, increase energy, pressure of speech disinhibition grandiose alteration of senses extravagant spending irritable overactivity
Psychiatric differential diagnosis of mania
mixed affective state schizoaffective disorder schizophrenia cyclothymia dysthymia ADHD
dysthymia
persistent mild depression
cyclothymia
relatively mild depression and hypomania
Medical differential diagnosis for mania
stroke, MS, tumour, hyperthyroid, epilepsy, AIDS
Tools to measure mania
SCID and SCAN
YMRS
Main treatments of mania
antipsychotics eg risperidone, olanzapine
mood stabiliser eg lamotrigine, sodium valproate
lithium
ECT
Bipolar affective disorder - what it consists of
repeated (2+) episodes of depression and mania or hypomania
If no mania or hypomania it is not bipolar but what instead?
recurrent depression
No depression but mania or hypomania
hypomania or bipolar
DSM-5: What is sufficient to diagnose bipolar?
1 episode of mania
What has improved agreement for mood disorders?
SCID and SCAN
What has hindered agreement for mood disorders?
differences in diagnostic classifications
Epidemiology of bipolar
M=F, age = 21
early onset with positive FH
no difference with income, education etc
prevalence increased in first degree relatives
Epidemiology of depression
2.9-12 lifetime prevalence
2:1 for females
mean age 27
MDD less in those employed
lower education, unstable marriage etc
excess of adverse live events
clinical outcome of major depression
4-6 months
80% have further episodes
15% suicide
Clinical outcomes of bipolar/mania
1-3 months manic episode
90% further episodes
10% suicide
