Affective Disorders Flashcards
Define mood
An individual’s emotional state
Define affect
Expression of an individual’s emotions
Define mood disorders
Disorders of mental status and function in which altered mood is the/a core feature
What are the mood disorders?
Depression
Mania
Bipolar disorder
What can cause disordered mood?
Can be a primary issue or can be a result of cancer, dementia, drug misuse, medical treatment (e.g. steroids)
What is commonly associated with depression?
Anxiety symptoms
Define cyclothymia
Below threshold bipolar disorder (must have been present for 2 years for diagnosis)
Define Dysthymia
Below threshold depression (has to present for two years)
What is the inpatient recurrence of depression?
80%
When does depression/mania become abnormal?
Often a matter of perspective, psychiatrists focus on persistence, pervasiveness of symptoms, degree of impairment and the presence of certain signs/symptoms
What are the three spheres that symptoms of depression occur in?
Physical
Social
Psychological
What symptoms are in the psychological sphere?
CHANGE IN MOOD Depression (diurnal variation - worse in morning) Anxiety Perplexity (esp in PND) - bewilderment Anhedonia
CHANGE IN THOUGHT CONTENT
Guilt
Hopelessness
Worthlessness
Neurotic symptomatology - e.g. hypochondriasis, agoraphobia, obsessions, compulsions, panic attacks
Ideas of reference
Delusions and hallucinations (severe depression)
What hallucinations do severely depressed people tend to get?
Auditory
What are ideas of reference?
Seeing things around you that are not connected to you, but strongly believing they are - e.g. walking past a group of people laughing at something and thinking they are laughing at you
What symptoms are in the physical sphere?
CHANGE IN BODILY FUNCTION Energy - fatigue Disturbed sleep/early wakening (in severe depression) Appetite (wt loss/gain) Libido Constipation Pain
CHANGE IN PSYCHOMOTOR FUNCTIONING
Agitation
Retardation
Stupor
What symptoms are in the social sphere?
Loss of interests
Irritability
Apathy
Withdrawal, loss of confidence, indecisiveness
Loss of concentration, registration, memory
Define agitation
State of restless overactivity, aimless and ineffective
Define anhedonia
Loss of ability to derive pleasure from experience
Define apathy
Loss of interest in own surroundings
Define anxiety
Thoughts of apprehension and fear predominate
Define depression
Thoughts of sadness or unhappiness predominate
Define retardation
A slowing of motor responses, incl. speech
Define stupor
Extreme retardation in which consciousness is intact
Patient stops moving, eating, speaking, drinking
Can clearly describe events occurring around them after recovery
Very severe depression
What is the ICD-10 classification of depression?
For at least 2 WEEKS and after ruling out previous hypomanic/manic episodes, organic disorders, substance misuse etc.
Based on symptoms split into mild, moderate and severe
What is somatic syndrome?
Cluster of physical symptoms: Anhedonia/apathy Lack of emotional reaction Waking 2 hours before normal time Depression worse in morning Psychomotor agitation/retardation Marked loss of appetite (5% body wt in a month) Marked loss of libido
What are the symptoms used in the ICD-10?
A -
Depressed mood for most of the day almost every day for the last 2 weeks, uninfluenced by circumstances
Loss of pleasure/interest
Increased fatiguability/reduced energy
B - Loss of confidence/self esteem Unreasonable guilt/self-reproach Suicidal ideation/behaviour Decreased concentration Agitation/retardation Sleep disturbance Change in appetite
Define mild depression as by the ICD-10 categorisation
At least 2 of A symptoms
Enough B symptoms to make up to 4 in total
Define moderate depression as by the ICD-10 categorisation
At least 2 of A symptoms
Enough B symptoms to make up to 6 in total
Define severe depression as by the ICD-10 categorisation
All 3 of A symptoms
Enough B symptoms to make up to 8 in total
What is baby blues?
75% of woman feel sad after giving birth (this is related to hormones, huge life change, tiredness)
What is post-natal depression?
10% woman develop MDD within 3-6 months after giving birth
What is puerperal psychosis?
1 in 500 deliveries
Other experiences psychotic symptoms - hallucinations, delusions, mania, depression, disinhibition etc.
What are the differential diagnoses for depression?
Grief SAD Dysthymia Cyclothymia Bipolar Stroke, dementia, Huntington's, tumour Hypothyroidism, Addison's, hyperparathyroidism Infections (e.g. HIV/AIDS) Drugs
What are the treatments for depression?
SSRIs, MAOI, TCAs etc
ECT, psychosurgery, DBS, VNS
CBT, IP, family therapy etc.
What tools can you use to measure depression?
SCID, SCAN
HADS - hospital anxiety and depression scale
Define mania
Elevated mood
What does mania tend to be associated with?
Rarely presents on its own
Tends to co-occur with grandiose ideas, disinhibition, loss of judgement
Lack of insight v common
Define hypomania by !CD-10
Lesser degree of mania, no psychosis
Mild elevation of mood for several days on end
Increased energy, activity, marked sense of wellbeing
Increased sociability, talkativeness, overfamiliarity, increased sexual energy
Decreased need for sleep
May be irritable
Concentration reduced, new interests, mild overspending
No social rejection/interference with work
Define mania by ICD-10
1 week (severe enough to disrupt work/social activities more or less completely)
Elevated mood, increased energy, overactivity, pressure of speech, decreased need for sleep
Disinhibition
Grandiosity
Alteration of senses (more intense)
Extravagant spending
Can be irritable rather than elated
What are differentials for mania?
Mixed affective disorder Schizoaffective disorder Schizophrenia Cyclothymia ADHD Drugs and alcohol Stroke, MS, tumour, epilepsy, AIDS, neurosyphilis, cushings, hyperthyroidism, SLE
What are tools used to measure mania symptoms?
SCID
SCAN
YMRS (young mania rating score)
How do you treat mania?
Antipsychotics - olanzapine,risperidone, quetiapine
Mood stabilisers - Na valproate, lamotrigine, carbamazepine
Lithium
ECT
Define bipolar disorder by ICD-10
2+ episodes of depression and mania/hypomania
Depression with no mania/hypomania is classed as what?
Recurrent depression
Mania with no apparent depression is classed as what?
Can be classed as bipolar (v. rare to have manic episodes alone)
How common is bipolar disorder?
Lifetime prevalence 0.7-1.6
What is the epidemiology of bipolar disorder?
F=M
Mean age onset = 21
Younger onset with +ve FH
How common is depression?
Lifetime prevalence 2.9-12
Milder forms - 1 in 5
What is the epidemiology of depression?
2x as common females (?cultural expectations)
Mean age onset 27
Less common in employed, financially stable, higher educational attainment, stable marriage
What may trigger the onset of depression?
An exit event, e.g. separation or loss
What is the outcome of depression?
Typical episode lasts 4-6 months
15% die by suicide
What is the outcome of bipolar disorder?
Typical manic episode lasts 1-3 months
10% die by suicide
90% have further episodes
