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Psychiatry > Affective Disorders > Flashcards

Affective Disorders Flashcards

1
Q

Define mood

A

An individual’s emotional state

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2
Q

Define affect

A

Expression of an individual’s emotions

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3
Q

Define mood disorders

A

Disorders of mental status and function in which altered mood is the/a core feature

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4
Q

What are the mood disorders?

A

Depression
Mania
Bipolar disorder

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5
Q

What can cause disordered mood?

A

Can be a primary issue or can be a result of cancer, dementia, drug misuse, medical treatment (e.g. steroids)

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6
Q

What is commonly associated with depression?

A

Anxiety symptoms

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7
Q

Define cyclothymia

A

Below threshold bipolar disorder (must have been present for 2 years for diagnosis)

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8
Q

Define Dysthymia

A

Below threshold depression (has to present for two years)

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9
Q

What is the inpatient recurrence of depression?

A

80%

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10
Q

When does depression/mania become abnormal?

A

Often a matter of perspective, psychiatrists focus on persistence, pervasiveness of symptoms, degree of impairment and the presence of certain signs/symptoms

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11
Q

What are the three spheres that symptoms of depression occur in?

A

Physical
Social
Psychological

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12
Q

What symptoms are in the psychological sphere?

A 
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)

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13
Q

What hallucinations do severely depressed people tend to get?

A

Auditory

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14
Q

What are ideas of reference?

A

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

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15
Q

What symptoms are in the physical sphere?

A 
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

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16
Q

What symptoms are in the social sphere?

A

Loss of interests
Irritability
Apathy
Withdrawal, loss of confidence, indecisiveness
Loss of concentration, registration, memory

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17
Q

Define agitation

A

State of restless overactivity, aimless and ineffective

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18
Q

Define anhedonia

A

Loss of ability to derive pleasure from experience

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19
Q

Define apathy

A

Loss of interest in own surroundings

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20
Q

Define anxiety

A

Thoughts of apprehension and fear predominate

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21
Q

Define depression

A

Thoughts of sadness or unhappiness predominate

22
Q

Define retardation

A

A slowing of motor responses, incl. speech

23
Q

Define stupor

A

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

24
Q

What is the ICD-10 classification of depression?

A

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

25
Q

What is somatic syndrome?

A 
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
26
Q

What are the symptoms used in the ICD-10?

A

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
27
Q

Define mild depression as by the ICD-10 categorisation

A

At least 2 of A symptoms

Enough B symptoms to make up to 4 in total

28
Q

Define moderate depression as by the ICD-10 categorisation

A

At least 2 of A symptoms

Enough B symptoms to make up to 6 in total

29
Q

Define severe depression as by the ICD-10 categorisation

A

All 3 of A symptoms

Enough B symptoms to make up to 8 in total

30
Q

What is baby blues?

A

75% of woman feel sad after giving birth (this is related to hormones, huge life change, tiredness)

31
Q

What is post-natal depression?

A

10% woman develop MDD within 3-6 months after giving birth

32
Q

What is puerperal psychosis?

A

1 in 500 deliveries

Other experiences psychotic symptoms - hallucinations, delusions, mania, depression, disinhibition etc.

33
Q

What are the differential diagnoses for depression?

A 
Grief
SAD
Dysthymia 
Cyclothymia
Bipolar 
Stroke, dementia, Huntington's, tumour 
Hypothyroidism, Addison's, hyperparathyroidism
Infections (e.g. HIV/AIDS)
Drugs
34
Q

What are the treatments for depression?

A

SSRIs, MAOI, TCAs etc
ECT, psychosurgery, DBS, VNS
CBT, IP, family therapy etc.

35
Q

What tools can you use to measure depression?

A

SCID, SCAN

HADS - hospital anxiety and depression scale

36
Q

Define mania

A

Elevated mood

37
Q

What does mania tend to be associated with?

A

Rarely presents on its own
Tends to co-occur with grandiose ideas, disinhibition, loss of judgement
Lack of insight v common

38
Q

Define hypomania by !CD-10

A

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

39
Q

Define mania by ICD-10

A

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

40
Q

What are differentials for mania?

A 
Mixed affective disorder
Schizoaffective disorder
Schizophrenia
Cyclothymia
ADHD
Drugs and alcohol 
Stroke, MS, tumour, epilepsy, AIDS, neurosyphilis, cushings, hyperthyroidism, SLE
41
Q

What are tools used to measure mania symptoms?

A

SCID
SCAN
YMRS (young mania rating score)

42
Q

How do you treat mania?

A

Antipsychotics - olanzapine,risperidone, quetiapine
Mood stabilisers - Na valproate, lamotrigine, carbamazepine
Lithium
ECT

43
Q

Define bipolar disorder by ICD-10

A

2+ episodes of depression and mania/hypomania

44
Q

Depression with no mania/hypomania is classed as what?

A

Recurrent depression

45
Q

Mania with no apparent depression is classed as what?

A

Can be classed as bipolar (v. rare to have manic episodes alone)

46
Q

How common is bipolar disorder?

A

Lifetime prevalence 0.7-1.6

47
Q

What is the epidemiology of bipolar disorder?

A

F=M
Mean age onset = 21
Younger onset with +ve FH

48
Q

How common is depression?

A

Lifetime prevalence 2.9-12

Milder forms - 1 in 5

49
Q

What is the epidemiology of depression?

A

2x as common females (?cultural expectations)
Mean age onset 27
Less common in employed, financially stable, higher educational attainment, stable marriage

50
Q

What may trigger the onset of depression?

A

An exit event, e.g. separation or loss

51
Q

What is the outcome of depression?

A

Typical episode lasts 4-6 months

15% die by suicide

52
Q

What is the outcome of bipolar disorder?

A

Typical manic episode lasts 1-3 months
10% die by suicide
90% have further episodes

Psychiatry (26 decks)

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