Affective disorders Flashcards
Depression Mania BPD
Define affective disorders
Disorders of mental status/ function
where altered mood is the core features
Affective disorders may be secondary to [4]
Cancer
Dementia
Drug misuse
Medical tx
Psychological symptoms of depression:
4 relating to changes in mood
and 1 general feature
4 relating to change in thought content
Changes in mood Depressed mood Anxiety Perplexity Anhedonia [Diurnal variation]
Changes in thought content: Guilt, hopelessness, worthlessness Neurotic symptomatology Ideas of reference Delusions, hallucination
Physical symptoms of depression:
Change in bodily function 4
Change in psychomotor function 2
Change in bodily function - energy - sleep, appetite - libido - constipation - pain Change in psychomotor function - agitation - retardation
Social symptoms of depression [5]
Loss of interests affecting job Irritability Apathy Social withdrawal Loss of confidence Indecisiveness
Depression Dx ICD-10
General criteria [3 components]
7 additional criteria
General criteria Depressed mood for most of the day lasting for: - > 2 weeks - almost everyday - largely uninfluenced by circumstances Anhedonia Decreased energy
Additional criteria
- Loss of self esteem
- Unreasonable feelings of guilt
- Decreased concentration
- Agitation or psychomotor retardation
- Sleep disturbance
- Appetite change
- Suicidal ideation
Severe depression - name 2 defining features
psychotic symptoms or stupor accompanying other criteria
Stupor definition
State of extreme retardation with intact consciousness
Stops moving, eating, drinking, speaking
But can recall on reocvery
Metabolic ddx to depression [3]
Hypothyroidism
Addisons disease
HyperPTH-ism
Infections ddx to depression
Influenza
Infectious mono
Hepatitis
HIV/AIDS
Tx depression
Name 3 modes with 3 examples of each
Rx
- TCA
- MAOIs
- SSRIs
Psychological
- CBT
- IPT
- Individual/family dynamic psychotherapy
Physical:
- ECT
- DBS
- Psychosurgery eg vagal nerve stimulation
Mania
3 types
Hypomania Mania with(out) psychotic sx
Hypomania
3 features
Lesser degree of mania
No psychosis
But not to extent to disrupt work
Characteristics of hypomania 10
Characteristics: Mild mood elevation for several days on end increased energy/activity marked feeling of well-being increased sociability, talkativeness Overfamiliarity, increased libio Less need for sleep Increased irritability Reduced concentration New interests Mild overspending
Mania without psychotic sx
Diagnosis: Duration + Severity
Characteristics [9]
1 week Enough to disrupt work 9 characteristics: Elevated mood increased energy Pressure of speech Less need for sleep Disinhibition Grandiosity Alteration of senses Extravagant spending Irritability
Mania without psychotic sx Treatment Give 3 eg of antipsychotics Give 3 eg of mood stabilizers Give 1 eg of physical tx
Antipsychotics - olanzapine - risperidone - quetiapine Mood stabilizers - valproic acid - lamotrigine - carbamazepine Lithium* ECT
BPD dx
Repeated episodes of depression AND (hypo)mania
If patient has repeated episodes of depression but no mania then diagnosis could be [1]
Recurrent depression
If patient has manic symptoms but no depression then diagnosis could be [2]
Hypomania
Bipolar disorder
Classification of severity of depression [DSM]
Mild, moderate, severe
Classification of severity of depression • Mild depression • At least 2 from general criteria • At least 4 from additional criteria list • Moderate depression • At least 2 from general criteria • At least 6 from additional criteria list • Severe depression • All of general criteria At least 8 from additional criteria list
Treatment of bipolar disorder
Acute episode mania, hypomania or mixed [3]
○ If agitated: IM neuroleptic or benzodiazepine
○ No agitation: mood stabilizer or atypical anti-psychotic
Adjunct: clonazepam
Treatment of bipolar disorder
If patient presents with mania [2]
If patient is rapid cycling [1]
Mania: Atypical anti-psychotic
Rapid cycling: Lithium
Treatment of bipolar disorder
After stabilization
Treatment if mania is predominant feature [2]
Treatment if depression is predominant feature [2]
Mania - predominant feature
○ Lithium or olanzapine
○ Psychosocial interventions and monitoring
Depression as predominant feature
○ Lamotrigine
○ Psychosocial interventions and monitoring
