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Year 3 > Affective Disorders > Flashcards

Affective Disorders Flashcards

1
Q

define mood disorders

A

disorders of mental status and function where altered mood is the (or a) core feature

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2
Q

give two broad examples of mood disorders

A

depression

mania

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3
Q

what are the commonest group of mental disorders?

A

mood disorders

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4
Q

how can a mood disorder present?

A

primary problem

consequence of another disorder or illness

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5
Q

what are mood disorders often associated with?

A

anxiety symptoms and anxiety disorder

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6
Q

where people have both depression and anxiety, the focus is on the treatment of what?

A

depression

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7
Q

name and describe two classification systems for psychiatric conditions

A

ICD-10
o International Classification of Disease 10th Edition
o WHO
• DSM-5
o Diagnostic and Statistical Manual of Mental Disorders 5th Edition
o American Psychiatric Association

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8
Q

describe depression as a symptom

A

o An emotion within the range of normal experience
§ Describe a state or feeling, or mood that can range from normal experience
to severe, life threatening illness
§ A systemic symptom (complaint) with similarities to fatigue and pain
§ Typically considered as a form of sadness, not just an absence of happiness

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9
Q

describe depression as a syndrome

A

a constellation of symptoms and signs

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10
Q

describe depression as a recurrent illness

A

o Recurrent depressive disorder
o If they have it once they are likely to have a further episode
o If severe enough to require inpatient treatment, approximately 80% will have a
further episode

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11
Q

in psychiatry how may you decide when sadness becomes abnormal?

A
  1. Persistence of symptoms
  2. Pervasiveness of symptoms
  3. Degree of impairment
  4. Presence of specific symptoms or signs
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12
Q

depressive illness symptoms occur in 3 spheres, name them

A

psychological
physical
social

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13
Q

name two broad psychological symptoms of depression

A

change in mood

change in though content

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14
Q

describe change in mood in depression

A

o Depression – may find diurnal variation
o Anxiety – inability to relax
o Perplexity – particularly in puerperal illness (post-natal), bewildered or overwhelmed
o Anhedonia – not being able to experience pleasure in the things you would usually
enjoy

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15
Q

describe change in thought content in depression

A

o Guilt – unjustified
o Hopelessness
o Worthlessness
o Any neurotic symptomatology e.g. hypochondriasis, agoraphobia, obsessions +
compulsions, panic attacks
o Ideas of reference – connecting things around you to negative things about you e.g.
laughing at
o Delusions and hallucinations if severe – psychotic symptoms

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16
Q

name two broad physical symptoms of depression

A

change in bodily function

change in psychomotor functioning

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17
Q

what changes in bodily function may a person suffering from depression experience?

A 
o Energy – fatigue
o Sleep – often insomnia, not being able to get to sleep, disturbed sleep, early waking
o Appetite – weight loss
o Libido
o Constipation
o Pain
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18
Q

what changes in psychomotor function may a person suffering from depression experience?

A

agitation

retardation

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19
Q

list the social symptoms of depression

A
  • Loss of interests
  • Irritability
  • Apathy
  • Withdrawal, loss of confidence, indecisive
  • Loss of concentration, registration and memory
20
Q

Describe the ICD-10 classification of depression

A

• Last for at least 2 weeks
• No hypomanic or manic episodes in lifetime
• Not attributable to psychoactive substance use or organic mental disorder
• If psychotic symptoms or stupor then severe depression with psychotic symptoms
o Need to exclude other psychotic illnesses first like schizophrenia

21
Q

Describe the ICD-10 classification of somatic syndrome

A

Somatic syndrome is a marked loss of interest or pleasure in activities that are normally pleasurable. There is a lack emotional reactions to events or activities that normally produce an emotional
response. Patients often wake 2 hours before the normal time and find that the depression is worse in the morning. Objective evidence of psychomotor agitation or retardation. Marked loss of appetite with weight loss (5% + of body weight in a month). Often marked loss of libido.

22
Q

Describe the ICD-10 classification of mild depression

A

• General criteria
• At least 2 of:
o Depressed mood that is abnormal for most of the day almost every day for the past
two weeks, largely uninfluenced by circumstances
o Loss of interest or pleasure
o Decreased energy or increased fatigability
• Additional from this list to give at least 4
o Loss of confidence or self esteem
o Unreasonable feelings of guilt or self-reproach or excessive guilt
o Recurrent thoughts of death by suicide or any suicidal behaviour
o Decreased concentration
o Agitation or retardation
o Sleep disturbance of any sort
o Change in appetite

23
Q

Describe the ICD-10 classification of moderate depression

A

• General criteria
• At least 2 of:
o Depressed mood that is abnormal for most of the day almost every day for the past
two weeks, largely uninfluenced by circumstances
o Loss of interest or pleasure
o Decreased energy or increased fatigability
• Additional from this list to give at least 6
o Loss of confidence or self esteem
o Unreasonable feelings of guilt or self-reproach or excessive guilt
o Recurrent thoughts of death by suicide or any suicidal behaviour
o Decreased concentration
o Agitation or retardation
o Sleep disturbance of any sort
o Change in appetite

24
Q

Describe the ICD-10 classification of severe depression

A

• General criteria
• All of:
o Depressed mood that is abnormal for most of the day almost every day for the past
two weeks, largely uninfluenced by circumstances
o Loss of interest or pleasure
o Decreased energy or increased fatigability
• Additional from this list to give at least 8
o Loss of confidence or self esteem
o Unreasonable feelings of guilt or self-reproach or excessive guilt
o Recurrent thoughts of death by suicide or any suicidal behaviour
o Decreased concentration
o Agitation or retardation
o Sleep disturbance of any sort
o Change in appetite

25
Q

for how long following child birth is there an increased risk of psychiatric admission

A

first 30 days

continues for 24 months

26
Q

what percentage of women experience the baby blues within 2 weeks of giving birth?

A

75%

27
Q

how many women develop MDD within 3-6 months of giving birth?

A

10%

28
Q

how common is puerperal psychosis and what is the risk of recurrence in subsequent deliveries?

A

1 in 500

1 in 3

29
Q

list the differential diagnoses for depression

A
  • Normal reaction to life event
  • SAD
  • Dysthymia
  • Cyclothymia
  • Bipolar
  • Stroke, tumour, dementia
  • Hypothyroidism, Addison’s, hyperparathyroidism
  • Infections – influenza, infectious mononucleosis, hepatitis, HIV/AIDS
  • Drugs
30
Q

what groups of treatment can be used for depression?

A

antidepressants
psychological treatments
physical treatments

31
Q

name some classes of antidepressants

A

SSRIs
SNRIs
TCAs
MOIs

32
Q

list psychological treatments for depression

A

CBT
IPT
Individual dynamic psychotherapy
Family therapy

33
Q

list physical treatments for depression

A

ECT
Psychosurgery
Deep brain stimulation
vagus nerve stimulation

34
Q

name 2 measurement tools in depression

A
  • SCID (Structured Clinical Interview for DSM disorders)

* SCAN (Schedules for Clinical Assessment in Neuropsychiatry)

35
Q

define mania

A

a state of feeling, or mood, that can range from a near normal experience
to severe, life-threatening illness. It is rarely a symptom, often associated with grandiose ideas,
disinhibition, loss of judgement; with similarities to the mental effects of stimulant drugs (AMPH, cocaine). Typically considered as a form of pathological, inappropriate elevated mood. Lack of insight.

36
Q

in psychiatry how may you decide between what is mania and what is not?

A
  • Persistence of symptoms
  • Pervasiveness of symptoms
  • Degree of impairment
  • Presence of specific symptoms or signs
37
Q

describe hypomania

A

• Lesser degree of mania, no psychosis
• Mild elevation of mood for several days on end
• Increased energy and activity, marked feeling of wellbeing
• Increased sociability, talkativeness, overfamiliarity, increased sexual energy, decreased need
for sleep
• May be irritable
• Concentration reduced, new interests, mild overspending
• Not to the extent of severe disruption of work or social rejection

38
Q

describe mania with or without psychosis

A
  • 1 week, severe enough to disrupt ordinary work and social activities more or less completely
  • Elevated mood, increased energy, overactivity, pressure of speech, decreased need for sleep
  • Disinhibition
  • Grandiosity
  • Alteration of senses
  • Extravagant spending
  • Can be irritable rather than elated
39
Q

list the psychiatric differentials for mania

A 
o Mixed affective state
o Schizophrenia disorder
o Schizophrenia
o Cyclothymia
o ADHD
o Drugs and alcohol
40
Q

list the medical differentials for mania

A

o Stroke, MS, tumour, epilepsy, AIDS, neurosyphilis
o Endocrine – Cushing’s, hyperthyroidism
o SLE

41
Q

what tools can be used to measure symptoms in mania

A

SCID
SCAN
Young Mania Rating Scale (YMRS)

42
Q

list the types of treatments for mania

A

Antipsychotics
Mood stabilisers
Lithium
ECT

43
Q

list the antipsychotics that could be used for mania

A

olanzapine
risperidone
quetiapine

44
Q

list the mood stabilisers that could be used for mania

A

sodium valproate
lamotrigine
carbamazepine

45
Q

what is bipolar disorder?

A

Bipolar affective disorder consists of repeated (2+) episodes of depression and mania or hypomania.
If no mania or hypomania then a diagnosis of recurrent depression is given. If there is no depression
then a diagnosis of hypomania or bipolar disorder is made. In DSM-5 a single episode of mania is
sufficient to diagnose bipolar disorder (because there is an assumption you’ve also had depressive
episodes).

46
Q

describe the clinical course of major depression

A
  • Typical episode lasts 4-6 months
  • 54% recovered at 26 weeks
  • 12% fail to recover
  • 80+% have further episodes
  • 15% die by suicide
47
Q

describe the clinical course of bipolar disorder/mania

A
  • Typical manic episode lasts 1-3 months
  • 60% recovered at 10 weeks
  • 5% fail to recover
  • 90% have further episodes
  • 1/3 have poor outcome
  • 1/3-1/4 have good outcome
  • 10% die by suicide

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