Affective Disorders Flashcards
define mood disorders
disorders of mental status and function where altered mood is the (or a) core feature
give two broad examples of mood disorders
depression
mania
what are the commonest group of mental disorders?
mood disorders
how can a mood disorder present?
primary problem
consequence of another disorder or illness
what are mood disorders often associated with?
anxiety symptoms and anxiety disorder
where people have both depression and anxiety, the focus is on the treatment of what?
depression
name and describe two classification systems for psychiatric conditions
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
describe depression as a symptom
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
describe depression as a syndrome
a constellation of symptoms and signs
describe depression as a recurrent illness
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
in psychiatry how may you decide when sadness becomes abnormal?
- Persistence of symptoms
- Pervasiveness of symptoms
- Degree of impairment
- Presence of specific symptoms or signs
depressive illness symptoms occur in 3 spheres, name them
psychological
physical
social
name two broad psychological symptoms of depression
change in mood
change in though content
describe change in mood in depression
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
describe change in thought content in depression
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
name two broad physical symptoms of depression
change in bodily function
change in psychomotor functioning
what changes in bodily function may a person suffering from depression experience?
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
what changes in psychomotor function may a person suffering from depression experience?
agitation
retardation
list the social symptoms of depression
- Loss of interests
- Irritability
- Apathy
- Withdrawal, loss of confidence, indecisive
- Loss of concentration, registration and memory
Describe the ICD-10 classification of depression
• 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
Describe the ICD-10 classification of somatic syndrome
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.
Describe the ICD-10 classification of mild depression
• 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
Describe the ICD-10 classification of moderate depression
• 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
Describe the ICD-10 classification of severe depression
• 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
for how long following child birth is there an increased risk of psychiatric admission
first 30 days
continues for 24 months
what percentage of women experience the baby blues within 2 weeks of giving birth?
75%
how many women develop MDD within 3-6 months of giving birth?
10%
how common is puerperal psychosis and what is the risk of recurrence in subsequent deliveries?
1 in 500
1 in 3
list the differential diagnoses for depression
- Normal reaction to life event
- SAD
- Dysthymia
- Cyclothymia
- Bipolar
- Stroke, tumour, dementia
- Hypothyroidism, Addison’s, hyperparathyroidism
- Infections – influenza, infectious mononucleosis, hepatitis, HIV/AIDS
- Drugs
what groups of treatment can be used for depression?
antidepressants
psychological treatments
physical treatments
name some classes of antidepressants
SSRIs
SNRIs
TCAs
MOIs
list psychological treatments for depression
CBT
IPT
Individual dynamic psychotherapy
Family therapy
list physical treatments for depression
ECT
Psychosurgery
Deep brain stimulation
vagus nerve stimulation
name 2 measurement tools in depression
- SCID (Structured Clinical Interview for DSM disorders)
* SCAN (Schedules for Clinical Assessment in Neuropsychiatry)
define mania
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.
in psychiatry how may you decide between what is mania and what is not?
- Persistence of symptoms
- Pervasiveness of symptoms
- Degree of impairment
- Presence of specific symptoms or signs
describe hypomania
• 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
describe mania with or without psychosis
- 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
list the psychiatric differentials for mania
o Mixed affective state o Schizophrenia disorder o Schizophrenia o Cyclothymia o ADHD o Drugs and alcohol
list the medical differentials for mania
o Stroke, MS, tumour, epilepsy, AIDS, neurosyphilis
o Endocrine – Cushing’s, hyperthyroidism
o SLE
what tools can be used to measure symptoms in mania
SCID
SCAN
Young Mania Rating Scale (YMRS)
list the types of treatments for mania
Antipsychotics
Mood stabilisers
Lithium
ECT
list the antipsychotics that could be used for mania
olanzapine
risperidone
quetiapine
list the mood stabilisers that could be used for mania
sodium valproate
lamotrigine
carbamazepine
what is bipolar disorder?
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).
describe the clinical course of major depression
- Typical episode lasts 4-6 months
- 54% recovered at 26 weeks
- 12% fail to recover
- 80+% have further episodes
- 15% die by suicide
describe the clinical course of bipolar disorder/mania
- 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
