Affective Disorders Flashcards
What are mood disorders?
Disorders of mental status with altered mood as a core focus
Commonest group
Can be primary or secondary
Mood disorders are often associated with what?
Anxiety symptoms/disorders
What are the classification systems for mental illnesses?
ICD-10
DSM-5
Depression present as what?
Symptom
Syndrome
Recurrent illness
When does depression become abnormal?
No clear or convenient division
Persistent, purvasive symptoms
Degree of impairment
Presence of specific symptoms
What are the spheres of depressive symptoms?
Psychological
Physical
Social
What is the psychological sphere of depression?
Change in mood (depression, anxiety, perplexity, anhedonia)
Change in thoughts (Guilt, Hopelessness, worthlessness, neuroses)
What is the physical sphere of depression?
Change in body: Energy Sleep Appetite Libido Constipation Pain Change in psychomotor function: Agitation Retardation
What is the social sphere of depression?
Loss of interests Irritability Apathy Withdrawal, loss of confidence Loss of concentration Memory loss
What is anhedonia?
Loss of ability to derive pleasure from experience
What is stupor?
Extreme retardation in which consciousness is intact
Patient stops moving, speaking, eating and drinking.
How is depression described by the ICD-10?
Atleast 2 weeks
No hypomania/manic episodes in that time
Not attributable to psychoactive/organic mental disorder
How does depression differ from severe depression with psychotic symptoms?
Psychotic symptoms or stupor on top
Must exclude other psychotic illnesses first
How does Somatic Syndrome present?
Marked loss of interest Lack of emotional reactions to events Waking 2hrs early Depression worse in morning Psychomotor agitation/retardation Loss of appetite - weight loss
What is the ICD-10 criteria for mild depression?
At least 2 of:
Depressed mood for most of day in past 2 weeks
Loss of interest or pleasure
Decreased energy
(with additional symptoms making up to 4)
What is the ICD-10 criteria for moderate depression?
At least 2 of:
Depressed mood for most of day in past 2 weeks
Loss of interest or pleasure
Decreased energy
(with additional symptoms making up to 6)
What are the additional/minor symptoms of depression?
Loss of confidence Unreasonable feelings of guilt or self reproach Recurrent thoughts of death by suicide Decreased concentration Agitation or retardation Sleep disturbance Change in appetite
What is the ICD-10 criteria for severe depression?
All of:
Depressed mood for most of day in past 2 weeks
Loss of interest or pleasure
Decreased energy
(with additional symptoms making up to 8)
How common is post-natal depression?
75% get ‘blues’ within 2 weeks
10% develop MDD within 3-6 mo
1 in 500 get perpetual psychosis
What is the differential for depression?
SAD Dysthymia Cyclothymia Bipolar Neurological illness Hypothyroidism Drugs
What are the treatments for depression?
Antidepressions
Psychological treatments
Physical treatments
What are the antidepressants indicated for depression?
SSRIs - Sertraline, Fluoxetine
Tricyclic antidepressants - Amitriptyline
Monoamine Oxidase inhibitors - Phenelzine
What are the psychological treatments indicated for depression?
CBT
Interpersonal Therapy
Individual dynamic psychotherapy
Family therapy
What are the physical treatments indicated for depression?
ECT
Psychosurgery
DBS, VNS
What are the measurement tools for depression?
SCID/SCAN HDRS (Hamilton Depression rating scale) BDI-II (Beck Depression Inventory II) HADS PHQ-9
What is Mania?
Pathologically inappropriate elevated mood Persistence of symptoms Pervasiveness of symptoms Degree of impairment Presence of specific symptoms of signs
What are the main types of mania according to the ICD-10?
Hypomania Mania without psychotic symptoms Mania with psychotic symptoms Other manic episodes Manic episode
How does the ICD-10 classify hypomania?
Lesser mania with no psychosis Mild elevation of mood for several days Increased energy, wellbeing, sociability Irritability Reduced concentration, overspending (Not to extent of work/social disruption)
How does the ICD-10 classify Mania with/without psychotic symptoms?
1 week severe enough to disrupt work/social activity
Elevated mood, energy, overactivity, speech
Disinhibition
Grandiosity
Alteration of senses
Extravagant spending
What is the differential diagnosis for mania?
Mixed effective state Schizoeffective/schizophrenia Cyclothymia ADHD Drugs Neurological disorders Hyperthyroid SLE
What tools are used to measure mania symptoms?
SCID
SCAN
YMRS (Young Mania Rating Scale)
What is the treatment for mania?
Antipsychotics - Olanzapine, Quetiapine
Mood stabilisers - Valproate, Carbamazepine, Lamotrigine
Lithium
ECT
What antipsychotics are used in mania?
Olanzapine
Resperidone
Quetiapine
What mood stabilisers are used in mania?
Sodium Valproate
Lamotrigine
Carbamazepine
What is Bipolar Affective disorder?
2+ episodes of depression and hypo/mania
If no mania = recurrent depression
If no depression = hypomania/bipolar
How common is bipolar disorder?
0.7-1.6
Bipolar disorder typically onsets at which age?
<30
Mean 21
Early onset with FH
Depression is common in which populations?
More common in women
18-44 (mean 27)
Associated with unemployment, lower educational attainment, unstable marriage
What is the typical clinical course for major depression?
4-6mo
54% recover at 26 weeks
80% have further episodes
15% die by suicide
What is the typical clinical course for bipolar/mania?
1-3mo 60% recover at 10 weeks 90% have further episodes 10% die by suicide 1/3 have poor outcome
