Affective Disorders

Question 1

What are mood disorders?

Answer 1

Disorders of mental status with altered mood as a core focus
Commonest group
Can be primary or secondary

Question 2

Mood disorders are often associated with what?

Answer 2

Anxiety symptoms/disorders

Question 3

What are the classification systems for mental illnesses?

Answer 3

ICD-10

DSM-5

Question 4

Depression present as what?

Answer 4

Symptom
Syndrome
Recurrent illness

Question 5

When does depression become abnormal?

Answer 5

No clear or convenient division
Persistent, purvasive symptoms
Degree of impairment
Presence of specific symptoms

Question 6

What are the spheres of depressive symptoms?

Answer 6

Psychological
Physical
Social

Question 7

What is the psychological sphere of depression?

Answer 7

Change in mood (depression, anxiety, perplexity, anhedonia)

Change in thoughts (Guilt, Hopelessness, worthlessness, neuroses)

Question 8

What is the physical sphere of depression?

Answer 8

Change in body:
Energy
Sleep
Appetite 
Libido 
Constipation
Pain
Change in psychomotor function:
Agitation
Retardation

Question 9

What is the social sphere of depression?

Answer 9

Loss of interests
Irritability 
Apathy
Withdrawal, loss of confidence
Loss of concentration
Memory loss

Question 10

What is anhedonia?

Answer 10

Loss of ability to derive pleasure from experience

Question 11

What is stupor?

Answer 11

Extreme retardation in which consciousness is intact

Patient stops moving, speaking, eating and drinking.

Question 12

How is depression described by the ICD-10?

Answer 12

Atleast 2 weeks
No hypomania/manic episodes in that time
Not attributable to psychoactive/organic mental disorder

Question 13

How does depression differ from severe depression with psychotic symptoms?

Answer 13

Psychotic symptoms or stupor on top

Must exclude other psychotic illnesses first

Question 14

How does Somatic Syndrome present?

Answer 14

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

Question 15

What is the ICD-10 criteria for mild depression?

Answer 15

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)

Question 16

What is the ICD-10 criteria for moderate depression?

Answer 16

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)

Question 17

What are the additional/minor symptoms of depression?

Answer 17

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

Question 18

What is the ICD-10 criteria for severe depression?

Answer 18

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)

Question 19

How common is post-natal depression?

Answer 19

75% get ‘blues’ within 2 weeks
10% develop MDD within 3-6 mo
1 in 500 get perpetual psychosis

Question 20

What is the differential for depression?

Answer 20

SAD
Dysthymia 
Cyclothymia
Bipolar 
Neurological illness
Hypothyroidism
Drugs

Question 21

What are the treatments for depression?

Answer 21

Antidepressions
Psychological treatments
Physical treatments

Question 22

What are the antidepressants indicated for depression?

Answer 22

SSRIs - Sertraline, Fluoxetine
Tricyclic antidepressants - Amitriptyline
Monoamine Oxidase inhibitors - Phenelzine

Question 23

What are the psychological treatments indicated for depression?

Answer 23

CBT
Interpersonal Therapy
Individual dynamic psychotherapy
Family therapy

Question 24

What are the physical treatments indicated for depression?

Answer 24

ECT
Psychosurgery
DBS, VNS

Question 25

What are the measurement tools for depression?

Answer 25

``` SCID/SCAN HDRS (Hamilton Depression rating scale) BDI-II (Beck Depression Inventory II) HADS PHQ-9 ```

Question 26

What is Mania?

Answer 26

``` Pathologically inappropriate elevated mood Persistence of symptoms Pervasiveness of symptoms Degree of impairment Presence of specific symptoms of signs ```

Question 27

What are the main types of mania according to the ICD-10?

Answer 27

``` Hypomania Mania without psychotic symptoms Mania with psychotic symptoms Other manic episodes Manic episode ```

Question 28

How does the ICD-10 classify hypomania?

Answer 28

``` 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) ```

Question 29

How does the ICD-10 classify Mania with/without psychotic symptoms?

Answer 29

1 week severe enough to disrupt work/social activity Elevated mood, energy, overactivity, speech Disinhibition Grandiosity Alteration of senses Extravagant spending

Question 30

What is the differential diagnosis for mania?

Answer 30

``` Mixed effective state Schizoeffective/schizophrenia Cyclothymia ADHD Drugs Neurological disorders Hyperthyroid SLE ```

Question 31

What tools are used to measure mania symptoms?

Answer 31

SCID SCAN YMRS (Young Mania Rating Scale)

Question 32

What is the treatment for mania?

Answer 32

Antipsychotics - Olanzapine, Quetiapine Mood stabilisers - Valproate, Carbamazepine, Lamotrigine Lithium ECT

Question 33

What antipsychotics are used in mania?

Answer 33

Olanzapine Resperidone Quetiapine

Question 34

What mood stabilisers are used in mania?

Answer 34

Sodium Valproate Lamotrigine Carbamazepine

Question 35

What is Bipolar Affective disorder?

Answer 35

2+ episodes of depression and hypo/mania If no mania = recurrent depression If no depression = hypomania/bipolar

Question 36

How common is bipolar disorder?

Answer 36

0.7-1.6

Question 37

Bipolar disorder typically onsets at which age?

Answer 37

<30 Mean 21 Early onset with FH

Question 38

Depression is common in which populations?

Answer 38

More common in women 18-44 (mean 27) Associated with unemployment, lower educational attainment, unstable marriage

Question 39

What is the typical clinical course for major depression?

Answer 39

4-6mo 54% recover at 26 weeks 80% have further episodes 15% die by suicide

Question 40

What is the typical clinical course for bipolar/mania?

Answer 40

``` 1-3mo 60% recover at 10 weeks 90% have further episodes 10% die by suicide 1/3 have poor outcome ```