Affective Disorders Flashcards by Laura M

What are mood disorders?

Disorders of mental status and function where altered mood is the core feature
Refers to states of depression and mania

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Classifications of mood disorders

ICD - International Classification of Disease

DSM - Diagnostic and Statistical Manual of Mental Disorders

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What is depression (symptom)?

Can be an emotion within the range of normal experience

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What is depression (syndrome)?

A constellation of symptoms and signs

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What is depression (recurrent illness)?

Recurrent depressive disorder

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What are the spheres of the symptoms of depressive illness?

Psychological
Physical
Social

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What are the psychological symptoms of depressive illness?

Change in mood
  - depression
  - anxiety
  - perplexity
  - anhedonia
Change in thought content
  - guilt
  - hopelessness
  - worthlessness
  - delusions and hallucinations

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What is anhedonia?

Loss of ability to derive pleasure from experience

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What are the physical symptoms of depressive illness?

Change in bodily function
  - energy (fatigue)
  - sleep
  - appetite (weight loss)
  - libido
  - constipation
  - pain
Change in Psychomotor functioning
  - agitation
  - retardation

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What are the social symptoms of depressive illness?

Loss of interests
Irritability
Apathy
Withdrawal, loss of confidence, indecisive
Loss of concentration, registration and memory

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Depression

Must last for at least two 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
- Need to exclude other psychotic illnesses first like schizophrenia

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General criteria of mild depression

At least two of =>

Depressed mood that is abnormal for most of the day almost everyday for the past two weeks, largely uninfluenced by circumstances
Loss of interest or pleasure
Decreased energy or increased fatigability

Additional to give at least four =>

Loss of confidence or self esteem
Unreasonable feelings of guilt or self reproach or excessive guilt
Recurrent thoughts of death by suicide or any suicidal behaviour
Decreased concentration
Agitation or retardation
Sleep disturbance of any sort
Change in appetite

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General criteria of moderate depression

At least two of =>

Depressed mood that is abnormal for most of the day almost everyday for the past two weeks, largely uninfluenced by circumstances
Loss of interest or pleasure
Decreased energy or increased fatigability

Additional to give at least four =>

Loss of confidence or self esteem
Unreasonable feelings of guilt or self reproach or excessive guilt
Recurrent thoughts of death by suicide or any suicidal behaviour
Decreased concentration
Agitation or retardation
Sleep disturbance of any sort
Change in appetite

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General criteria of severe depression

At least two of =>

Depressed mood that is abnormal for most of the day almost everyday for the past two weeks, largely uninfluenced by circumstances
Loss of interest or pleasure
Decreased energy or increased fatigability

Additional to give at least eight =>

Loss of confidence or self esteem
Unreasonable feelings of guilt or self reproach or excessive guilt
Recurrent thoughts of death by suicide or any suicidal behaviour
Decreased concentration
Agitation or retardation
Sleep disturbance of any sort
Change in appetite

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Differential diagnosis

Normal reaction to life event
SAD
Dysthymia
Cyclothymia
Bipolar
Stroke, tumour, dementia
Hypothyroidism, Addison’s, Hyperparathyroidism
Infections – Influenza, infectious mononucleosis, hepatitis, HIV/AIDS
Drugs

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Treatments of depression

Antidepressants
Psychological treatments
Physical treatments

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Types of antidepressant

Selective Serotonin Reuptake Inhibitors (SSRIs)
Tricyclic antidepressants (TCAs)
Monamine Oxidase Inhibitors

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Psychological treatments

CBT
IPT
Individual dynamic psychotherapy
Family therapy

Physical treatments

ECT
Psychosurgery
DBS
VNS

IPT

Interpersonal therapy

ECT

Electroconvulsive therapy

DBS

Deep brain stimulation

VNS

Vagus nerve stimulation

SCID

Structured Clinical Interview for DSM disorders

SCAN

Schedules for clinical Assessment in Neuropsychiatry

What is mania?

A state of feeling, or mood that can range from near-normal experience to severe, life-threatening illness Often associated with grandiose ideas, disinhibition, loss of judgment; with similarities to the mental effects of stimulant drugs

What is 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

What is 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

Psychiatric differential diagnosis mania

``` Mixed affective state Schizoaffective disorder Schizophrenia Cyclothymia ADHD Drugs and Alcohol ```

Medical differential diagnosis mania

``` Stroke MS Tumour Epilepsy AIDS Neurosyphilis Endocrine => - Cushing’s - Hyperthyroidism SLE ```

Symptom measurement methods for mania

SCID SCAN YMRS

YMRS

Young mania rating scale

Mania treatment

Antipsychotics Mood stabilisers Lithium ECT

Antipsychotics

Olanzapine Risperidone Quetiapine

Mood stabilisers

Sodium valproate Lamotrigene Carbamazepine

Classification of mania

``` Hypomania Mania without psychotic symptoms Mania with psychotic symptoms Other Manic episodes Manic episode, unspecified ```

Classification of bipolar disorder

``` Currently hypomanic Current manic without psychosis Current manic with psychosis Current mild/mod depression Current severe depression without psychosis Current severe depression with psychosis Current episode mixed Current episode in remission Other bipolar affective disorders Bipolar affective disorder, unspecified ```

What is bipolar disorder?

Repeated (2+) episodes of depression and mania or hypomania.

What is psychosis?

A mental disorder characterized by symptoms such as delusions or hallucinations, that indicate impaired contact with reality

Is misidentification of persons more likely in acute organic psychosis or schizophrenia?

Organic psychosis

Are visual hallucinations more likely in acute organic psychosis or schizophrenia?

Organic psychosis

Are audio hallucinations more likely in acute organic psychosis or schizophrenia?

Schizophrenia

Is clear conscioussness more likely in acute organic psychosis or schizophrenia?

Schizophrenia

Is presence of delusions more likely in acute organic psychosis or schizophrenia?

Schizophrenia